High burden of fatigue amongst socioeconomically disadvantaged South Africans with rheumatoid arthritis

Background Fatigue substantially affects quality of life in rheumatoid arthritis (RA), yet evidence from sub-Saharan Africa is limited. This study determined the prevalence of fatigue and factors associated with severe fatigue among South African patients with RA. Methods Consecutive adults with RA were drawn from a registry at a tertiary hospital for this cross-sectional analysis. Demographic and socioeconomic characteristics, disease activity, treatment, comorbidities, and patient-reported outcomes, including the Brief Pain Inventory, Health Assessment Questionnaire–Disability Index, EuroQol 5-Dimension questionnaire, and Hospital Anxiety and Depression Scale, were collected. Fatigue was assessed using the 13-item Functional Assessment of Chronic Illness Therapy–Fatigue scale. Any fatigue was defined as a FACIT-F score <40 and severe fatigue as <27. Associations with severe fatigue were examined using multivariable logistic regression. Results Among 550 participants, 467 (84.9%) were female, the mean age was 55.8 (SD 12.9) years, and 369 (67.1%) were socioeconomically disadvantaged. Any fatigue was present in 403 participants (73.3%): 168 (30.5%) reported some fatigue, 148 (26.9%) quite a lot, and 87 (15.8%) extreme fatigue. Severe fatigue was present in 235 participants (42.7%). In the complete-case multivariable model ( n  = 516), severe fatigue was independently associated with current smoking [adjusted odds ratio (aOR) 1.78, 95% CI 1.14–2.79], multimorbidity (aOR 2.22, 95% CI 1.40–3.53), problems with usual activities (aOR 1.91, 95% CI 1.02–3.60), pain severity (aOR 1.23 per point, 95% CI 1.06–1.42), pain interference (aOR 1.18 per point, 95% CI 1.04–1.35), anxiety symptoms (HADS-A ≥ 11; aOR 3.13, 95% CI 1.94–5.06), and depressive symptoms (HADS-D ≥ 11; aOR 1.96, 95% CI 1.22–3.16). Conclusion Fatigue was highly prevalent in this socioeconomically disadvantaged RA cohort, with more than two-fifths meeting the study definition of severe fatigue. Severe fatigue was associated with smoking, multimorbidity, limitations in usual activities, pain, anxiety, and depression. These findings support assessment of physical, psychological, behavioral, and comorbidity-related factors in patients with RA who report fatigue.