Introduction
Fatigue is commonly reported by Crohn's Disease patients even in the absence of disease activity.
Other possible causative factors need to be determined in order to successfully address this problem, which significantly affects patients' lives even when treatment targets have been achieved.
Sarcopenia and Depression are also common in Crohn's Disease and possibly related to fatigue.
Aims & Methods
Consecutive patients with Crohn's Disease who came to the infusion center to receive maintenance intravenous infliximab treatment were included. All participants had to be in full clinical (HBI <5), biological (C-RP < 0.5 mg/dL and/or fecal calprotectin <100 μg/mg) , endoscopic (SES-CD 0-2), or enterographic remission in the past 6 months. Anthropometric measurements (Weight, Height, Body Mass Index, Circumcenter waist, hips, gastrocnemius, Waist to Hip Ratio), Body Composition Measurements (Body Fat, Total Body Water, Body Fat Mass Index, Lean Body Mass), Physical Activity Tests (Handgrip Strength test, 6-meter Walk Test, One Leg Standing test, 30-second Chair Stand test) and Questionnaires related to Sarcopenia ( Lawton Instrumental Activities of Daily Living Scale-LIADLS, Activities Daily Living Scale-ADLS, Dixon's Diet Score-DASH, Mini Nutritional Assessment-MNA, Mediterranean Diet Serving Score MDSS, the Mind Diet Score-MDS) were conducted. We used the Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-F) to measure fatigue. We used the Hamilton Depression Rating Scale (HAM-D) to assess for depression. Linear regression analysis was used to assess the impact of sarcopenia and depression on fatigue.
Results
A total of 39 patients were included: mean age 38.6 years, mean body weight 80 Kg, median disease duration 9 years, female 22 (56,%), male 17 (44%).
We included patients with ileal disease (48%), perianal disease (28%), stomas (8%), extraintestinal manifestations (12%), on second or third biologic therapy (56%), smokers (10%).
Median C-RP was 0.13 mg/dL and median albumin was 4.5 g/dL.
Sarcopenia was almost non existent by all measures: Indicatively, Median Max Hand Grip was 25.7 (range 10.8-57.4).
Median FACIT-F was 45 (range 7-52).
Median HAM-D was 4 (range 0-25).
There was no correlation between FACIT-F and Sarcopenia (Max Hand Grip): p=0,280, β coefficient = 0,159.
There was a correlation between FACIT-F and HAM-D: p<0,001, β coefficient = -1,576.
Interestingly there was also a correlation between HAM-D and max Hand Grip: p=0,029, β coefficient = -0,804.
Conclusion
We found expectantly low (though not in all patients) estimates of sarcopenia, fatigue and depression in this selected group of Crohn's Disease patients in complete remission receiving intravenous infliximab.
Fatigue could not be attributed to sarcopenia. On the contrary depression seemed to be one of the main determinants of fatigue.
Multidisciplinary care of fatigue should include psychological evaluation and possible intervention.
Further research in the field of fatigue related to Inflammatory Bowel Disease is needed.
