A biopsychosocial network model of fatigue in rheumatoid arthritis: a systematic review

We propose a network model of fatigue encompassing multiple and mutually interacting biological, psychological and social factors

Rinie Geenen; Emma Dures


Scholarcy highlights

  • Fatigue in RA is prevalent, intrusive and disabling
  • Based on existing models and in analogy to pain, we suggest that fatigue may be conceptualized as a network model in which fatigue encompasses multiple and mutually interacting biological, 1Department of Psychology, Utrecht University, Utrecht, The Netherlands, 2Department of Nursing and Midwifery, University of the West of England and 3Academic Rheumatology, the Bristol Royal Infirmary, Bristol, UK Submitted 18 April 2019; accepted 9 August 2019
  • The multivariate association was significant after controlling for variables such as demographics, disease activity, depression, sleep and physical functioning in all studies, but there was one that included another pain measure as a covariate
  • This literature review offered a comprehensive overview of six categories of variables that were associated with fatigue in patients with RA: physical functioning, psychological functioning, medical status, comorbidities and symptoms, biographical variables and miscellaneous variables
  • Often significant but not as high and often not surviving multivariate analyses were associations of fatigue with physical activity, physical capacity, stress and stressors, psychological management and relational factors, obesity and female gender, while the association between fatigue and younger age tended to be significant in multivariate but not univariate analyses
  • That associations of physical disability, poor mental well-being, pain, sleep disturbance and depression and anxiety often stayed significant in multivariate analyses suggests the partly independent association of these variables with https://academic.oup.com/rheumatology v17
  • The observed associations between fatigue and a cluster of variables clearly shows that in the treatment of fatigue the following variables should always be considered as potential maintaining factors: psychological and physical functioning, pain, sleep disturbance and depression and anxiety

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