Pain and fatigue in patients with psoriatic arthritis (PsA) receiving tumor necrosis factor inhibitors (TNFis) significantly reduce health-related quality of life (HRQoL), physical function, and work productivity, according to study results published in Rheumatic and Musculoskeletal Diseases.

In this retrospective analysis of global data, researchers evaluated the incidence and severity of pain and fatigue in patients with PsA receiving TNFis, and assessed the association between pain and fatigue severity and HRQoL and work productivity.

A total of 3782 patients with PsA undergoing TNFi treatment participated in the study. Characteristics including patient demographics and comorbidities were collected by questionnaires completed by both patients and their physicians; patient-reported forms included the 3-level 5-dimension EuroQoL, the Medical Outcomes Study 36-Item Short-Form version 2 (SF-36v2), and the Work Productivity and Activity Impairment (WPAI) questionnaires.

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Among the total cohort, 640 patients (43.4%) were included in the analysis who were receiving TNFis for ≥3 months and had completed the SF-36v2 bodily pain and vitality domains of the questionnaire. Overall, 37.7% and 45.6% of patients reported severe pain and fatigue, respectively. A greater percentage of patients who reported severe vs low or no pain and fatigue were considered to have “severe” and “unstable/deteriorating” disease by their physicians, respectively. In addition, a higher percentage of patients who reported severe vs low or no pain and fatigue had current flares. A total of 83.3% and 88.0% of patients who reported severe pain and fatigue, respectively, were considered to have stable/improving disease by their physicians; however, physicians reported that 39.8% and 45.5% of patients with severe pain and fatigue were considered to be in remission, which indicated a discordance between patient and physician assessment of pain and fatigue.

Scores across HRQoL and WPAI were significantly different across the pain and fatigue severity cohorts (P <.0001). Both HRQoL and WPAI measures were worse in patients with moderate to severe vs low pain and/or fatigue, indicating an association with greater work impairment.

Based on these findings, the investigators indicated that despite treatment with TNFis, patients with PsA experienced substantial pain and/or fatigue, which was associated with decreased HRQoL, physical function, and work productivity.

Study limitations included the potential subjectivity of physicians’ ratings, the variability of reporting across regions, and the inclusion of pain and fatigue data only from patients receiving TNFis.

Researchers concluded, “The high burden that severe pain and/or fatigue, in spite of TNFi treatment, place on patients in terms of limited function, diminished HRQoL and reduced ability to contribute to society as part of the workforce indicate that these are areas of significant unmet need in the treatment and management of PsA.”


Conaghan PG, Alten R, Deodhar A, et al. Relationship of pain and fatigue with health-related quality of life and work in patients with psoriatic arthritis on TNFi: results of a multi-national real-world study [published online July 1, 2020]. RMD Open. doi:10.1136/rmdopen-2020-001240