{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T17:08:34Z","timestamp":1776791314902,"version":"3.51.2"},"reference-count":16,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2020,11,9]],"date-time":"2020-11-09T00:00:00Z","timestamp":1604880000000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2020,11,1]]},"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec id=\"s1\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To define fatigue trajectories in patients with rheumatoid arthritis (RA) who initiate biological DMARD (bDMARD) treatment, and explore baseline predictors for a trajectory of continued fatigue.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s2\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>One-hundred and eighty-four patients with RA initiating bDMARDs were assessed at 0, 1, 2, 3, 6 and 12\u00a0months. Swollen and tender joint counts, patient reported outcomes (PROMs), blood samples and ultrasound examinations were collected at each time point. Fatigue was assessed by the fatigue Numeric Rating Scale (0\u201310) from the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire. Clinically significant fatigue was predefined as fatigue \u22654. Three trajectories of interest were defined according to level of RAID fatigue: no fatigue (\u22643 at 5\/6 visits), improved fatigue (\u22654 at start, but \u22643 at follow-up) and continued fatigue (\u22654 at 5\/6 visits). Baseline variables were compared between groups by bivariate analyses, and logistic regression models were used to explore baseline predictors of continued vs improved fatigue.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s3\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The majority of patients starting bDMARD therapy followed one of three fatigue trajectories, (no fatigue; n=61, improved; n=33 and continued fatigue; n=53). Patients with continued fatigue were more likely to be anti\u2013citrullinated protein antibody and\/or rheumatoid factor positive and had higher baseline PROMs compared to the other groups, while there were no differences between the groups for variables of inflammation including. Patient global, tender joint count and anxiety were predictors for the continued fatigue trajectory.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s4\">\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>A trajectory of continued fatigue was determined by PROMs and not by inflammatory RA disease activity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2020-001372","type":"journal-article","created":{"date-parts":[[2020,11,19]],"date-time":"2020-11-19T10:49:27Z","timestamp":1605782967000},"page":"e001372","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Trajectories of fatigue in actively treated patients with established rheumatoid arthritis starting biologic DMARD therapy"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5442-902X","authenticated-orcid":false,"given":"Sella Aarrestad","family":"Provan","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0103-2840","authenticated-orcid":false,"given":"Brigitte","family":"Michelsen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway"},{"name":"Department of Rheumatology, Hospital of Southern Norway Trust Kristiansand, Kristiansand, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Sexton","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tillmann","family":"Uhlig","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hilde Berner","family":"Hammer","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,11,19]]},"reference":[{"key":"2025090312074520000_6.3.e001372.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60008-8"},{"key":"2025090312074520000_6.3.e001372.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0218831","article-title":"Severity of fatigue in people with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis - results of a cross-sectional study","volume":"14","author":"Pilgaard","year":"2019","journal-title":"PLoS One"},{"key":"2025090312074520000_6.3.e001372.3","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.100271"},{"key":"2025090312074520000_6.3.e001372.4","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ki.5002087"},{"key":"2025090312074520000_6.3.e001372.5","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kew241"},{"key":"2025090312074520000_6.3.e001372.6","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780310302"},{"key":"2025090312074520000_6.3.e001372.7","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1002\/acr.23339","article-title":"Inflammatory assessments including ultrasound: results from a longitudinal study of rheumatoid arthritis patients","volume":"70","author":"Hammer","year":"2018","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090312074520000_6.3.e001372.8","first-page":"1349","article-title":"A 78-joints ultrasonographic assessment is associated with clinical assessments and is highly responsive to improvement in a longitudinal study of patients with rheumatoid arthritis starting adalimumab treatment","volume":"69","author":"Hammer","year":"2010","journal-title":"AnnRheumDis"},{"key":"2025090312074520000_6.3.e001372.9","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1002\/acr.23176","article-title":"Associations between five important domains of health and the patient acceptable symptom state in rheumatoid arthritis and psoriatic arthritis: a cross-sectional study of 977 patients","volume":"69","author":"Puyraimond-Zemmour","year":"2017","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090312074520000_6.3.e001372.10","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1002\/acr.21949","article-title":"Fatigue and factors related to fatigue in rheumatoid arthritis: a systematic review","volume":"65","author":"Nikolaus","year":"2013","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090312074520000_6.3.e001372.11","doi-asserted-by":"crossref","first-page":"255","DOI":"10.3109\/03009742.2015.1095943","article-title":"Correlations between fatigue and disease duration, disease activity, and pain in patients with rheumatoid arthritis: a systematic review","volume":"45","author":"Madsen","year":"2016","journal-title":"Scand J Rheumatol"},{"key":"2025090312074520000_6.3.e001372.12","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.141498"},{"key":"2025090312074520000_6.3.e001372.13","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kep458"},{"key":"2025090312074520000_6.3.e001372.14","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1002\/acr.22787","article-title":"Predictors of fatigue in rheumatoid arthritis patients in remission or in a low disease activity state","volume":"68","author":"Olsen","year":"2016","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090312074520000_6.3.e001372.15","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-011-1876-0"},{"key":"2025090312074520000_6.3.e001372.16","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1093\/rheumatology\/kex370","article-title":"The revised bristol rheumatoid arthritis fatigue measures and the rheumatoid arthritis impact of disease scale: validation in six countries","volume":"57","author":"Hewlett","year":"2018","journal-title":"Rheumatology (Oxford)"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2020-001372","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T19:07:52Z","timestamp":1756926472000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2020-001372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11]]},"references-count":16,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,11,19]]},"published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1136\/rmdopen-2020-001372"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2020-001372","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11]]}}}