Although most rheumatologists understand the burden of fatigue associated with rheumatoid arthritis (RA) few are comfortable managing this problem, research findings indicate.
Fatigue is generally considered to be the second most problematic symptom of RA after pain. The various ways of measuring and defining fatigue mean that different studies have found that the problem affects anywhere between 40% and 80% of patients.
Indeed, not only are prevalence rates unclear, but there is little information available on the level of rheumatologists knowledge about fatigue and how they typically manage the condition.
Accordingly, Han Repping-Wuts (Radboud University, Nijmegen, Netherlands) and colleagues questioned 204 experienced rheumatologists and 49 rheumatology trainees in the Netherlands about their knowledge of fatigue in RA patients.
As published in the journal Clinical Rheumatology, knowledge of, attitudes toward, and management of, fatigue in RA was similar in experienced and trainee rheumatologists. However, over 60% of the respondents conceded that their knowledge of fatigue was limited and that they had received little training on how to manage the problem.
The authors report that 96% of those questioned assumed that RA patients discussed fatigue with nurses, while 34% said that fatigue is best managed by nurse specialists. Despite this, 93% of respondents believed that fatigue is a problem even after pain is controlled, although only seven of the 110 physicians questioned reported using an assessment instrument to measure fatigue levels.
"Despite the acknowledgement of poor communication about fatigue and the awareness that if you ask patients about fatigue they seldom deny the symptom, rheumatologists reported that it is the patient rather than the rheumatologist who raises the issue of fatigue during the consultation," write the researchers.
"This is despite the fact that in qualitative studies, patients indicated that they seldom discuss fatigue with healthcare professionals, assuming that they have to manage fatigue alone because it is part of the disease," note the authors.
To address this discrepancy, Repping-Wuts and team recommend further studies to determine how often patients or rheumatologists talk about fatigue during consultations.