Fatigue in Early Multiple Sclerosis: Severity and Progression

Presenting at CMSC 2022, researchers described the progression of fatigue in patients with multiple sclerosis.

Experiencing mild or worse fatigue in the first few years of multiple sclerosis (MS) is common and over time, fatigue will worsen for at least 50% of patients, according to study results presented at the 2022 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) held from June 1-4, in National Harbor, Maryland.

Studies with small sample sizes with brief follow-ups have commonly linked MS with fatigue and a reduced quality of life. In the current study, researchers sought to describe the progression of fatigue in people with MS.

To accomplish this, they conducted a retrospective study of semiannual update survey data from the North American Research Committee on Multiple Sclerosis Registry of 3057 participants (mean 44.5 years of age at enrollment, 42.6 years of age at diagnosis; 83.5% female; 87.5% White) between 2004 and 2019 with up to 7 years of tracking the same type of data, and relapsing MS within 5 years of their initial MS diagnosis. The Patient-Determined Disease Steps (PDDS) scale was utilized to measure disability with a median score of 2 (moderate disability) at enrollment. The Fatigue Performance Scale (FPS) was utilized to measure fatigue (0=normal; 5=total fatigue), with worsening defined by a 1 point or greater increase in score at the next measurement date.

About 25% of participants reported minimal or no fatigue as the first survey update index, and about 75% reported mild to total fatigue (23.8% mild, 24.4% moderate, 20.6% severe, and 4.0% total fatigue). As fatigue levels increased so did mean age at index and at diagnosis (P <.001 for both). For the majority of participants at each level of FPS except for severe, fatigue worsened (no fatigue, 69.7%; minimal, 71.4%; mild, 60.9%; moderate, 57.4%; severe, 20.6%). Over all levels of fatigue, time to worsening fluctuated from 3.2 to 5.4 years. Among participants with minimal or mild index level fatigue, PDDS scale progression than no worsening was reported by a greater proportion with fatigue worsening (minimal: 73.3% vs 47.9%; mild: 75.2% vs 51.1%; P <.01).

Researchers concluded that, “Most participants with MS early in their disease experienced at least mild fatigue, and at least half reported worsening fatigue over time.”

Additional investigation into the relationship between worsening fatigue and disability progression is warranted, the researchers acknowledged.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Salter A, Keenan A, Le HH, et al. Severity and progression of fatigue among individuals with multiple sclerosis. Presented at: CMSC 2022 Annual Meeting; June 1-4, 2022; National Harbor, Maryland. Abstract QOL03.