Rheumatoid arthritis (RA) is a systematic, chronic autoimmune disease which is characterized by connective tissue inflammation throughout the body. Specific parts of the body mostly affected include joints as well as organs and tissues. Synovial joints are the specific joints that are likely to be affected by this illness. The outcome of the attack is inflammatory response, extra synovial fluid and production of components referred to as pannus in the joints. Articular cartilage is destroyed during disease development. Statistics that was carried out revealed that about 1.3 of all American have been affected by rheumatoid arthritis. Inflammation in the body as well as cartilage and bone damage is as a result of the inflammatory chemicals that are usually realized by the immune cells a defense mechanism of the body (Holland, Breitbart and Jacobsen, 2010).
Besides body inflammation and damaged cartilage patients significantly suffers extreme pain as well as systemic manifestations which are usually widespread. Examples of such systemic manifestations include neuropathies and pleural effusions. Fatigue is as a result of systemic symptoms that a patient usually develops. Fatigue is one of the commonest problems among rheumatoid arthritis. From what has been researched it’s evident that the levels of fatigue are usually high when compared to pain levels in rheumatoid arthritis patient. Despite the fact that patients feel more fatigue than the actually pain; a number RA patients have complained that doctors usually address pain and leave out the excessive fatigue. Physicians believe that the fatigue which is experienced by rheumatoid arthritis patients is a reflection of the underlying pain as well as disease process and that is the reason much attention is given to pain as opposed to fatigue.
Proper assessment of fatigue experienced by patients has not been up to date. A few year back non-specific scales were usually used to assess patients fatigue level. Therefore it’s important for a proper assessment tool to be developed for efficient assessment of fatigue. This is very important because it will contribute much in developing the needed treatment for fatigue.
The purpose of this study is to use the developed fatigue scale and pain scale to determine the correlation between fatigue and pain in rheumatoid arthritis patients. My study will be one of its kinds to use the new scale, and the results will be reported to the developer of the scale for further validation to the data.
The theoretical model that has been used for this study is Pender’s Health Promotion Model. Pender strongly emphasizes that health cares should give priority to disease prevention as well as health promotion rather than focusing on treatment. Most health cares have given priority to treatment rather than promotion of health and preventive measure. In her model Nora Pender defines disease prevention as a desire to actively remain healthy which can only be achieved by avoiding illness and incase one fails to avoid getting ill they should detect sickness early. Early detection and maintenance of functions are very instrumental for nursing rheumatoid arthritis patients. These principles can be applied in this study by knowing the great importance of proper fatigue treatment which is essential for maintaining daily function.
It’s important for health cares to realize the importance that rheumatoid arthritis patients put on fatigue. Rheumatoid patients want fatigue to be treated as part of their normal treatment. This can only be achieved when proper scale for measuring fatigue is in use. Successful treatment can only be achieved when the physician clearly knows the amount of fatigue and pain that a patient is going through. A better instrument which can be used to measure the level of fatigue includes Functional Assessment of Chronic Illness therapy (FACIT). Basically this system is essential in ensuring quality life for chronically ill patients (Kirwan, Newman, tugwell and Wells 2009).
Review of literature
The literature that has been reviewed for this study majorly base on determining the correlation between fatigue and pain in rheumatoid arthritis (RA) patients. Pain experienced by Rheumatoid Arthritis patient is a reflection of the fatigue and not disease activity. Pain is one of the most common complaints among these patients though large majorities also report that, fatigue affects their daily life just as much if not more. Patients report that their providers adequately address pain but on the other hand they often ignore complaints of fatigue or just dismiss them. Providers maintain that without an accurate way to measure fatigue levels, it is difficult to develop a treatment plan that includes managing fatigue. This review of literature will discuss the significance that rheumatoid arthritis patients place on pain and fatigue, the other scales that were there prior to the development of the rheumatoid specific scale were also used to measure pain in chronically ill patients (Bingham et al 2009).
Pain in rheumatoid arthritis patients
Pain is a common characteristic in RA patients and most of the time this patients experience radical mood changes. Research that was carried out to twenty five RA patients revealed that environmental as well as psychological factors greatly influence the variation in pain and moods. Other factors that were put into consideration include age of the patient, sex and the time that the patient has heard the illness. Through the research it was concluded that synchronous state of the patient is related to the pain and mode variations. Most of the time this patients experience intense pain in the cartilage of the hands. Measurement of pain is what is manly used in addressing their sickness. Besides the pain that RA arthritis patients goes through fatigue is considered the second indication of their turmoil (Rheum 2008).
Research that was carried out to determine the amount of pain that the Rheumatoid Arthritis patients face indicated, pain experienced at night is about 28%. It was also clear that most of the patients who experienced pain at night had increased tenderness in the joints as well as swollen joints. Most health organization use a brief pain inventory (BPI) form to access the pain situation of a patient. By feeling this form correctly a physician is able to access the amount of pain that a patient is experiencing. The same form is useful in assessing the mood changes that a patient experiences since shift in the mood is closely associated with pain. This gadget has is scaled from zero to ten whereby at zero there is no any form of pain and at ten the patient is going through intense pain. Other environmental factors that affect RA patients can be assessed by the use of the same scale for instance general activity as well as an individuals walking ability (Jensen, Thornby and Shanti 2004).
Fatigue is a common feature in all rheumatoid arthritis patients and when a patient does not feel fatigued the physicians perceive that the disease has subsided. Qualitative research that has been done has indicated the importance that rheumatoid arthritis patients places on fatigue. About eighty to forty percent of all rheumatoid arthritis patients which attend clinic experience fatigue which is considered to be a clinical condition. Only five percent of all these patients do not experience fatigue and such patients are said to be in remission. From the above information its clear that the activity of the illness is the basic factor in fatigue pathogenesis in all its victims. Its very unfortunate because the influence of disease activity on development of fatigue has not been studied to a large extends. Rheumatoid arthritis specialists have put much emphasis on Randomized Controlled Trial (RCT) of an anti-Tumor Necrotic Factor agent that have proved successful in reducing fatigue which is experienced by the rheumatoid arthritis patients (Repping-Wuts et al 2008).
Specialists have related increased fatigue to diminished disease activity and therefore its evident that inflammatory synovitis is a potential causal of rheumatoid arthritis fatigue. There is no much evidence on the contribution of the usual disease modifying anti-rheumatic drugs (DMARDs) in eliminating fatigue. The only component that has proved to be potential in reducing fatigue still remains RCT. There are a number of factors that are known to influence fatigue in rheumatoid arthritis patient’s for instance weak social support, psychosocial factors, illness perceptions as well as health beliefs. It’s important to note that fatigue is strongly related to depression and pain. The strong relationship between fatigue, pain and depression was the main factor that led to the invention of fibromyalgic rheumatoid arthritis by Wolfe. Wolfe basically coined the term with the intention of describing excessive levels of depression, fatigue and pain in patients of rheumatoid arthritis.
Fatigue in musculoskeletal conditions
Fatigue is a common feature in many patients with musculoskeletal conditions. This fatigue is very severe and vital as pain. Despite of its significance there are few interventions which are evidence based. Most patients with such condition give priority to fatigue and that is the reason behind the vigorous interventions. Patients with musculoskeletal conditions experience varied fatigue frequency and intensity most days. This fatigue keeps changing from exhaustion, heaviness to weariness. They consider fatigue to be same or more than the experienced pain. The fatigue experienced is not just limited to the physical but also extends to inability to think, be motivated or even concentrate.
Research that has been done reveals high fatigue levels among RA patients and in other systemic conditions. Disease activity is not closely related to the amount of fatigue which these patients go through. On the other hand some studies have indicated that greater disease activity within the first year is a prediction of higher fatigue. Different fatigue levels among men and women with musculoskeletal conditions are not evidence based. In situations were the pain is extreme fatigue is also extreme or more than the pain. Mood has a complex relation with fatigue among these patients. Biological agents and DMARDs are used together or individually to manage fatigue.
Outcomes Patients Consider Important to Treatment
Hewlett, Carr, Ryan, Kirwan, Richards et al. (2005) conducted a study to determine what outcomes patients consider important in treatment. Using a questionnaire listing twenty- three outcomes previously generated by RA patients, researchers redistributed it asking the participants to rate the outcomes based on importance. Researchers were able to determine that independence, pain, and mobility were most frequently selected by patients as their top three but only by about 40%, with the next most commonly chosen being fatigue and feeling well. These patients also went on to report that pain and mobility had been addressed and successfully treated by their provider, while fatigue and well-being were infrequently addressed.
Basing of the negative effects that rheumatoid arthritis cause in its patients they have all rights to care about their well being as well as independence. Rheumatoid arthritis being an autoimmune disease means that the inflammation that occurs in the joints is a hindrance to personal movement. These are the reasons why these patients seek medication that help in giving them back their independence as well as elimination of the much pain that they go through. Capsules surrounds human joint with the objective of supporting and protecting it. This capsule is not bare since it’s surrounded by synovium, a specialized tissue which produces lubricating and nourishing fluid that is referred to as synovial fluid this is the normal state in a healthy person. In a patient suffering from rheumatoid arthritis the situation is different and this is because the specialized joint tissue is destroyed making it to swell. Other changes that occur in synonium include redness, pain, swelling and warmth. Further development of the disease often results in damaged bone joint as well as cartilage causing difficulty in movement (Tsonaka, Verbeke and Lesaffre 2009).
Damaged bones and ligaments results in weakening of the surrounding muscles and when the disease advances the great risk is loss of bone a condition referred to as osteoporosis. Rheumatoid arthritis specialists places much value on early diagnosis because its important in reducing some great risks like bones loss which mainly occurs during the first two years of the disease. Most common symptoms of rheumatoid arthritis include:
- Swollen joints which are warm and tender
- Development of symmetrical patterns in the affected joints
- Joint inflammation particularly in the joints of the fingers as well as the wrist, other areas that are often affected besides this include joint inflammation which might spread to wide extend in areas like the knees, feet, neck, hips among many others.
- Other symptoms include pain and stiffness usually in the morning or after a long rest, fatigue other times one may experience occasional fever or malaise.
One of the most interesting factors about this illness is its differential effect on people. For instance some people are only affected by the disease for a few months or years before it’s disappears on its own without nay form of medical interventions. Other people may develop mild symptoms with worse periods called flares such patients may go several months without fatigue and pain therefore referred to as period of remissions. The worst outcome of this disease is the continuous period of active severe disease which may last for a very long period of time causing extreme damages for instance disability and joint damage. Patients suffering from rheumatoid arthritis are prone to osteonecrosis a condition characterized by loss of blood supply to the particular bone that is affected leading to bone death (Russell 2004).
Specialists indicate that inflammation is very dangerous because it often leads to crippling arthritis a condition that is difficult to control. There are many scaring complications that may result from inflammation for instance heart and lung complications. That is the reason why arthritis patients are advised to see their doctor in case of any strange or new symptoms. Bone deformation may also result from rheumatoid arthritis. Some of the factors that are critically looked at when treating rheumatoid arthritis include weight control. Patients are recommended to cut weight since excessive weight may not be supported by the weak bones. Proper exercise is essential for all people suffering from this ailment. This is because exercise has the capacity to increase motion range without much straining. Exercise that has the capability to strengthen the muscles as well as stabilization of joints is very useful (Lader, Cardinali and Pandi-Perumal 2006).
Some of the medications that are recommended to rheumatoid arthritis patients include the usage of heat or cold when trying to relieve their pain. A patient is advised to seek the interventions of a doctor before using cold or hot water at the inflamed place. It’s important for the patient to take the necessary precaution in order to avoid further damages and this is more particular to those patients which have some other complications like diabetes. Other times patients are allowed to use brace or splints which are necessary if joints have to rest. Transcutaneous Electrical nerve Stimulation (TENS) may also be used to relieve pain by supplying electric nerves to the hurting areas. It’s quite evident that much emphasis when it comes to rheumatoid arthritis has been emphasized on relieving pain as opposed to fatigue elimination.
There are a number of physical effects that are experienced by rheumatoid arthritis patients which makes them to be victims of social isolation. The social isolation that these people experience does not contribute to their well being. This is among the reasons why these patients consider independence, mobility and better life as a better solution. Because of isolation it’s recommended that they should be able to access some health services that may meet their social and emotional needs. Such support networks include hydrotherapy, occupational as well as physiotherapy. Research has revealed that women are three times likely to be affected by this disease as compared to men. Rheumatoid arthritis is likely to come when one is between ages forty and sixty though there are chances of developing the disease before that age (Fireman 2006).
Patients’ Perceptions of Fatigue
Another study by Hewlett, Cockshott, Byron, Kitchen, Tipler et al. (2005) also addresses how patients perceive fatigue and how they relate it to their disease process. Based on The American College of Rheumatology’s core set of disease activity measures for rheumatoid arthritis, fatigue is not a recommended core outcome for clinical trials. This could possibly explain why providers rarely address fatigue as a separate treatment target. With this study, Hewlett et al. interviewed RA patients that rated their fatigue > 7 on a 10cm visual analog scale (VAS), and the transcripts of the interviews were coded by independent researchers until three major themes were established and reports compiled. The median fatigue score was 8.1 and the three major themes were overwhelming fatigue different from normal, fatigue permeating every sphere of their life, and variable self-management with rare professional support (p. 699). By analyzing the reports, the researchers were able to conclude that patients place a significant amount of importance on fatigue but feel that it is not sufficient.
Chronic fatigue syndrome is what is basically used to define extreme fatigue which is often associated with great disability. Cognitive behavioral models suggest that the perception that the patient has on his condition plays an important role in extending disability levels. This reality has been supported by the evidence that was obtained from the various researches that were carried out. Though its not clear how the patients perspective contributes to the development of the disorder. Research is yet to determine the relationship since patient adaption to the disease is greatly influenced by the perception that one has developed. CFS patients and rheumatoid arthritis patients share some aspects which include fatigue. Rheumatoid patients often complain of mobility difficulties as well as socializing problems. On addition to that this patients have a lot of issues when it comes to performing their daily chores (Pray 2006).
One of the main factors that make rheumatoid arthritis patients to develop a negative attitude towards their illness is the fact that there is no cure for this disease. The facts that rheumatoid arthritis is characterized by joint damage further worsen their predicament. There are a number of reasons that one will feel that these patients are justified to think the way they do. One of the bothersome symptoms in the rheumatoid arthritis patients if fatigue. Research that has been conducted indicated that fatigue has many far reaching consequences than any other rheumatoid arthritis symptoms. These patients have indicated different forms of fatigue which has made the distinction mental and physical fatigue to be possible. Research that has been done indicated that women mostly develop negative emotions as opposed to men. These emotions may be characterized by feeling of worthlessness as well as worsened moods. In most cases women often become over sensitive which is associated with quick irritation. At times they may not be in a position to deal with simple issues because of feeling miserable, aggressive and rebellious among many other forms of irritation. Mostly women feel too tired to carry out their daily duties and things comes a ling with many other bad feelings making their lives to be very difficult.
There are many negative emotions that result with fatigue for instance when one fail to carry out their daily normal duties as a mother or wife. Fatigue hinders the activities and mobility of rheumatoid arthritis patients. Rheumatoid arthritis patients who are above age sixty seven are not badly affected by fatigue. Fatigue restricts many of these patients to gardening as well as house keeping. It’s true that most of them cannot do things as they used to due to excessive pain and uncontrollable fatigue. Many of rheumatoid arthritis patients are forced to rest for a very long time and as a result they have to learn to take life and other things easy. Most women are forced to counsel most of their appointments which they cannot attend to due to fatigue. Stress might develop in these patients due to fatigue when they realize that they cannot help and support their friends and family as they used to. This fatigue has many implications in almost all life areas of these patients they basically become unable to work and as a result their yearly income is implicated negatively.
Research that has been carried out through interviews and questioners indicated that women have problems with coping with fatigue and that is the reason why most of them develop stress because of the daily tiredness that they experience. There is also much variation in the way they cope with the fatigue. This greatly affects women sometimes they may accept it as part of their daily life and another time they may not create much variation. The effects of fatigue are very adverse in women when compared to men. Women seem to be affected greatly while men tend to accept their situation and look for ways of handling their disadvantages. Most women reported that they can no longer handle their full time job without having to skip some other responsibilities that are essential like family.
There are different forms of fatigue that are experienced by this patients and it comes in a variety of forms. For instance poor sleep may contribute to the fatigue that one experiences. The worst part is that they often become fatigued without nay reason. Some forms of fatigue may come with pain as well as dizziness. Other times rheumatoid arthritis patients feel fatigued but they find it difficult to get some rest making it more difficult and painful than it’s already. Different forms of fatigue can be basically defined basing on how severe, frequent or even length of time that it lasts. Many rheumatoid arthritis patients have difficulties when it comes to normal sleeping and that is the major contributor to the fatigue they experience.
Proper treatment of fatigue does not occur because many of the rheumatoid arthritis patients fail to explain themselves to the physician when it comes to describing the severity of the situation. They also fail to identify the frequency of the fatigue as well as the time that the fatigue lasts. Most of the time rheumatoid arthritis patients think that the fatigue they experience all the time is the same and that is the reason proper measurement of fatigue levels is not done. Its also important to realize that some factors like the activities one is doing greatly contributes to the form of fatigue that one experiences. There are other rheumatoid arthritis patients who take fatigue positively though there are very few compared to those that view fatigue as a hindrance to their daily lives. Those who take fatigue positively tend to notice that its time for making sober decisions for instance they tend to carry out their activities differently basing on their health situation.
It’s important for rheumatoid arthritis patients to realize that, that is the right tine to do tasks that really matters or tasks that are rather important. By realizing this they will be able to take their situation positively. This is the time when they can realize the importance of rest which is an essential part of humanity. Another aspect that was reported by the patients was that fatigue makes life a bit easy because there are a number of things which they would have been forced to do but because of their condition they are able to leave them undone. Rheumatoid arthritis patients view fatigue from different angle depending on their personalities. For instance some opt to look at things that life brings positively which other opt to see the negative side of the whole issue (Deluca, 2005).
From the survey that was done it was evident that women find it difficult to cope with fatigue. On addition to that they experienced some fatigue patterns that are not similar to those experienced by men for instance bad mood and negative emotions among many other trends. There were some differences in the fatigue experienced by women on the basis of age. For instance young women were greatly affected by fatigue as opposed to older women this is supported by the fact that young women have many responsibilities to handle when compared to aged women. For example young women have demanding jobs as well as families to take care of therefore making it hard for them to accomplish all these responsibilities with the kind of fatigue that they experience. Its interesting that aged patients did not show any sign of fatigue meaning that there were not affected at all by fatigue. Aged people don’t have many active and demanding responsibilities to take care of therefore there might be no difference between fatigue and their way of life.
Women feel much pressed with fatigue because of the many roles that they must accomplish. It’s naturally for people to expect a lot of things from a woman and that is why the disease put much stress on them because of the things that they are expected to accomplish for their families. On the hand things take a different turn as one grow old because many responsibilities tend to reduce because of the reduced energy. Retirement lessens the responsibilities of women and that is why the impacts of fatigue in older women are minimal or insignificant. These are some of the reasons why women feel limited by fatigue as opposed to men. Basically many women manage fatigue by simply dosing or properly planning their activities and that is the reason they tend to develop negative attitude more than men. One of the reasons why they tend to develop negative attitude is because they expectations in relation to their activities don’t measure up. At most of the time external demands worsen the whole issue leaving them worse than they were (Chaitow and Baldry, 2003)
The best strategy in dealing with negative emotion is proper adjustment of the goals that one has. Negotiation of the external demands might also yield positive fruits when it comes to dealing with the negative emotion. Patients suffering from rheumatoid arthritis are also advised to realize some positive aspects of fatigue because this will greatly help them in handling their problem. It becomes easy to handle negative influence when one is aware of the positive aspects of whatever situation. It’s usually beneficial to find some positive aspect in any negative issue because it’s essential in helping one to cope with the current situation. For example positive aspects of fatigue may help its patients to adapt to the situation thus improving their health. On the other hand negative emotions may worsen the disease because some of the rheumatoid arthritis patients develop stress and depression because of the negative emotions that they developed due to fatigue.
Rheumatoid arthritis professionals have a role to play in helping their patients deal with bothering issues like fatigue. It’s important for these specialists to develop a mechanism that will support the attitude of their patients. Patients should be allowed to discuss their fatigue though they never do it well because of the different expectations. This sector has not been fully addressed because of the absence of theoretical model that analyses the level of fatigue. Therefore it’s important for the future scientists to work hard at developing a theoretical model which may be of great usefulness. For better treatment and assessment of fatigue in rheumatoid arthritis patients it’s important that researchers develop the necessary models that are needed for proper assessment of fatigue.
Reasons and Methods for Measuring Fatigue
Kirwan and Hewlett (2007) authored a study based on a Patient Perspective Workshop at an Outcome Measures in Rheumatology Clinical Trials (OMERACT) group meeting. The two major subjects they addressed were the importance of fatigue to RA patients and the ability to measure it. Citing the previous study by Hewlett, the Patient Perspective Workshop was conducted in a similar manner with patient interviews resulting in validation of the Hewlett study. The OMERACT delegates agreed based on the interviews that “fatigue was an important symptom in RA (95% agreed); measures of fatigue should be validated in RA (100% agreed); after further work, fatigue may warrant consideration for inclusion in the core set for RA (86% agreed)” (p. 1172). the second subject covered in the workshop was the ability to measure fatigue. Kirwan and Hewlett discussed one of their previous studies conducted with M. Hehir in which they did a systematic review of scales being used to measure fatigue. This study of scales identified twenty three different scales used in various studies and found that only six of them could be validated for use in RA. Given this research, OMERACT acknowledged the importance of an instrument to measure fatigue.
Fatigue is a common symptom to most rheumatoid arthritis patients. There is a difference between normal tiredness that people experience from fatigue which is experienced by rheumatoid arthritis patients. Fatigue that is experienced permeates every sphere of the patient’s life and the most challenging factor is the variation in its management. Despite this fact fatigue receives little or no support from rheumatoid arthritis specialists. There are twenty six scales that are used to measure fatigue though only six scales sufficiently pass the needed filter or test. Researches have also indicated that fatigue measurements can be influenced by changes that might be as a result of rheumatoid arthritis interventions (Jones and Moots, 2004).
Interventions that have been done by specialist in respect to measurement of fatigue come to the realization that the patient intervention, is needed if fatigue has to be successfully addressed. Information obtained from OMERACT meetings indicated that rheumatoid arthritis patients are greatly concerned with general well being, disturbed sleep as well as fatigue. From the information that was obtained from the patients the concerned parties felt the need for development of new devices that may be of use in meeting the needs of these patients. Researchers resorted to developing new prevalence as well fatigue measurement devices that can effectively help them to serve rheumatoid arthritis patients.
There are a number of researches that were carried out basing on the patients perspective and the results clearly indicated the need of including fatigue measurement into rheumatoid arthritis interventions. Women that were interviewed during the OMERACT conferences rated pain as an important aspect of rheumatoid arthritis diagnosis. In further conferences that were done fatigue was also included as a major issue affecting rheumatoid arthritis patients. In the researches that were conducted later fatigue was suggested as the main measure of measuring the health status of a rheumatoid arthritis patient. Patients have hoped that when fatigue measurement will be used to measure their health status they will improve greatly.
Measuring fatigue is important for effective treatment of arthritis patients places much importance on this issue because fatigue affects their daily lives in all aspects. For these reason they believe that proper handling of fatigue by their specialist will greatly improve their day to day life. All patients that were interviewed at the OMERACT conference from many parts of the developed countries indicated the same issue; the needs to reduce the oppression rheumatoid arthritis patients go through as a result of fatigue. Despite the fact that its difficult to measure fatigue and explain it, it plays a significant role in the well being of rheumatoid arthritis patients. Fatigue analysis that was carried out indicated that patients go through overwhelming tiredness that comes as a result of fatigue. This tiredness is a great hindrance to their day to day activities as well as personal achievement.
Patients halt most of their activities at the onset of this overwhelming tiredness. Rheumatoid arthritis patients linked their fatigue to lack of sleep, inflammation as well as the straining that occurs as a result of straining already damaged tissues. Fatigue causes a lot of havoc for instance the daily social life of rheumatoid arthritis patients is greatly interfered with and besides that their physical activities keep lagging behind. Patient’s perspective in treating rheumatoid arthritis helped the specialists to realize the value that patients have put on treating fatigue. As a result there was a special need to clarify the instruments that are used to measure fatigue in order for better result to be obtained. It was important to introduce the fatigue measurement devices so that they can be effectively used in treating rheumatoid arthritis.
There are six different scales that can be used successfully to measure fatigue though there is need for validity of the obtained measurements. These scales include ordinal scale which is rarely used, SF-36 scale which can also be of usefulness in measuring other factors associated to rheumatoid arthritis. Other scales include Multi-dimensional assessment of Fatigue (MAF), FACIT-F scale, Profile of Mood States (POMS) as well as analog scales for visualization. These instruments can effectively be used to measure fatigue in rheumatoid arthritis patients and the results obtained can be useful in designing treatment for this issue. It’s important to get the necessary treatment for fatigue because it will help patients to cope with the disease bearing in mind that there is no cure that has been found for treating rheumatoid arthritis.
Review of Scales in Use for Measuring Fatigue
A rheumatoid specific fatigue scale is currently being developed. Hewlett, Hehir, and Kirwan (2007) collaborated on a study to identify various scales that have been used to measure fatigue in previous studies. Of twenty three scales identified, only six could be validated as being effective in measuring fatigue in RA. The researchers also stress the implications of using scales that cannot be validated, and how results obtained with these scales limit the interpretation of the results. One of the fatigue measurement systems that is still under development is FACIT. Basically FACIT is a collection of questioners that are used to collect information that contributes to a healthy life in rheumatoid arthritis patients.
FACIT was designed basing on four important concepts that could greatly contribute to the well being of rheumatoid arthritis patients. The important aspects that were touched while designing this system included physical, social, emotional and functional well being of rheumatoid arthritis patients. These system was initially developed to better the lives of cancer patients though it’s was latter used in helping patients with other forms of chronic illness. The questioners that were used were very specific in order to capture the important information that could be used to compare the various chronic illnesses. There have been different versions of FACIT for instance the forth version was specifically developed for the purpose of clarity and precision of the measurements without tempering with the validity of the measurement as well as its reliability (McNeil and Sack 2005).
Complete development of this measuring device will greatly ease the burden which patients have in relation to data collection. There are about forty FACIT scales which are used to measure different concepts. There are a number of benefits that investigators gain by using this scale to measure the health status of a patient. This device was developed through the influence of all the participating factors and these reason the information that is obtained is all rounded and it can be used to assess different health situations. The available data on FACIT is of great importance in comparison though the other measurement scales can also be used to compare the acquired information. FACIT can be used for personal as well as clinical assessment and this scale was validated basing on the standard value therefore its use in measuring fatigue can help rheumatoid arthritis patients to a great extend.
Fatigue and Its Relationship to Other Common Clinical Features
Researchers have carried out studies to determine the level of fatigue that is experienced by the RA patients and how it relates to other clinical features like pain and synovitis. The same study was intended at determining the efficacy of DMARDS and TNF therapies in reducing fatigue. In their study the researchers employed two cohorts of 274 and 238 RA patients. They observed patients response to treatment among thirty patients using anti-TNF and DMARDS with the other fifty four patients within a period of three to six months. They used visual analogue scores to measure fatigue. During the study the researchers recorded the activity of the disease in 28 joints and its related components (Wolfe and Michaud 2004).
The results that were obtained from the study indicated that over 80% of all RA patients experience clinical fatigue of about VAS20mm while 50% experience high levels of fatigue of over VAS 50%. The researchers related the experienced fatigue to mental health variations, pain as well as depression. Before the administration of the anti-TNF and DMARDs fatigue levels were high in over 87% of the patients under study but, on admission of the drugs fatigue levels reduced to about 50%. Therefore treatment reduces pain which in turn reduces fatigue. The researchers concluded that increased fatigue is linked to depression and pain in the RA patients. Fatigue is not directly related to disease activity and anti-TNF and DMARD are effective in reducing fatigue to some extend.
Research was conducted to determine the efficacy and safety of using methotrexate and rituximab in treating RA active patients who did not improve after administration of anti-TNF. The study was carried out in patients who had enrolled for FEFLEX. The researchers admitted intravenous rituximab to patients who had shown inadequate improved from the anti-TNF. The results that were obtained showed a marked improvement in patients who had received rituximab treatment. The patients showed significant improvement as far as quality of life, disability and fatigue is concerned. The drug had no significant effect on the immunoglobulin level though peripheral CD20+ and B cells were depleted. The drug showed some adverse effects after infusion but they were not very severe. It was therefore concluded that a combination of concomitant MTX therapy with a single course of rituximab is effective in improving disease activity in RA active patients (Feltelius et al 2005).
Researches indicate that fatigue that is experienced by the rheumatoid arthritis patients is related to other clinical features of rheumatoid arthritis. For instance inflammation that is very common in these patients is thought to greatly contribute to the excessive tiredness. There are a number of clinical effects that are related to fatigue which include stiffness, swelling, pain redness and warmth. The fatigue that is experienced maybe related to the stiffness that patients experience in various joints after a long period of rest. Rheumatoid arthritis patients takes a long time before their stiffened joints go back to there normal condition. The excessive fluid that accumulates it the affected joints may hinders one from free moment and as a result tiredness results. It’s very common for one to feel fatigue when you are generally not feeling well therefore the many complications that results from rheumatoid arthritis greatly influences the functioning of the body resulting to overwhelming tiredness (Wallace and Clauw 2005).
Chronic fatigue is associated with other chronic illness besides rheumatoid arthritis. About twenty percent of all patients that seek medical attention often complain of fatigue for this reason fatigue is manly considered as a general medical symptom because it’s common in many medical conditions. Chronic fatigue is basically characterized by relapsing and persisting tiredness which cannot be easily compared thus making its description relatively difficult. Most of the time that a patient experiences fatigue other clinically symptoms are usually not present making it difficult to personal describe the type of fatigue that one was experiencing. For instance Fibromyalgia Syndrome patients have medical symptoms which are similar to those of rheumatoid arthritis. Other medical complications which cause chronic fatigue include mycoplasmal infections that are considered systemic (Clair, Pisetsky and Haynes, 2004).
There are underlying correlation between pain and fatigue which is commonly experienced by rheumatoid arthritis patients. Generally fatigue is not considered as a diagnostic measure because it’s a common aspect in many other forms of chronic illness. Pain is mainly associated with the developmental process of rheumatoid arthritis. Patients of rheumatoid arthritis mainly identifies with the chronic fatigue which they have deal with on a daily basis. Sometime this fatigue is accompanied by pain and dizziness while other times it not. Fatigue is mainly related to the joint inflammation that is so rampant in rheumatoid arthritis patients as well as lack of sleep. Most of these patients report that they experience a lot of difficult when it comes to resting or sleeping. Rest is basically important for any human being. There is refreshment that comes when one gets enough rests therefore this patient’s feel extremely tired because of lack of sufficient rest. There is no much evidence in actual relationship between pain and fatigue that is experienced by these patients though the two symptoms are present in diagnosis of this medical condition. Patients have greatly emphasized on proper addressing of fatigue which impacts their lives negatively on a great extend.