Rheumatoid arthritis fatigue research

Rheumatoid arthritis fatigue research at UWE Bristol

Fatigue is a major problem for people with rheumatoid arthritis (RA). We have conducted and published qualitative research, which shows that patients struggle to manage physical and cognitive fatigue and feel ignored by health professionals.

We have been working with patients to raise the profile of fatigue in RA. We now have international agreement that must be measured in all clinical trials. In addition, we have published a conceptual model of RA fatigue, and a randomised controlled trial of cognitive-behavioural therapy for self-management with excellent results.

We are currently conducting Cochrane reviews of fatigue interventions in RA.

Bristol Rheumatoid Arthritis Fatigue Scales

We have developed and validated the Bristol Rheumatoid Arthritis Fatigue Scales (BRAFS).

The BRAFS multi-dimensional questionnaire (MDQ), for the first time provides not only a global score but also a score for four different dimensions:

  • living with fatigue
  • physical fatigue
  • emotional fatigue
  • cognitive fatigue.

In addition, we have developed and validated a trio of single items that measure fatigue coping, severity and effect, using numerical rating scales (NRS). These scales were developed through a series of studies.

We started with qualitative interviews with RA patients to identify important concepts. Next was focus groups of patients to draft specific items, then cognitive interviews to test the language and understanding. Finally, we used a large cohort of 229 patients to test the draft scales, resulting in a robust 20 item BRAF-multi-dimensional questionnaire, and the three single item BRAF-NRS.

The BRAFS have been shown to be reliable in patients who are stable, and sensitive to change in patients receiving medication change.

The scales are available in 36 languages and free to use for academic and clinical purposes. UWE Bristol makes no warranty or representation that these scales are fit for any purpose, and all decisions regarding their use are the sole responsibility of the user. We would be grateful if you could report the use of the scales to UWE Bristol. Please email Dr Emma Dures.

Bristol Rheumatoid Arthritis Fatigue Scales


For further information, please contact MAMBO Theme Lead, Dr Emma Dures.

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