A recent study published in Med Glas (Zenica) has highlighted the substantial burden of fatigue among patients with rheumatoid arthritis (RA), finding that greater disease activity was associated with more severe fatigue. The findings underscore the importance of routinely assessing fatigue as part of comprehensive RA management rather than focusing solely on joint inflammation and disease activity measures.
Fatigue is one of the most common and disabling symptoms experienced by people with RA. It is generally characterized by persistent physical or mental exhaustion that is not adequately relieved by rest. Beyond tiredness, fatigue can interfere with daily activities, occupational functioning, social participation, and emotional well-being. For some patients, its impact can be comparable to that of pain, contributing substantially to reduced quality of life.
The study evaluated fatigue using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, a validated patient-reported outcome measure designed to assess fatigue and its impact on functioning. Although initially developed for patients with cancer and anemia, FACIT-F has subsequently been validated in RA and other chronic conditions. The instrument evaluates fatigue and its effects on physical, emotional, functional, and social well-being over the preceding seven days. Lower scores indicate greater fatigue severity.
The cross-sectional observational study included 90 adults with RA. Fatigue severity was assessed using FACIT-F, while RA disease activity was evaluated using the Disease Activity Score in 28 joints (DAS28). The investigators summarized continuous variables using medians and interquartile ranges (IQRs) and examined associations using Spearman correlation, Mann-Whitney U and Kruskal-Wallis tests, and robust linear regression. The median FACIT-F score was 37.0 (IQR, 27.0–45.0), with 35.6% of participants experiencing moderate-to-severe fatigue. Importantly, fatigue severity was significantly associated with disease activity. FACIT-F scores showed a negative correlation with DAS28 (ρ = −0.381; p < 0.001), indicating that patients with higher disease activity tended to report greater fatigue.
The association remained significant after adjustment for age and disease duration. In multivariable robust regression, each increase in DAS28 was associated with a reduction in FACIT-F score (β = −3.54; 95% confidence interval [CI], −5.39 to −1.68; p < 0.001). In contrast, neither age nor disease duration showed a significant independent association with fatigue severity. The investigators also observed differences in FACIT-F scores according to sex and employment status. However, fatigue scores did not differ significantly across treatment categories, suggesting that the relationship between fatigue and disease burden may be more complex than treatment exposure alone.
The findings reinforce the view that fatigue in RA is a multidimensional symptom influenced by inflammatory disease activity as well as physical, psychological, and social factors. Although controlling inflammation remains a central goal of RA treatment, persistent fatigue may not always resolve completely when inflammatory activity improves. Factors such as sleep disturbances, mood disorders, pain, physical deconditioning, anemia, medication effects, and occupational or social stressors may also contribute.
Patient-reported outcomes such as FACIT-F can therefore provide information that may not be captured by conventional measures such as DAS28, swollen and tender joint counts, or laboratory markers. Incorporating fatigue assessment into routine clinical evaluation may help identify patients who continue to experience a substantial symptom burden despite treatment.
The study found that more than one-third of patients with RA had moderate-to-severe fatigue and that higher disease activity was independently associated with greater fatigue severity. The authors emphasized the importance of recognizing fatigue as a clinically meaningful component of RA and supporting its assessment alongside inflammatory disease activity to provide more comprehensive, patient-centered care.
Reference
Salihović Jahić M, Skokić M, Kurtanović N, Serak Tokic A, Tulumović Mešanović A, Bećirović E, Bećirović M, Imamović A, Bajrektarević H, Dizdarević N, Čerkezović N. Assessment of fatigue in patients with rheumatoid arthritis using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale. Med Glas (Zenica). 2026 Aug 7;23(2).