Fatigue independently predicts different work disability dimensions in etanercept-treated rheumatoid arthritis and ankylosing spondylitis patients

Katie L Druce, Laraine Aikman, Maria Dilleen, Annie Burden, Piotr Szczypa, Neil Basu, Katie L Druce, Laraine Aikman, Maria Dilleen, Annie Burden, Piotr Szczypa, Neil Basu

Abstract

Background: Work disability remains a significant problem in ankylosing spondylitis (AS) and rheumatoid arthritis (RA), despite biological therapy. This study aimed to test the hypothesis that the prevalent symptom of fatigue longitudinally predicts work disability among RA and AS patients commencing etanercept.

Methods: Two observational studies, comprising RA and AS etanercept commencers, respectively, were analysed. Both provided data on work disability over 1 year and a comprehensive set of putative predictors, including fatigue. A series of repeated measures models were conducted, including baseline variables, visit (6/12 months), and the interaction between visit and each of the explanatory variables.

Results: A total of 1003 AS and 1747 RA patients were assessed. For AS, fatigue was significantly associated with presenteeism (linear mixed model coefficient 3.75, 95% confidence interval (CI) 2.14 to 5.36) and activity impairment (2.62, 1.26 to 3.98), but not with work productivity loss (1.81, -0.40 to 4.02) or absenteeism (generalised linear mixed model odds ratio (OR) 1.18, 95% CI 0.92 to 1.51). In RA, fatigue was associated with presenteeism (coefficient 3.44, 95% CI 2.17 to 4.70), activity impairment (1.52, 0.79 to 2.26), work productivity loss (4.16, 2.47 to 5.85), and absenteeism (OR 1.23, 95% CI 1.02 to 1.49). The lack of significant interactions between fatigue and visit supported a consistent effect of baseline fatigue over time.

Conclusions: Among patients beginning etanercept therapy, fatigue has a significant and independent effect on absenteeism, presenteeism, productivity loss, and activity impairment for RA patients and a significant but dimension-selective effect on work disability among AS patients.

Trial registration: ClinicalTrials.gov, NCT00544557 . Registered on 16 October 2007. ClinicalTrials.gov, NCT00488475 . Registered on 20 June 2006.

Keywords: Fatigue; Rheumatoid arthritis; Spondyloarthritis; Work disability.

Conflict of interest statement

Ethics approval and consent to participate

Ethical approvals for the original studies, and further use of data (i.e. for the purposes of secondary data analysis), were obtained from the Ethics Committee of the State Chamber of Physicians (Landesaertzekammer; NCT00544557, 21 September 2007, and NCT00488475 15 September 2006). Consent to participate was obtained from all participants at the time of recruitment to each trial. At the time of recruitment, participants also provided consent for their data to be stored and used further without naming names (i.e. in secondary data analysis).

Competing interests

NB has received research funding and lecture fees from Pfizer. MD, LA, and PS are employees of Pfizer and hold company stock or shares. AB is an employee of Quanticate and is a paid contractor to Pfizer. KLD declares that she has no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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