Rapid Improvement of Fatigue and Sleep in Active Rheumatoid Arthritis with Anti-TNF Therapy: A Retrospective Observational Study

Objective: Patients with rheumatoid arthritis (RA) suffer from high burdens of fatigue and poor sleep quality which persist even when joint inflammation is controlled. We aimed to retrospectively evaluate the 3-month impact of initiating anti-TNF therapy initiation on fatigue sleep quality and functional status in patients with active RA. Methods: We conducted a 3-month single-center retrospective cohort study reviewing the records of 39 patients with active RA (Disease Activity Score 28 [DAS28] > 5.1) despite stable csDMARDs. A matched group of 36 healthy controls was used for baseline comparisons. Patients had initiated adalimumab, etanercept, or infliximab. Assessments had been performed at baseline and 3 months using the DAS28 (disease activity), Health Assessment Questionnaire (HAQ), Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Inventory (BDI). 31 patients had completed the 3-month follow-up and had complete data for analysis. Results: At 3 months, patients showed significant clinical improvement. Mean DAS28 decreased from 5.5 ± 1.2 to 3.3 ± 1.6 (p < 0.001) and 39% (12/31) achieved remission. Significant improvements were seen in patient-reported outcomes. The mean MFSI-SF total fatigue score decreased from 27.6 to 10.4 (p < 0.001) and the mean global PSQI score improved from 9.5 to 7.0 (p < 0.001). Functional status (HAQ) and depressive symptoms (BDI) also improved significantly (both p < 0.001). At baseline, fatigue strongly correlated with poor sleep (r=0.626), depression (r=0.674), and HAQ (r=0.656). Improvement in fatigue correlated moderately with improvement in depression (Δ-BDI r=0.571). Conclusion: Anti-TNF therapy provides rapid and significant improvements not only in clinical disease activity but also in the key patient-reported burdens of fatigue, sleep quality, and depression within three months of initiation. Keywords: rheumatoid arthritis, anti-TNF therapy, fatigue, sleep quality,