Rheumatology: Current Research
Open Access

Abstract

Temporal Dissociation between Disease Activity Reduction and Improvements in Fatigue and Physical Function After Infliximab in Rheumatoid Arthritis

Camila Ventura, Bruno Gualano, Hamilton Roschel, Guilherme Giannini Artioli, Fernanda Rodrigues Lima, Ieda Laurindo, Eloisa Bonfá and Ana Lúcia de Sá-Pinto

Objective: To evaluate the temporal responses to infliximab in fatigue and other selected parameters of physical function, inflammation, disease activity, and QOL in a cohort of rheumatoid arthritis patients. Methods: A prospective study was conducted. At baseline (PRE), after two (POST 2) and six (POST 6) months of treatment with infliximab (3 mg/Kg), fatigue, muscle function and strength, quality of life, disease activity, and markers of inflammation were assessed in 25 consecutive patients. Results: Infliximab treatment resulted in a significant reduction in fatigue at POST 2 and POST 6 when evaluated by both Chalder and the Global Fatigue VAS scale. Similarly, improvements in physical function at POST 2 and POST 6 as assessed by both the timed-stands test and SF-36 physical functioning domain was also observed. Conversely, disease activity, as assessed by DAS-28, remained unchanged at POST 2 and improved only at POST 6. The reduction in clinical markers of inflammation (i.e. CRP and ERS) did not reach significance at POST 2 or at POST 6, except for a trend in CRP after 6 months of treatment. Muscle strength remained unchanged throughout the trial. Additionally, no significant correlations were found between delta changes of either disease activity or inflammation parameters and physical function and fatigue parameters. Conclusion: These findings clearly reveal a temporal dissociation between the improvements in fatigue, physical function, and quality of life and the reduction in disease activity in response to infliximab in rheumatoid arthritis patients. The predictive value of these early response factors merits further investigations.