The study, “Understanding fatigue‐related disability in rheumatoid arthritis and ankylosing spondylitis: The importance of daily correlates,” was published in the journal Arthritis Care & Research.
Fatigue is a common symptom of chronic illnesses, including arthritis, and may hamper a person’s ability to participate in their usual activities — which is termed “fatigue-related disability.”
Accumulating evidence suggests that the physical sensation of fatigue is not enough to fully explain fatigue-related disability in people with arthritis. A person’s psychological state is thought to play a substantial role in mediating fatigue-related disability. However, most studies to date have been done retrospectively — that is, having participants recount their experiences in the past.
Since the experience of fatigue can vary day to day, researchers in New Zealand sought to understand how someone’s psychological state on a given day is related to the daily experience of fatigue and fatigue-related disability.
Their study recruited 143 participants with inflammatory arthritis: 97 people with rheumatoid arthritis and 46 with ankylosing spondylitis. Ages ranged from 24 to 85 years.
The participants were asked to complete daily online diaries for 10 consecutive days to rate fatigue, fatigue-related disability, and pain. They were also asked to rate daily mindfulness — the extent to which they were in the present moment — and participation in activities they found to be meaningful. These are both aspects of what the researchers called psychological flexibility.
“An individual is psychologically flexible when they are aware and accepting of their internal experiences (e.g., bodily sensations like fatigue), and are able to change or persist with their behaviour, depending on both the situation and their goals and values,” the researchers wrote. “In contrast, an individual is psychologically inflexible when their internal experiences dominate their behaviour so that they are focused on controlling those internal experiences, even when this comes at the cost of achieving their daily goals and living a meaningful life.”
The team looked for patterns in the data, both across participants and within the same individual day-to-day. The most common comorbidities, or simultaneous conditions, were depression and/or anxiety (11.6%), hypertension (10.1%), and asthma (4.8%). About one-fifth of patients (20.4%) had fibromyalgia.
Results showed that fatigue alone explained 54.3% of the day-to-day variation in fatigue-related disability, while another 5.1% was explained by pain.
Components of psychological flexibility collectively explained 15.6% of the variance in fatigue-related disability. Notably, this pattern was seen in both ankylosing spondylitis and rheumatoid arthritis patients, and remained consistent after controlling for factors such as age, sex, and whether the patient had fibromyalgia.
“This study confirms that psychological flexibility plays an important role in fatigue-related disability in the daily lives of inflammatory arthritis patients,” the researchers wrote. “On days when patients engaged in more valued activity or were more mindful of their experiences, they were significantly less disabled by their fatigue.”
The findings also support the idea that engaging in less valued activity and being less mindful result from fatigue-related disability, the team added.
“The next step in this line of research is to examine whether improvements in daily psychological flexibility cause reductions in daily levels of fatigue-related disability,” the investigators wrote. “This would ideally be done through intervention studies designed to increase psychological flexibility.”
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