Bristol rheumatoid arthritis patients in new fatigue trial
More than 100 rheumatoid arthritis patients in Bristol are to be recruited onto a new clinical trial which aims to find out more effective ways of managing a major symptom of the condition – fatigue.
The clinical trial of 120 patients from the Bristol Royal Infirmary will be led by a multi-disciplinary team of experts led by Arthritis Research Campaign reader in clinical nursing, Dr Sarah Hewlett, from the University of the West of England. The three-year study is being funded by a grant of almost £150,000 by the Arthritis Research Campaign (arc).
Earlier small studies by the Bristol team showed that many patients with rheumatoid arthritis consider fatigue to be almost as important as pain, that it is hard to manage, and that doctors and other health professionals do not treat it. Fatigue is overwhelming and different to tiredness, in that it is severe, unpredictable and has no apparent cause, and can affect every aspect of life.
“Up to 90 per cent of people with RA experience fatigue, 40 per cent on a daily basis, yet patients feel that fatigue is neglected and not addressed by the medical profession,” explained Dr Hewlett. “Some people with RA feel very distressed because of their fatigue, so it’s important to explain to people that it is part of having the condition.
“But even when this is explained to them, it doesn’t help them to manage it on a practical level. In other long-term conditions, self-management programmes that address thoughts, feelings and behaviour and use exercise can be helpful. Now we intend to test this in RA.”
Dr Hewlett and a multi-disciplinary team comprising an occupational therapist, a physiotherapist, a clinical psychologist, and a research nurse, will compare the effectiveness of two methods of managing fatigue.
One group of patients will be given two arc leaflets on looking after joints and managing fatigue, during a one-hour group session led by rheumatology nurses.
The other group will be offered a six-week self-management course led by a clinical psychologist which will cover topics such as goal setting, graded exercise, how to manage energy, and exploring the links between fatigue, pain, stress and depression.
Patients will be encouraged to channel their frustration and anger into positive action, learn to establish some “me time”, and how to set priorities for the limited amount of energy they have.
Results of the study will enable the Bristol researchers to produce a package of guidelines that could be used nationally, incorporating the most effective methods of managing fatigue. Recruitment to the trial will start in the summer.
The trial is part of a bigger programme of work by Dr Hewlett and her team who are investigating ways of measuring fatigue as well as managing it. arc has also awarded Dr Hewlett and Professor Michael Calnan (University of Bristol) a £74,000 PhD studentship to support related research into well-being and RA.
Rheumatoid arthritis is a serious inflammatory type of arthritis which affects more than 380,000 people in the UK, and causes painful, swollen joints.
