Fatigue and health-related quality of life depend on the disability status and clinical course in RRMS

Henrik Ahvenjärvi; Marja Niiranen; Sakari Simula; Päivi Hämäläinen; Heljä-Marja Surcel; Anne M Remes; Mervi Ryytty; Johanna Krüger

doi:10.1016/j.msard.2023.104861

Fatigue and health-related quality of life depend on the disability status and clinical course in RRMS

Mult Scler Relat Disord. 2023 Sep:77:104861. doi: 10.1016/j.msard.2023.104861. Epub 2023 Jul 4.

Authors

Henrik Ahvenjärvi¹, Marja Niiranen², Sakari Simula³, Päivi Hämäläinen⁴, Heljä-Marja Surcel⁵, Anne M Remes⁶, Mervi Ryytty⁷, Johanna Krüger⁸

Affiliations

¹ Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland.
² Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. Box 100, FI-70029 Kuopio, Finland; Institute of Clinical Medicine-Neurology, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland.
³ Southern Savo Hospital District, Department of Neurology, Porrassalmenkatu 35-37, FI-50100 Mikkeli, Finland.
⁴ Masku Neurological Rehabilitation Centre, Vaihemäentie 10, FI-21250 Masku, Finland; Department of Psychology, FI-20014 University of Turku, Finland.
⁵ Faculty of Medicine, University of Oulu, P.O. Box 8000, FI-90014 University of Oulu, Finland; Biobank Borealis of Northern Finland, Northern Ostrobothnia Hospital District, P.O. Box 10, FI-90029 Oulu University Hospital, Finland.
⁶ Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Clinical Neurosciences, P.O. Box 4, Yliopistonkatu 3, FI-00014 University of Helsinki, Finland.
⁷ Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Neurocenter, Neurology, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland.
⁸ Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Neurocenter, Neurology, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland. Electronic address: johanna.kruger@oulu.fi.

PMID: 37442075
DOI: 10.1016/j.msard.2023.104861

Abstract

Background: Fatigue is a prominent and disabling symptom of multiple sclerosis (MS), impairing quality of life. The disease course of relapsing remitting MS (RRMS) is individual.

Objectives: We aimed to study the effects of demographic and clinical characteristics, as well as lifestyle risk factors on experienced fatigue and health-related quality of life (HRQoL) among RRMS patients, comparing benign and severe disease types.

Methods: Altogether 198 Finnish RRMS patients were recruited for this real-life cross-sectional study. Self-reported questionnaires were used to evaluate fatigue and HRQoL by using Fatigue Scale for Motor and Cognitive Functions and 15D health-related quality of life questionnaires. Patients were categorized into subgroups based on the current disability status measured by the Expanded Disability Status Scale (EDSS) cut-off value of 4.5, and by retrospective clinical course divided into benign and aggressive RRMS.

Results: All in all, 73% of the RRMS patients suffered from fatigue. Lower HRQoL had a strong correlation with more prominent fatigue (r = -0.719). Higher EDSS was associated with more prominent fatigue and lower HRQoL in the whole RRMS cohort. Older age at the disease onset was associated with more prominent fatigue and decreased HRQoL in the groups of aggressive RRMS and EDSS > 4.5. In the groups of EDSS ≤ 4.5 and benign RRMS, a higher number of used disease-modifying treatments (DMTs) was associated with more pronounced fatigue and reduced HRQoL. In addition, higher BMI was associated with lower HRQoL in patients with benign RRMS. Side effects (45 %) and lack of efficacy (26 %) were the most common reasons for discontinuing a DMT. Cessation due to side effects was the only reason that was significantly associated with more prominent fatigue and lower HRQoL. Use of nicotine products, gender, or disease duration were not associated with fatigue or HRQoL.

Conclusions: Individuals with severe RRMS and higher EDSS scores are more prone to experience fatigue and lower HRQoL. In addition, fatigue and lower HRQoL are more commonly observed among RRMS patients with older age at disease onset and in those with multiple DMT switches.

Keywords: Fatigue; Multiple sclerosis; Quality of life.

MeSH terms

Cross-Sectional Studies
Disease Progression
Fatigue / complications
Fatigue / etiology
Humans
Multiple Sclerosis* / complications
Multiple Sclerosis, Relapsing-Remitting* / complications
Multiple Sclerosis, Relapsing-Remitting* / drug therapy
Multiple Sclerosis, Relapsing-Remitting* / epidemiology
Quality of Life / psychology
Retrospective Studies