Fatigue burden and patient attribution across remission states in inflammatory bowel disease: a longitudinal cohort study.
- 1Division of Gastroenterology, Lenox Hill Hospital, New York, NY 10025, United States.
- 2Division of Gastroenterology, Northshore University Hospital, Manhasset, NY 11030, United States.
Abstract
Background and aims
Fatigue is common in inflammatory bowel disease (IBD), but prior work has largely focused on symptomatic disease activity rather than progressively objective remission states. We evaluated the relationship between fatigue and hierarchical remission depth, repeated changes in remission status, and patients' attribution of fatigue to IBD.Methods
Adults with confirmed IBD completed PROMIS Fatigue surveys at 2 tertiary-care centers. PROMIS Fatigue was analyzed continuously and as clinically significant fatigue (T-score ≥55). Remission was classified hierarchically as no remission, physician-global-assessment (PGA)-defined clinical remission, endoscopic remission, or histologic remission. Visit-level repeated measures were analyzed using a linear mixed-effects model. First-visit logistic regression evaluated clinically significant fatigue after adjustment for anxiety, depression, anemia, and IBD subtype; corticosteroid exposure was added in a sensitivity model. Attribution analyses included only explicit Yes or No responses.Results
We surveyed 481 patients, contributing 900 surveys. PGA-defined clinical, endoscopic, and histologic remission remained associated with lower mean PROMIS Fatigue T-scores than no remission (adjusted differences -3.68, -3.45, and -3.27 points; all P ≤ .001). No remission remained associated with clinically significant fatigue after adjustment for anxiety, depression, anemia, IBD subtype (OR 2.75, 95% CI, 1.83-4.14), and for corticosteroid exposure (OR 2.34, 95% CI, 1.52-3.58). Attribution of fatigue to IBD differed by remission status (P < .000000001). Findings remained significant when objective remission was restricted to colonoscopy within 180 days of PROMIS completion (adjusted OR 2.23, 95% CI, 1.42-3.49).Conclusion
Remission was associated with lower fatigue burden, and patients in objective remission were less likely to attribute fatigue to IBD. These observational findings support assessing inflammatory disease control early in the evaluation of fatigue while also evaluating sleep, mood, anemia, pain, medications, and other non-inflammatory contributors.
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BibTeX
@article{swaminath2026fatigue,
title = {{Fatigue burden and patient attribution across remission states in inflammatory bowel disease: a longitudinal cohort study.}},
author = {Arun Swaminath and Jakob Saidman and Jeremy Polman and Laura Durbin and Rachel Maggi and Troy Laurence and Keith Sultan},
journal = {Crohn's \& colitis 360},
year = {2026},
month = sep,
doi = {10.1093/crocol/otag109},
url = {https://europepmc.org/article/MED/42856496},
note = {CC BY},
}
RIS
TY - JOUR
TI - Fatigue burden and patient attribution across remission states in inflammatory bowel disease: a longitudinal cohort study.
AU - Arun Swaminath
AU - Jakob Saidman
AU - Jeremy Polman
AU - Laura Durbin
AU - Rachel Maggi
AU - Troy Laurence
AU - Keith Sultan
PY - 2026
DA - 2026/09/24
JO - Crohn's & colitis 360
DO - 10.1093/crocol/otag109
UR - https://europepmc.org/article/MED/42856496
AB - Background and aims Fatigue is common in inflammatory bowel disease (IBD), but prior work has largely focused on symptomatic disease activity rather than progressively objective remission states. We evaluated the relationship between fatigue and hierarchical remission depth, repeated changes in remission status, and patients' attribution of fatigue to IBD.Methods Adults with confirmed IBD completed PROMIS Fatigue surveys at 2 tertiary-care centers. PROMIS Fatigue was analyzed continuously and as clinically significant fatigue (T-score ≥55). Remission was classified hierarchically as no remission, physician-global-assessment (PGA)-defined clinical remission, endoscopic remission, or histologic remission. Visit-level repeated measures were analyzed using a linear mixed-effects model. First-visit logistic regression evaluated clinically significant fatigue after adjustment for anxiety, depression, anemia, and IBD subtype; corticosteroid exposure was added in a sensitivity model. Attribution analyses included only explicit Yes or No responses.Results We surveyed 481 patients, contributing 900 surveys. PGA-defined clinical, endoscopic, and histologic remission remained associated with lower mean PROMIS Fatigue T-scores than no remission (adjusted differences -3.68, -3.45, and -3.27 points; all P ≤ .001). No remission remained associated with clinically significant fatigue after adjustment for anxiety, depression, anemia, IBD subtype (OR 2.75, 95% CI, 1.83-4.14), and for corticosteroid exposure (OR 2.34, 95% CI, 1.52-3.58). Attribution of fatigue to IBD differed by remission status (P < .000000001). Findings remained significant when objective remission was restricted to colonoscopy within 180 days of PROMIS completion (adjusted OR 2.23, 95% CI, 1.42-3.49).Conclusion Remission was associated with lower fatigue burden, and patients in objective remission were less likely to attribute fatigue to IBD. These observational findings support assessing inflammatory disease control early in the evaluation of fatigue while also evaluating sleep, mood, anemia, pain, medications, and other non-inflammatory contributors.
SN - 2631-827X
ER -