title: Perceptions of the Cause, Impact and Management of Persistent Fatigue in Patients with Rheumatoid Arthritis Following Tumour Necrosing Factor Inhibition Therapy.
abstract: Fatigue is a major symptom of rheumatoid arthritis (RA), the most common chronic inflammatory joint disease. The present study explored patients' experiences of RA fatigue to elucidate unique elements and management strategies.
  
  
  
  This single site study recruited tumour necrosis factor-α inhibitor (TNFi)-treated RA patients with a moderate/good response in disease activity and persistent moderate/greater fatigue on a five-point verbal rating scale. This qualitative descriptive design used semi-structured questions, individual interviews and content analysis of narrative data.
  
  
  
  Ten patients were interviewed (six women), with age and disease duration ranges of 44-75 and 6-36 years, respectively. Perceptions of the RA fatigue experience generated four categories (experiencing a distinct, yet seldom discussed RA symptom; seeking an explanation for fatigue; being in an incapacitating state; and trying to manage) and eight subcategories. Fatigue was newly identified as a distinct part of the entity of RA. While patients proposed many plausible root causes, the only rational explanation for the nature of this fatigue was that it was integral to their RA. Singularly, fatigue contributed considerably to RA-imposed lifestyle restrictions. Patients had learnt to accommodate and self-manage fatigue in the absence of professional input. Novel management strategies proposed included patients talking about the nature of RA fatigue with others and the need for staff to alert patients to this distinct symptom of RA.
  
  
  
  Fatigue, branded as a distinct symptom of RA, exerted an identifiable impact on patients. Fatigue is potentially amenable to modification; talking about fatigue was proposed as a novel management strategy. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Rheumatic Musculoskeletal Disease Unit, Our Lady's Hospice and Care Services, Dublin, Ireland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Minnock
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Ringnér
authors.affiliation: Rheumatic Musculoskeletal Disease Unit, Our Lady's Hospice and Care Services, Dublin, Ireland.|St Vincent's University Hospital, Dublin, Ireland.|University College, Dublin, Ireland.
authors.forename: Barry
authors.initials: B
authors.lastname: Bresnihan
authors.affiliation: Rheumatic Musculoskeletal Disease Unit, Our Lady's Hospice and Care Services, Dublin, Ireland.|St Vincent's University Hospital, Dublin, Ireland.|Dublin Academic Medical Centre, Dublin, Ireland.|The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.
authors.forename: Douglas
authors.initials: D
authors.lastname: Veale
authors.affiliation: Rheumatic Musculoskeletal Disease Unit, Our Lady's Hospice and Care Services, Dublin, Ireland.|St Vincent's University Hospital, Dublin, Ireland.|University College, Dublin, Ireland.|The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.
authors.forename: Oliver
authors.initials: O
authors.lastname: FitzGerald
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: McKee
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D005221:Fatigue / Q000209:etiology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D000079424:Tumor Necrosis Factor Inhibitors
chemical_list: D018501:Antirheumatic Agents; D000079424:Tumor Necrosis Factor Inhibitors
keywords: Rheumatoid arthritis; fatigue; patient perspectives; qualitative content analysis