http://informahealthcare.com/mor ISSN 1439-7595 (print), 1439-7609 (online) From the Brazilian Registry of Spondyloarthritis (RBE). Correspondence to: Dr. P. D. Sampaio-Barros, Disciplina de Reumatologia, Faculdade de Medicina, Universidade de S ã o Paulo, Av. Dr. Arnaldo, 455 – 3, Andar, Cerqueira C é sar, S ã o Paulo SP, CEP 01246-903, Brasil. E-mail: pdsampaiobarros@uol.com.br ORIGINAL ARTICLE Assessment of fatigue in a large series of 1492 Brazilian patients with Spondyloarthritis Washington A. Bianchi 1 , Fernanda R. Elias 1 , Sueli Carneiro 2 , Adriana B. Bortoluzzo 3 , C é lio R. Gon ç alves 4 , Jos é Antonio Braga da Silva 5 , Antonio Carlos Ximenes 6 , Manoel B. B é rtolo 7 , Sandra L. E. Ribeiro 8 , Mauro Keiserman 9 , Thelma L. Skare 10 , Rita Menin 11 , Valder í lio F. Azevedo 12 , Walber P. Vieira 13 , Elisa N. Albuquerque 14 , Rubens Bonfi glioli 15 , Cristiano Campanholo 16 , Hellen M. S. Carvalho 17 , Izaias P. Costa 18 , Angela P. Duarte 19 , Charles L. Kohem 20 , Nocy H. Leite 21 , Sonia A. L. Lima 22 , Eduardo S. Meirelles 23 , Iv â nio A. Pereira 24 , Marcelo M. Pinheiro 25 , Elizandra Polito 26 , Gustavo G. Resende 27 , Francisco Airton C. Rocha 28 , Mittermayer B. Santiago 29 , Maria de F á tima L. C. Sauma 30 , Val é ria Valim 31 , and Percival D. Sampaio-Barros 4 1 Santa Casa do Rio de Janeiro, 2 Universidade Federal do Rio de Janeiro and Universidade do Estado do Rio de Janeiro, 3 Insper Institute of Education and Research, S ã o Paulo, 4 Division of Rheumatology, Universidade de S ã o Paulo, 5 Universidade de Bras í lia, 6 Hospital Geral de Goi â nia, 7 Universidade de Campinas, 8 Universidade Federal do Amazonas, 9 Pontif í cia Universidade Cat ó lica de Porto Alegre, 10 Hospital Evang é lico de Curitiba, 11 Faculdade de Medicina de S ã o Jos é do Rio Preto, 12 Universidade Federal do Paran á , 13 Hospital Geral de Fortaleza, 14 Universidade do Estado do Rio de Janeiro, 15 Pontif í cia Universidade Cat ó lica de Campinas, 16 Santa Casa de S ã o Paulo, 17 Hospital de Base, 18 Universidade Federal do Mato Grosso do Sul, 19 Universidade Federal de Pernambuco, 20 Universidade Federal do Rio Grande do Sul, 21 Faculdade de Medicina Souza Marques, 22 Hospital do Servidor P ú blico Estadual, 23 Instituto de Ortopedia e Traumatologia, Universidade de S ã o Paulo, 24 Universidade Federal de Santa Catarina, 25 Universidade Federal de S ã o Paulo, 26 Santa Casa de Belo Horizonte, 27 Universidade Federal de Minas Gerais, 28 Universidade Federal do Cear á , 29 Escola de Medicina e Sa ú de P ú blica de Salvador, 30 Universidade Federal do Par á , and 31 Universidade Federal do Esp í rito Santo Abstract Background. The aim of the present study was to analyze the score of fatigue in a large cohort of Brazilian patients with SpA, comparing diff erent disease patterns and its association with demo- graphic and disease-specifi c variables. Methods. A common protocol of investigation was prospectively applied to 1492 Brazilian patients classifi ed as SpA according to the European Spondyloarthropathies Study Group (ESSG) criteria, attended at 29 reference centers. Clinical and demographic variables were recorded. Fatigue was evaluated using the fi rst item of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) questionnaire. Results. The mean BASDAI fatigue score was 4.20 � 2.99. There was no signifi cant diff erence in the fatigue score between the diff erent SpA. Fatigue was higher in female patients ( p � 0.001), with mixed (axial � peripheral) involvement ( p � 0.001) and in those who did not practice exercises ( p � 0.001). Higher scores of fatigue were signifi cantly associated with infl ammatory low back pain ( p � 0.013), alternating buttock pain ( p � 0.001), cervical pain ( p � 0.001), and hip involve- ment ( p � 0.005). Fatigue presented a moderate positive statistical correlation with Bath Ankylos- ing Spondylitis Functional Index (BASFI) (0.469; p � 0.001) and Ankylosing Spondylitis Quality of Life (0.462; p � 0.001). Conclusion. In this large series of Brazilian SpA patients, higher fatigue scores were associated with female gender, sedentary, worse functionality, and quality of life. Mod Rheumatol, 2014; Early Online: 1–5 © 2014 Japan College of Rheumatology DOI: 10.3109/14397595.2014.906049 History Received 23 May 2013 Accepted 27 January 2014 Published online 28 May 2014 Keywords Spondyloarthritis , Fatigue , Disease activity , Quality of life Introduction Spondyloarthritis (SpA) encompasses a group of interrelated infl ammatory disorders characterized by infl ammation of the axial skeleton, enthesitis, peripheral arthritis that is usually asymmet- ric and aff ects the lower limbs, typical extra-articular manifesta- tions, and shared genetic markers [1 – 3]. Pain and stiff ness have been widely recognized as important primary symptoms of SpA, whereas fatigue has been considered a core symptom that signifi - cantly aff ects patients in the last two decades [4 – 7]. Fatigue is a common symptom frequently reported by ill people as well as in the general population. Given its subjective nature, it can be a diffi cult symptom to be characterized. However, it can be defi ned as a progressive impairment of muscle capacity (periph- eral or muscle fatigue) or lessened capacity for work and reduced effi ciency of accomplishment, usually accompanied by a feeling of weariness, sleepiness, or irritability. On the other hand, fatigue can be considered a subjective sensation of generalized tiredness or exhaustion [8 – 10]. Fatigue has been considered as a multifactorial and multidi- mensional phenomenon modulated by various factors: physio- logic, psychological, social, and personal factors [9,11]. In healthy M od R he um at ol D ow nl oa de d fr om in fo rm ah ea lth ca re .c om b y 20 1. 83 .4 .4 o n 06 /0 2/ 14 Fo r pe rs on al u se o nl y.