Ab0262 fatigue patterns in difficult to treat rheumatoid arthritis patients

Background Fatigue study is scarce in D2T RA. The experience of fatigue is multidimensional, implying complex, multicausal pathways. Objectives to identify the factors associated with fatigue on its different subscales (Physical, Living, Cognitive and Emotional). Methods Cross-sectional study. 22 patients with D2T RA were included; patients were being followed up in the rheumatology outpatient clinic of Hospital Clínico San Carlos, Madrid, Spain. Data were collected between July 2018 and November 2022. All patients met the ACR/EULAR 2010 criteria and they were in treatment with Biological agents (anti-TNF and Non anti-TNF) or Targeted Synthetic DMARDs (jakinibs). Outcome: Difficult to treat Rheumatoid Arthritis Patients (fulfillment of EULAR criteria). Main variable: Fatigue was assessed by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ) and the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS). Covariables: Sociodemographic and disease-related variables. Statistical analysis: A descriptive analysis was carried out for the different variables. To identify factors independently associated to BRAF-MDQ and its subscales, multivariable linear regression was applied. Results were expressed as coef with their corresponding 95% CI. A value of p < 0.05 was consider as statistically significant. Results A total of 22 (15.38%) patients were found D2T RA, comprising of 11 females (50%) with a mean age of 62.82±13.45 years and mean disease duration of 17.76±8.47 years. RF was positive in 59% of patients. Regarding comorbidities, 32% had dyslipidemia, 28% hypertension, 10% vascular disease, 27% hypothyroidism and 23% depression. The DAS28-ESR mean score of the patients were 4.10 ± 0.67. The factors affecting the global fatigue and its different subscales was evaluated in multivariate analyze Table 1. Our results shows a different correlation structure between disease and treatment factors and the different dimensions of the BRAF-MDQ. Patients who reported high disability scores had more global fatigue, while those with a poor patient global health assessment perceived more physical fatigue. In addition, an association was observed between depression and cognitive fatigue. Male sex and positive RF was associated with less living fatigue. Conclusion It is important to evaluate fatigue in a multidimensional perspective, each of the different subscales could be modulated by different factors. The results of our study indicated that disability predicts global fatigue, however, other factors can configure different patterns of fatigue in D2T RA patients, and identify them is key to the approach of this complex symptom. Table 1. Multivariate analyses of BRAF-MDQ and its subscales Total BRAF-MDQ Physical Living Cognitive Emotional Age 1.014 (0.881) -0.027 (0.151) -0.011 (0.126) -0.063 (0.090) 0.006(0.073) Sex 0.794 (0.585) 2.292 (0.610) -4.334 (1.871)* 3.525(1.752) 0.163(3.905) RF positive 1.264 (0.809) -2.266 (3.749) -4.919 (1.951)* -0.769(1.845) -0.070(1.303) HAQ 6.200 (3.11)** 2.199(1.881) 1.207 (1.664) 2.077(1.14) 0.035(1.905) PGHA: patient global health assessment 0.154 (0.117) 0.127(0.038)* -0.030(0.046) -0.069(0.027) -0.295(0.045) VAS Pain 0.170(0.244) -0.006(0.094) -0.020(0.158) -0.038(0.083) 0.014(0.020) Depression 9.2(6.783) -1.137(2.956) -0.676(3.163) 4.566(2.048)* 0.963(1.256) Other biological (vs TNFi) -0.717(6.490) -1.853(2.164) 0.006(1.924) 1.486(1.368) 0.003(2.007) JAKi (vs TNFi) -12.221(10.965) -2.455(3.657) -4.949(3.447) -1.866(2.433) -0.99(2.072) BRAF-MDQ Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire, *p < 0.05,**p < 0.001. Cells represent beta coefficients with standard error REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.