title: The Longitudinal Course of Fatigue in Rheumatoid Arthritis: Results from the Norfolk Arthritis Register.
abstract: OBJECTIVE
  Fatigue is common and burdensome in rheumatoid arthritis (RA). Despite RA fatigue progression varying significantly between individuals in practice, existing longitudinal analyses only examine symptom advancement on a population level. This study aimed to determine fatigue trajectories at an individual level and to characterize those patients with the poorest prognosis, with a view to enabling earlier interventions.
  
  
  METHODS
  Patients with RA reporting clinically relevant baseline fatigue (≥ 20 mm on a 0-100 mm visual analog scale) were identified from a longterm inflammatory polyarthritis cohort (the Norfolk Arthritis Register). Fatigue changes from baseline to 1- and 4-year followups were calculated, and sex-stratified group-based trajectory modeling (GBTM) determined trajectories of the symptom between which baseline characteristics were compared.
  
  
  RESULTS
  Among 338 patients, only minimal average changes were observed between recruitment to 1 year (6.0 mm, SD 26.9) and 4 years (5.5 mm, SD 29.3). This was despite 45.6% and 40.7% of participants reporting clinically significant improvements (≥ 10 mm) at these respective followups. GBTM revealed varied trajectories of fatigue, which for both sexes consisted of Improved (men, n = 48 and women, n = 81) or persistent Moderate-high paths (n = 54, n = 105), and further included a persistent High trajectory in women (n = 50). Participants who followed persistent trajectories were best distinguished from improvers by patient-reported rather than demographic or clinical variables.
  
  
  CONCLUSIONS
  Among patients with RA presenting with clinically relevant fatigue, distinct longitudinal symptom trajectories were identified on an individual level despite nominal average changes in fatigue on a group level. It is possible to identify and characterize subgroups of participants who report persistent fatigue and should therefore be targeted to receive future fatigue-alleviating interventions.
authors.affiliation: From the Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen, Aberdeen; Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK.K.L. Druce, MSc, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; G.T. Jones, MSc, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; G.J. Macfarlane, MBChB, MD (Hons), PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; S.M. Verstappen, PhD, Arthritis Research UK Epidemiology Unit, University of Manchester; N. Basu, MBChB, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen.
authors.forename: Katie L
authors.initials: KL
authors.lastname: Druce
authors.affiliation: From the Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen, Aberdeen; Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK.K.L. Druce, MSc, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; G.T. Jones, MSc, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; G.J. Macfarlane, MBChB, MD (Hons), PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; S.M. Verstappen, PhD, Arthritis Research UK Epidemiology Unit, University of Manchester; N. Basu, MBChB, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen.
authors.forename: Gareth T
authors.initials: GT
authors.lastname: Jones
authors.affiliation: From the Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen, Aberdeen; Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK.K.L. Druce, MSc, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; G.T. Jones, MSc, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; G.J. Macfarlane, MBChB, MD (Hons), PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; S.M. Verstappen, PhD, Arthritis Research UK Epidemiology Unit, University of Manchester; N. Basu, MBChB, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Macfarlane
authors.affiliation: From the Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen, Aberdeen; Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK.K.L. Druce, MSc, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; G.T. Jones, MSc, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; G.J. Macfarlane, MBChB, MD (Hons), PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; S.M. Verstappen, PhD, Arthritis Research UK Epidemiology Unit, University of Manchester; N. Basu, MBChB, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen.
authors.forename: Suzanne M M
authors.initials: SM
authors.lastname: Verstappen
authors.affiliation: From the Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen, Aberdeen; Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK.K.L. Druce, MSc, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; G.T. Jones, MSc, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; G.J. Macfarlane, MBChB, MD (Hons), PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen; S.M. Verstappen, PhD, Arthritis Research UK Epidemiology Unit, University of Manchester; N. Basu, MBChB, PhD, Epidemiology Group, the Institute of Applied Health Sciences, University of Aberdeen. epidemiology@abdn.ac.uk.
authors.forename: Neil
authors.initials: N
authors.lastname: Basu
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D015897:Comorbidity; D004185:Disability Evaluation; D018450:Disease Progression; D005221:Fatigue / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D017678:Sex Distribution; D018434:Sickness Impact Profile; D006113:United Kingdom
chemical_list: D018501:Antirheumatic Agents
keywords: FATIGUE; RHEUMATOID ARTHRITIS; TRAJECTORY