Biologics reduce fatigue in people with RA

Treatment with a biologic agent reduces fatigue in people with rheumatoid arthritis, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Chicago.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

In addition to joint pain, people with RA often experience fatigue that diminishes their quality of life and limits their ability to complete even the simplest tasks. Biologics, such as tumor necrosis factor-alpha blockers, which reduce the inflammation caused by the disease, may also reduce accompanying fatigue. Investigators from Germany recently evaluated the effectiveness of several biologic treatments to also relieve fatigue symptoms in people with rheumatoid arthritis.

"Chronic fatigue is a symptom of RA that significantly limits patient's social life," says Anja Strangfeld, MD; group leader at Deutsches Rheuma-Forschungszentrum Berlin, Germany and lead investigator in the study. "With data from our German biologics register RABBIT, which observes more than 9,500 patients with RA from start of treatment with either a conventional disease-modifying antirheumatic drug or any approved biologic agent, we were able to investigate the improvement of fatigue under different treatments and demonstrate that biologic agents were best able to improve this symptom."

Dr. Strangfeld's team included 5,432 patients from their cohort in the analysis - who were, at baseline, on average 55 years old with an average disease duration of 12 years. They had been unsuccessfully treated with conventional disease-modifying antirheumatic drugs (commonly called DMARDs) before starting a biologic agent, or had been switched from one conventional DMARD to another (control group). Only patients with at least six months of follow up were included in the analysis.

The researchers measured patient-reported fatigue using a scale from zero (no) to 10 (high). Once initial measurements were taken, fatigue was reevaluated at three and six months. While taking into consideration other factors that might affect a person's fatigue level (e.g., co-existing diseases, use of steroids, and limited functional capacity), they compared the effectiveness of each therapy in fighting fatigue by determining if the therapy was successful in significantly improving it (change in score of three points or more).

At six months, researchers noted that fatigue improved in all participants. However, participants who received biologics reported improvement significantly more frequently when compared with participants who received conventional DMARDs.

Dr. Strangfeld further comments, "improvement of fatigue under treatment with biologics was already seen after three months and independent of disease activity. Despite these findings, further studies are needed to evaluate the effectiveness of switching treatments to manage chronic fatigue in people with RA."