New insights into the experience of fatigue among patients with rheumatoid arthritis: a qualitative study

Objectives Patients with rheumatoid arthritis (RA) commonly experience fatigue. The aim of this study was to gain further insight into the experience of fatigue in RA. Methods Participants were 31 outpatients with RA of Medical Spectrum Twente, Enschede, The Netherlands, with all levels of fatigue. In-depth structured interviews on the patients' experience of fatigue were conducted and analysed using a bottom-up coding scheme, meaning that answers of patients were summarised and categorised. Results Patients' mean fatigue severity score was 50 (visual analogue scale (VAS); theoretical range 0-100). Interviews showed interindividual differences in the experience and impact of fatigue. Different patterns in emotions, consequences and management of fatigue were found. Especially younger women with multiple daily roles seemed to be vulnerable to the negative impact of RA fatigue. Patients also reported positive aspects of fatigue. Moreover, varying forms of fatigue were described. Conclusions Results point to the existence of differences in fatigue experience according to gender, age and daily roles. This finding indicates a need for targeting advice and interventions to the individual situation of a patient. Furthermore, the positive aspects patients reported about their fatigue could facilitate an approach that is focused on remaining opportunities and not just on restrictions.