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Front. Physiol. | doi: 10.3389/fphys.2018.01395

Perceived versus performance fatigability in patients with rheumatoid arthritis

  • 1Human Health and Nutritional Sciences, University of Guelph, Canada
  • 2Department of Physiology and Pharmacology, Karolinska Institutet (KI), Sweden
  • 3Wellington Ortho and Rehab, Community Rheumatologist, Canada

Rheumatoid arthritis (RA) is a chronic, inflammatory disease that affects 1% of the general population. Fatigue is a common complaint of patients with RA, however their perceived fatigue may be more exacerbated than objective measures of fatigue may indicate. The assessment of fatigue is made complex due to inconsistent and vague terms used to define fatigue, and the task dependence of fatigability. Fatigue is defined as a state of exhaustion and decreased strength, while fatigability indicates an individual’s susceptibility to fatigue. In order to offer some clarity to the manifestation of fatigue in clinical populations, in this review we outline that fatigue should be described with subsections that are related to the symptom, such as: perceived fatigability and performance fatigability. Where perceived fatigability indicates the subjective state of the individual and thus involves the individual’s subjective measure of fatigue, performance fatigability would be measured through clinical and laboratory -based assessments that quantify the functional decline in performance. This review describes RA and the various neuromuscular changes associated with the disease that can lead to alterations in both perceived and performance fatigue. From there, we discuss fatigue and RA, how fatigue can be assessed, effects of exercise interventions on RA symptoms and fatigue, and recommendations for future studies investigating subjective and objective measures of fatigability.

Keywords: Inflammation, Rheumatoid arthritis, performance fatigability, perceived fatigability, Fatigue, fatigability, Cytokines

Received: 11 May 2018; Accepted: 13 Sep 2018.

Edited by:

Sandra K. Hunter, Marquette University, United States

Reviewed by:

Sridhar Poosapadi Arjunan, RMIT University, Australia
Alison R. Harmer, University of Sydney, Australia  

Copyright: © 2018 Marrelli, Cheng, Brophy and Power. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Geoffrey A. Power, University of Guelph, Human Health and Nutritional Sciences, Guelph, N1L0M2, Ontario, Canada,