A biopsychosocial network model of fatigue in rheumatoid arthritis: a systematic review

Abstract

Fatigue in RA is prevalent, intrusive and disabling. We propose a network model of fatigue encompassing multiple and mutually interacting biological, psychological and social factors. Guided by this model, we reviewed the literature to offer a comprehensive overview of factors that have been associated with fatigue in RA. Six categories of variables were found: physical functioning, psychological functioning, medical status, comorbidities and symptoms, biographical variables and miscellaneous variables. We then systematically reviewed associations between fatigue and factors commonly addressed by rheumatology health professionals. Correlations of fatigue with physical disability, poor mental well-being, pain, sleep disturbance and depression and anxiety were ∼0.50. Mostly these correlations remained significant in multivariate analyses, suggesting partly independent influences on fatigue and differences between individuals. These findings indicate the importance of research into individual-specific networks of biopsychosocial factors that maintain fatigue and tailored interventions that target the influencing factors most relevant to that person.

Keywords: biopsychosocial model; depression; disease activity; fatigue; obesity; pain; physical functioning; psychological functioning; rheumatoid arthritis; sleep.

Fig. 1

Network model reflecting factors that are associated with fatigue Relations between all factors of this biopsychosocial model are assumed to be dynamic and reciprocal, with mutually influencing pathways similar to a hanging mobile toy, in which movement of one factor causes changes in all other factors. Another assumption is that individuals differ in terms of the factors involved in fatigue as well as the importance of both the weight of these factors and the strength of the relationships between these factors.

Fig. 2

Flow chart of the literature review