title: Fatigue predicts disease worsening in relapsing-remitting multiple sclerosis patients.
abstract: It is unclear whether fatigue is a consequence or a predictive trait of disease worsening.
  
  
  
  To investigate the predictive value of fatigue toward conversion to confirmed moderate-severe disability in patients with relapsing-remitting multiple sclerosis (RRMS).
  
  
  
  We retrospectively selected from the Comprehensive Longitudinal Investigations in MS at the Brigham and Women's Hospital (CLIMB) study cohort RRMS patients who converted to confirmed (⩾2 years) Expanded Disability Status Scale (EDSS) score ⩾3 within a follow-up period ⩾3 years. We contrasted the Modified Fatigue Impact Scale (MFIS) score of 33 converters, obtained at least 1 year before conversion to EDSS ⩾3, with that of 33 non-converter RRMS patients matched for baseline characteristics.
  
  
  
  Total MFIS score was higher in converter versus non-converter MS patients (median 37 vs 13; p < 0.0001). EDSS and Center for Epidemiological Studies Depression scale (CES-D) scores were also higher in the converters (median EDSS 1.5 vs 0, p < 0.0001; median CES-D 30 vs 24, p < 0.0001) and were both associated with MFIS score (EDSS: rho = 0.42, p = 0.0005; CES-D: rho = 0.72, p < 0.0001). After adjusting for EDSS and CES-D in multivariate analysis, MFIS remained a significant predictor of subsequent conversion to confirmed EDSS ⩾3.
  
  
  
  Fatigue is a promising indicator of risk for conversion to confirmed moderate-severe disability in RRMS patients.
authors.affiliation: Partners Multiple Sclerosis Center, Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Cavallari
authors.affiliation: Partners Multiple Sclerosis Center, Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Miklos
authors.initials: M
authors.lastname: Palotai
authors.affiliation: Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Bonnie I
authors.initials: BI
authors.lastname: Glanz
authors.affiliation: Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Egorova
authors.affiliation: Partners Multiple Sclerosis Center, Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Prieto
authors.affiliation: Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Healy
authors.affiliation: Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Tanuja
authors.initials: T
authors.lastname: Chitnis
authors.affiliation: Partners Multiple Sclerosis Center, Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA guttmann@bwh.harvard.edu.
authors.forename: Charles Rg
authors.initials: CR
authors.lastname: Guttmann
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005221:Fatigue / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000503:physiopathology*; D011379:Prognosis; D012189:Retrospective Studies
keywords: Expanded Disability Status Scale; Fatigue; disability; neuropsychology; progressive multiple sclerosis; quality of life