title: Assessment of fatigue in routine care on a Multidimensional Health Assessment Questionnaire (MDHAQ): a cross-sectional study of associations with RAPID3 and other variables in different rheumatic diseases.
abstract: OBJECTIVE
  To characterise associations of fatigue with other variables within a multidimensional health assessment questionnaire (MDHAQ) in routine care of patients with different rheumatic diagnoses.
  
  
  METHODS
  All patients complete MDHAQ, which includes fatigue on a 0-10 visual analogue scale (VAS), and routine assessment of patient index data (RAPID3), a composite of function, pain, and patient global. Physicians complete a RheuMetric checklist which includes 4 VAS for overall global status (DOCGL), inflammation, damage, and distress. Median score for fatigue and other MDHAQ and RheuMetric scores were compared in 4 diagnosis groups: rheumatoid arthritis (RA), osteoarthritis (OA), systemic lupus erythematosus (SLE), and fibromyalgia (FM), using a Kruskall-Wallis test. Associations of fatigue with other variables were analysed using Spearman correlations and multivariate regressions.
  
  
  RESULTS
  612 patients were included: 173 RA, 199 with OA, 146 with SLE, and 94 with FM. Median fatigue was significantly higher in FM (7) than in RA (4), OA (5), and SLE (5). Fatigue was correlated significantly with all other MDHAQ scores, at higher levels in RA and SLE versus OA and FM. Fatigue was correlated significantly with DOCGL in RA, OA, SLE, but not FM. In multivariate analyses, fatigue scores were explained independently by higher pain and symptom number in RA; lower age and higher symptom number in OA; only higher pain in SLE; and none of the variables in FM.
  
  
  CONCLUSIONS
  Fatigue is common in rheumatic diseases and strongly associated with higher pain and number of symptoms. The MDHAQ provides a useful tool to assess fatigue in clinical settings.
authors.affiliation: Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Isabel
authors.initials: I
authors.lastname: Castrejon
authors.affiliation: Rheumatology Department, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Elena
authors.initials: E
authors.lastname: Nikiphorou
authors.affiliation: Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Ruchi
authors.initials: R
authors.lastname: Jain
authors.affiliation: Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Annie
authors.initials: A
authors.lastname: Huang
authors.affiliation: Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Block
authors.affiliation: Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA. tedpincus@gmail.com.
authors.forename: Theodore
authors.initials: T
authors.lastname: Pincus
mesh_terms: D000328:Adult; D000368:Aged; D057189:Checklist; D002641:Chicago / Q000453:epidemiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005221:Fatigue / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D000071066:Patient Reported Outcome Measures; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires