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Clin Rheumatol. 2016 Feb;35(2):409-15. doi: 10.1007/s10067-015-3035-6. Epub 2015 Aug 15.

The prevalence of severe fatigue in rheumatic diseases: an international study.

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Department of Clinical and Health Psychology, Utrecht University, PO Box 80.140, 3508 TC, Utrecht, The Netherlands.
Department of Clinical and Health Psychology, Utrecht University, PO Box 80.140, 3508 TC, Utrecht, The Netherlands.
Department of Rheumatology, Hospitais da Universidade de Coimbra, 3000-075, Coimbra, Portugal.
Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, PO Box 85.500, 3508 GA, Utrecht, The Netherlands.


Fatigue is a common, disabling, and difficult-to-manage problem in rheumatic diseases. Prevalence estimates of fatigue within rheumatic diseases vary considerably. Data on the prevalence of severe fatigue across multiple rheumatic diseases using a similar instrument is missing. Our aim was to provide an overview of the prevalence of severe fatigue across a broad range of rheumatic diseases and to examine its association with clinical and demographic variables. Online questionnaires were filled out by an international sample of 6120 patients (88 % female, mean age 47) encompassing 30 different rheumatic diseases. Fatigue was measured with the RAND(SF)-36 Vitality scale. A score of ≤35 was taken as representing severe fatigue (90 % sensitivity and 81 % specificity for chronic fatigue syndrome). Severe fatigue was present in 41 to 57 % of patients with a single inflammatory rheumatic disease such as rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, Sjögren's syndrome, psoriatic arthritis, and scleroderma. Severe fatigue was least prevalent in patients with osteoarthritis (35 %) and most prevalent in patients with fibromyalgia (82 %). In logistic regression analysis, severe fatigue was associated with having fibromyalgia, having multiple rheumatic diseases without fibromyalgia, younger age, lower education, and language (French: highest prevalence; Dutch: lowest prevalence). In conclusion, one out of every two patients with a rheumatic disease is severely fatigued. As severe fatigue is detrimental to the patient, the near environment, and society at large, unraveling the underlying mechanisms of fatigue and developing optimal treatment should be top priorities in rheumatologic research and practice.


Fatigue; Fibromyalgia; Osteoarthritis; Rheumatic diseases; Rheumatoid arthritis; Vitality

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