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PROMIS Fatigue short forms are reliable and valid in adults with rheumatoid arthritis


Bingham Iii CO1, Gutierrez AK2, Butanis A2, Bykerk VP3, Curtis JR4, Leong A5, Lyddiatt A6, Nowell WB7, Orbai AM2, Bartlett SJ2,8. J Patient Rep Outcomes. 2019 Feb 21;3(1):14. doi: 10.1186/s41687-019-0105-6.

Author Information

1 Johns Hopkins Medicine, Division of Rheumatology, Mason F Lord Center Tower, 5200 Eastern Ave #434A, Baltimore, MD, 21224, USA. cbingha2@jhmi.edu.

2 Johns Hopkins Medicine, Division of Rheumatology, Mason F Lord Tower, 5200 Eastern Avenue, Rm 4100, Baltimore, MD, 21224, USA.

3 Hospital for Special Surgery, Weill Cornell Medical College, 525 East 71st St, 7th floor, New York, NY, 10021, USA.

4 Division of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.

5 Healthy Motivation, Santa Barbara, CA, USA.

6 Patient Partners, Ingersoll, ON, Canada.

7 Global Healthy Living Foundation, Upper Nyack, NY, USA.

8 Center for Health Outcomes Research, McGill University, 5252 de Maisonneuve West, #3D-57, Montreal, QC, H4A 3S5, Canada.



Fatigue is prevalent and impactful in rheumatoid arthritis (RA). There is no standardized measure for its assessment nor data concerning the performance of PROMIS-Fatigue short forms (SFs) in people with RA. We evaluated the construct validity of 4-, 7-, and 8-item PROMIS-Fatigue SFs in RA patients across the range of disease activity.


Adult RA patients were recruited from an online patient community and an observational cohort from three academic medical centers. Measures included PROMIS-Fatigue SFs, other PROMIS measures, and other patient reported outcomes including RAND-36 Vitality, Fatigue NRS, and patient global assessment of disease activity. Other measures from the observational cohort included 28-joint swollen and tender joints, physician global assessment, and the composite RA clinical disease activity index (CDAI).


Two-hundred online participants and 348 participants from the observational cohort were included. PROMIS Fatigue SF scores spanned the measurement continuum and correlated highly with each other (r's ≥ 0.91) and other fatigue measures (r's ≥ 0.85). PROMIS-Fatigue SF scores were highly and inversely associated with Physical Function and Participation (r's - 0.77 to - 0.78), and moderately-highly and positively correlated with pain, sleep disturbance, anxiety, and depression (r's 0.60 to 0.75). PROMIS-Fatigue SF scores showed dose-response relationships across fatigue severity descriptors and CDAI categories.


These results provide robust evidence supporting the construct validity of the 4, 7, and 8-item PROMIS-Fatigue SFs. They capture fatigue across the spectrum of RA disease activity in diverse groups of individuals and should be considered for use as patient-centered assessments of disease control and treatment efficacy.