Fatigue during hospitalization was the clearest early warning signal for later problems in a study of older adults with rheumatoid arthritis. Patients with higher fatigue scores in hospital tended to report worse sleep and slightly greater functional limitation one month after discharge.
The study included 177 adults aged 55 and older treated in the rheumatology department of Beijing Hospital. The average age was 67.5, 79% of participants were women, and rheumatoid arthritis had been present for an average of 77 months. Of 195 people enrolled, 177 completed both assessments.
What the researchers found
Participants were assessed face to face during hospitalization and again by telephone one month after discharge. Researchers tracked five symptoms: joint pain, fatigue, anxiety-depression, sleep disturbance and functional limitation.
Fatigue was reported by 70.1% of participants during hospitalization and 63.3% one month later. Sleep disturbance was reported by 66.1% in hospital and 68.9% at follow-up. Average sleep disturbance scores also rose slightly, from 7.31 to 7.84 on the Pittsburgh Sleep Quality Index, which ranges from 0 to 21.
In the study’s time-based statistical analysis, higher fatigue predicted worse later sleep scores. The reported edge weight was 0.250, with a 95% confidence interval from 0.038 to 0.621. Fatigue also predicted slightly greater functional limitation, with an edge weight of 0.045 and a 95% confidence interval from 0.016 to 0.068. Both links remained after correction for multiple testing.
After adjustment for age, sex, marital status, disease duration, family history and joint function, fatigue still predicted later sleep and functional limitation. The adjusted estimates were 0.209 for sleep and 0.044 for functional limitation.
These estimates should not be compared directly: sleep was scored from 0 to 21, while functional limitation was scored from 0 to 3.
Most symptoms followed their own earlier pattern
Fatigue was the only one of the five tracked symptoms that statistically predicted other symptoms over time. Pain, sleep, functional limitation and anxiety-depression mainly reflected their own earlier levels.
Every symptom predicted its own later level. The strongest of these within-symptom links were seen for sleep disturbance, functional limitation and fatigue.
Combined anxiety-depression had the highest incoming expected influence in the network, but no individual link into that combined measure was statistically significant. Because anxiety and depression were analyzed together, the study cannot show whether the two experiences follow different patterns.
Why the finding matters—and what it does not show
The results suggest that fatigue may be a useful part of the broader symptom picture after hospitalization for rheumatoid arthritis. However, this was an observational study with only two time points. A statistical prediction from an earlier measurement does not establish that fatigue caused later sleep problems or functional limitation.
The analysis did not include disease activity, inflammation levels or medication changes. Those factors, along with others not measured, could help explain the pattern. The one-month follow-up may also miss slower changes, particularly in mood.
Earlier research cited in the study provides broader context rather than proof of causation. A 2019 systematic review reported correlations of at least 0.50 between rheumatoid arthritis fatigue and physical disability, poor mental well-being, pain, sleep disturbance, depression and anxiety. A separate 12-month observational study of 100 people found that 83% reported fatigue and 60% still had fatigue after one year; baseline pain was the only independent predictor of persistent fatigue reported in that source.
Whether addressing fatigue improves sleep or daily function remains unanswered here. Participants did not receive a fatigue treatment as part of this study.
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