Prevalence of severe fatigue among adolescents with pediatric rheumatic diseases

OBJECTIVES: To determine the prevalence of severe fatigue and fatigue-related limitations among adolescents with juvenile idiopathic arthritis (JIA) and other pediatric rheumatic diseases (PRD). In addition, we assessed the effect of disease activity and pain on the severity of fatigue.

METHODS: This cross-sectional study included 175 patients (10-18 years of age) who visited the pediatric rheumatology and immunology outpatient clinic at Wilhelmina Children's Hospital from April through July 2013. Patients completed validated questionnaires regarding fatigue, physical functioning, and school attendance. Disease activity in JIA patients was measured using the Juvenile Arthritis Disease Activity Score (JADAS-27). The results were compared against a healthy control group.

RESULTS: The prevalence of severe fatigue among patients with PRD was 25.1%, which was significantly higher than the healthy control group (p<0.001). Fatigued patients had significantly lower levels of physical functioning compared to non-fatigued patients (62.1% vs. 89.0%, respectively; p<0.001) and a significantly higher percentage of school absences (21.2% vs. 11.6%, respectively; p =0.005). Among JIA patients, the level of pain was significantly correlated with fatigue. Finally, disease activity was not a predictor for fatigue.

CONCLUSIONS: Fatigue is a common problem among teenagers with PRD, with a higher prevalence among these patients than in the general population. Severe fatigue leads to significant impairments, including increased school absences and decreased physical functioning. Interestingly, fatigue was associated with pain, but not with the disease activity. Therefore, in this patient population, fatigue may be a promising therapeutic target for improving functioning, school attendance, and possibly pain as well. This article is protected by copyright. All rights reserved.