title: Fatigue in psoriatic arthritis - a cross-sectional study of 246 patients from 13 countries.
abstract: OBJECTIVE
  Fatigue is an aspect of psoriatic arthritis (PsA), which is important to patients. The objective was to evaluate magnitude of fatigue in PsA patients and to assess factors that might explain high levels of fatigue.
  
  
  METHODS
  This was an ancillary analysis of a cross-sectional study in 13 countries of unselected PsA patients who fulfilled the CASPAR criteria. Patient-perceived importance of fatigue was assessed through a priority exercise. Levels of fatigue were assessed by a numeric rating scale (range 0-10). Factors potentially associated with fatigue>5/10: i.e., demographic variables (age, gender, disease duration, education level) and disease related characteristics including joint counts, C-reactive protein, skin psoriasis, axial involvement, enthesitis, dactylitis, structural damage, were assessed by univariate, multivariate logistic and multiple linear regression.
  
  
  RESULTS
  In all, 246 patients were analysed: mean±standard deviation age 51.2±13.0years, mean disease duration 9.9±10.1years, mean DAS28 3.5±1.3. Fatigue was ranked second in patient-perceived importance, after pain. Magnitude of fatigue was high: mean fatigue 5.0±3.0. Fatigue>5/10 was well explained (variance explained 73%) by skin psoriasis (odds ratio 4.67 [95% confidence interval 1.05; 20.72]), tender joints (1.30 [1.01; 1.68]) and lower education level (1.09 [1.02; 1.23]). In the multiple linear regression model, fatigue was explained by skin psoriasis, tender joints, enthesitis, female gender, education level.
  
  
  CONCLUSIONS
  Fatigue is a priority for PsA patients. Fatigue levels were high in these patients and fatigue>5/10 was mainly associated with disease-related factors but also patient-related variables, indicating that the etiology of fatigue in PsA is multifactorial.
authors.affiliation: Department of Rheumatology, Sorbonne universités, UPMC université Paris 06, institut Pierre-Louis d'épidémiologie et de santé publique, GRC-UPMC 08 (EEMOIS), Pitié-Salpêtrière Hospital, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Research Center of Rheumatic Diseases, University of Medicine and Pharmacy Carol Davila, St Maria Hospital, 011172 Bucharest, Romania.
authors.forename: Tania
authors.initials: T
authors.lastname: Gudu
authors.affiliation: Epidemiology and Biostatistics Unit, Sorbonne Paris Cité Research Center, Inserm U1153, 75014 Paris, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Etcheto
authors.affiliation: Patient Research Partner, People with Arthritis/Rheumatism in Europe (PARE), 8802 Zurich, Switzerland.
authors.forename: Maarten
authors.initials: M
authors.lastname: de Wit
authors.affiliation: Department of Health and Social Sciences, Østfold University College, Halden, Regional Research Support, Oslo University Hospital, 4950 Oslo, Norway.
authors.forename: Turid
authors.initials: T
authors.lastname: Heiberg
authors.affiliation: Patient Research Partner, ADIPSO (Associazione per la Difesa degli Psoriasici)-PE.Pso.POF (Pan European Psoriasis Patients' Organization Forum), 00193 Rome, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Maccarone
authors.affiliation: Research Center of Rheumatic Diseases, University of Medicine and Pharmacy Carol Davila, St Maria Hospital, 011172 Bucharest, Romania.
authors.forename: Andra
authors.initials: A
authors.lastname: Balanescu
authors.affiliation: 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, 1023 Budapest, Hungary.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Balint
authors.affiliation: 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, 1023 Budapest, Hungary.
authors.forename: Dora S
authors.initials: DS
authors.lastname: Niedermayer
authors.affiliation: Arthritis Unit, Department of Rheumatology, Hospital Clínic and IDIBAPS, 08036 Barcelona, Spain.
authors.forename: Juan D
authors.initials: JD
authors.lastname: Cañete
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, LS7 4SA Leeds, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Helliwell
authors.affiliation: Division of Rheumatology, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey.
authors.forename: Umut
authors.initials: U
authors.lastname: Kalyoncu
authors.affiliation: Rheumazentrum Ruhrgebiet, Herne and Ruhr-Universität Bochum, 44652 Herne, Germany.
authors.forename: Uta
authors.initials: U
authors.lastname: Kiltz
authors.affiliation: Rheumatology Department, Tallinn Central Hospital, 10138 Tallinn, Estonia.
authors.forename: Kati
authors.initials: K
authors.lastname: Otsa
authors.affiliation: Dublin Academic Medical Centre, St Vincent's University Hospital, D4 Dublin, Ireland.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Veale
authors.affiliation: Department of Rheumatology, University Hospitals Leuven, 3000 Leuven, Belgium.
authors.forename: Kurt
authors.initials: K
authors.lastname: de Vlam
authors.affiliation: Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, 00185 Rome, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Scrivo
authors.affiliation: Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, 1090 Vienna, Austria.
authors.forename: Tanja
authors.initials: T
authors.lastname: Stamm
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, No-0370 Oslo, Norway.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.affiliation: Department of Rheumatology, Sorbonne universités, UPMC université Paris 06, institut Pierre-Louis d'épidémiologie et de santé publique, GRC-UPMC 08 (EEMOIS), Pitié-Salpêtrière Hospital, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: laure.gossec@aphp.fr.
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015535:Arthritis, Psoriatic / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005221:Fatigue / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D038622:Internationality; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018434:Sickness Impact Profile
keywords: Fatigue; Patient perspective; Psoriatic arthritis; Quality of life