Study On Fatigue Symptom And Influencing Factors In Rheumatoid Arthritis Patients Based On The Theory Of Unpleasant Symptoms

Object:Use latent class analysis to understand the fatigue characteristics of rheumatoid arthritis patients,investigate the fatigue status of rheumatoid arthritis patients;use the theory of unpleasant symptoms as the theoretical framework to explore the influencing factors of fatigue and the relationship between fatigue and quality of life in rheumatoid arthritis patients;construct a structural equation model to verify whether there is a mediating effect between negative emotions and insomnia between pain and fatigue,so as to provide a basis for clinically formulating rheumatoid arthritis fatigue intervention programs.Method:This study is cross-sectional survey.A convenient sampling method was used to investigate 233 rheumatoid arthritis patients who visited the rheumatology and immunology clinic of Northern Theater General Hospital from October 2018 to October2019.The survey tools include a general questionnaire,Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire,Visual Analog Scale,Athens Insomnia Scale,Hospital Anxiety and Depression Scales,Social Support Rating Scale and medical outcomes study 12-item short-form health survey.The software of Epidata 3.0 was used for data double entry,SPSS 20.0 software was used for statistical description,correlation analysis,univariate analysis and multiple linear regression analysis,and the software of Mplus 7.0 was used for latent class analysis and mediation effect analysis.Result : 1.This study used a latent class analysis to classify 233 rheumatoid arthritis patients into severe fatigue(66,28.3%),moderate fatigue(110,47.2%),and mild(57,24.5%)according to the characteristics of RA patients’ response to different items.2.Analysis of influencing factors of RA fatigue based on the theory of unpleasant symptoms:(1)The results of univariate analysis showed that age,the time of morning stiffness,biologic drugs,joint function,disease activity,Tender Joint Count,Swollen Joint Count,the time of illness,anemia,pain,and insomnia in physiological factors have a significant effect on RA fatigue(P<0.05);anxiety and depression in psychological factors have a significant effect on RA fatigue(P<0.05);social support,employment,and marital status in the environmental factors have a significant effect on fatigue(P<0.05).(2)The results in multiple linear regression analysis showed that the effects of joint function,disease activity,pain,depression,and insomnia on fatigue were statistically significant(P<0.05).3.Fatigue has a negative correlation with the physical component summary and mental component summary of SF-12(r=-0.696 ~-0.727,P<0.05).The higher the fatigue score,the lower the score of physical component summary and mental component summary.4.The revised mediating effect analysis showed that pain has a direct effect on fatigue(P<0.05).Negative emotion(anxiety and depression)has a partial mediating effect between pain and fatigue(P<0.05).Negative emotion and insomnia have a partial mediating effect between pain and fatigue(P<0.05).The total indirect effect between pain and fatigue accounts for 55.69%(0.724/1.300)of the total effect.Conclusion:1.Fatigue of rheumatoid arthritis patients can be divided into mild fatigue,moderate fatigue and severe fatigue.Most patients are moderate fatigue.2.Physiological factors,psychological factors,and environmental factors all have an impact on fatigue.Among them,psychological factors and physiological factors dominate,indicating that more attention should be paid to psychological and physiological adjustments.3.The worse the fatigue of rheumatoid arthritis patients,the lower the quality of life.4.Pain is the pathologically related physiological factor of RA fatigue.Negative emotion(anxiety and depression)is a psychological factor,and insomnia is a non-pathophysiological factor.Negative emotion and insomnia play a mediating role in pain and fatigue,indicating that physiological factors in pathology are the cause,psychological factors and non-pathophysiological factors are the mediator,fatigue is the performance.Correcting the physiological factors and adjusting the psychological factors are the keys to alleviating fatigue in RA patients.