Severe Fatigue Predicts Worsening Disability in Patients With MS

Researchers investigated a link between fatigue and disease worsening in patients with multiple sclerosis.

Severe fatigue can predict worsening of disability in patients with multiple sclerosis (MS), according to study results reported in Multiple Sclerosis Journal.

Study investigators retrospectively analyzed patients with MS from the New York State Multiple Sclerosis Consortium who had reported moderate to severe fatigue (n=2714). Participants were frequency matched according to age, baseline Kurtzke Expanded Disability Status Scale (EDSS), disease duration, and MS phenotype with less-fatigued patients with MS (n=2714). Using baseline and follow-up patient-reported outcomes, investigators categorized patients as individuals with either stable/improved outcomes or individuals who experienced worsened outcomes. Cox proportional hazards modeling was used to analyze the association between fatigue and sustained EDSS worsening in patients with available longitudinal data (n=1951).

In the comparison of participants with severe fatigue vs less fatigue, participants with severe fatigue were more likely to have pain when getting up, climbing stairs, and standing (all P <.001). Fatigue at baseline was also associated with a greater likelihood of patients reporting sustained EDSS worsening during the follow-up period (hazard ratio 1.4; 95% CI, 1.2-1.7). In addition, the likelihood for worsening psychosocial limitations from baseline to follow-up was higher in patients who reported fatigue at baseline.

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Limitations of the study included its inability to adjust for smoking status and the self-reported assessment of fatigue and its associated outcomes.

According to the researchers, the findings from this study “suggest identification of substantial fatigue in [persons with MS] merits concern about more rapid disability worsening and should result in consideration for more effective therapies.”


Vaughn CB, Kavak KS, Dwyer MG, et al. Fatigue at enrollment predicts EDSS worsening in the New York State Multiple Sclerosis Consortium [published online December 3, 2018]. Mult Scler. doi:10.1177/1352458518816619