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Patients' perceptions of fatigue in rheumatoid arthritis: Overwhelming, uncontrollable, ignored

Hewlett, Sarah; Cockshott, Zo�; Byron, Margaret; Kitchen, Karen; Tipler, Sue; Pope, Denise; Hehir, Maggie


Zo� Cockshott

Margaret Byron

Karen Kitchen

Sue Tipler

Denise Pope

Maggie Hehir


Objective. Fatigue is commonly reported by patients with rheumatoid arthritis (RA) but is rarely a treatment target. The aim of this study was to explore the concept of fatigue as experienced by patients with RA. Methods. Fifteen patients with RA and fatigue (≥7 on a 10-cm visual analog scale) were individually interviewed and asked about the description, cause, consequence, and management of fatigue. Transcripts were systematically analyzed by 2 researchers independently, relevant phrases were coded, and earlier transcripts were checked for the emerging codes. A random sample of analyses were independently reviewed. A total of 191 codes arising from the data were grouped into 46 categories and overarching themes. Results. Vivid descriptions reflect 2 types of fatigue: severe weariness and dramatic overwhelming fatigue. RA fatigue is different from normal tiredness because it is extreme, often not earned, and unresolving. Participants described physical, cognitive, and emotional components and attributed fatigue to inflammation, working the joints harder, and unrefreshing sleep. Participants described far-reaching effects on physical activities, emotions, relationships, and social and family roles. Participants used self-management strategies but with limited success. Most did not discuss fatigue with clinicians but when they did, they felt it was dismissed. Participants held negative views on the management of fatigue. Conclusion. The data show that RA fatigue is important, intrusive, and overwhelming, and patients struggle to manage it alone. These data on the complexity of fatigue experiences will help clinicians design measures, interventions, and self-managment guidance. © 2005, American College of Rheumatology.


Hewlett, S., Cockshott, Z., Byron, M., Kitchen, K., Tipler, S., Pope, D., & Hehir, M. (2005). Patients' perceptions of fatigue in rheumatoid arthritis: Overwhelming, uncontrollable, ignored. Arthritis Care and Research, 53(5), 697-702.

Journal Article Type Article
Publication Date Oct 15, 2005
Journal Arthritis Care and Research
Print ISSN 2151-464X
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 53
Issue 5
Pages 697-702
Keywords fatigue, rheumatoid arthritis, qualitative, tiredness, outcome, importance, perception
Public URL
Publisher URL
Additional Information Additional Information : Selected for oral presentations at the British Society of Rheumatology (plenary) and American College of Rheumatology, and invited talks in England, Wales, Scotland, Amsterdam, Iceland and Malta. Research team included a patient partner (KK). Led to funding of an RCT of cognitive-behavioural therapy for fatigue self-management (Arthritis Research Campaign).