History of affective disorder and the temporal trajectory of fatigue in rheumatoid arthritis

This study examines whether the general level and rate of change of fatigue over time is different for those rheumatoid arthritis (RA) patients with a nd those without a history of a affective disorder (AD). Four hundred fifte en RA patients from a national panel had yearly telephone interviews to obt ain fatigue and distress reports, and a one-time semistructured assessment of the history of depression and generalized anxiety disorder Growth-curve analysis was used to capture variations in initial fatigue levels and chang es in fatigue over 7 years for those with and without a history. RA patient s with a history of major AD reported levels of fatigue that were 10% highe r than those without a history in the Ist year of the study. Their fatigue reports remained elevated over 7 years. Further analysis showed that the ef fects of a history of AD on fatigue are fully mediated through current dist ress, although those with a history had a significantly smaller distress-fa tigue slope. Thus, a history of AD leaves RA patients at risk for a 7-year trajectory of fatigue that is consistently higher than that of patients wit hout a history. The elevation in fatigue reports is, at least in part, a fu nction of enduring levels of distress.