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To identify the determinants of fatigue among patients with ANCA-associated vasculitis (AAV).A multicentre cross-sectional study was conducted. Subjects fulfilling the European Medicines Agency criteria for granulomatosis with polyangiitis (Wegener's), microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (Churg-Strauss) were approached according to consecutive clinic attendance and invited to complete a questionnaire assessing fatigue and putative biopsychosocial determinants of this symptom. Concurrently, potential clinical determinants were recorded. Independent associations of fatigue were identified using forward stepwise logistic regression modelling and their overall impact expressed as population attributable risk (PAR).The majority (74.8%) of participants (n = 410) reported high levels of fatigue that were found to be significantly associated with numerous biopsychosocial and clinical factors. Sleep disturbance [odds ratio (OR) 5.3, 95% CI 2.7, 10.5] and pain (OR 3.8, 95% CI 2.0, 7.3) were the strongest independent associations of fatigue and, on a population level, each was more than twice as important as any other putative determinant (PAR 18.1% and 16.5%, respectively). Female gender (OR 2.1, 95% 1.1, 4.0), elevated CRP (OR 3.7, 95% CI 1.7, 8.1) and the dysfunctional coping strategies of behavioural disengagement (OR 2.4, 95% CI 1.04, 5.6) and denial (OR 2.4, 95% CI 0.9, 6.7) were also independently associated with fatigue.The data suggest that AAV-related fatigue is multifactorial in origin. Sleep disturbance and pain were found to be most important, although inflammation, as measured by CRP, was also associated. This study has identified potentially modifiable determinants that will inform future interventions aimed at alleviating fatigue.

Original publication

DOI

10.1093/rheumatology/ket191

Type

Journal article

Journal

Rheumatology (Oxford, England)

Publication Date

09/2013

Volume

52

Pages

1680 - 1685

Addresses

School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK. neilbasu@abdn.ac.uk

Keywords

Humans, Pain, Churg-Strauss Syndrome, Fatigue, Cross-Sectional Studies, Adaptation, Psychological, Sex Factors, Aged, Middle Aged, Female, Male, Microscopic Polyangiitis, Granulomatosis with Polyangiitis, Surveys and Questionnaires, Sleep Wake Disorders