Skip to main content
Top
Published in: Health and Quality of Life Outcomes 1/2015

Open Access 01-12-2015 | Research

Fatigue in Egyptian patients with rheumatic diseases: a qualitative study

Authors: Mohamed Mortada, Amal Abdul-Sattar, Laure Gossec

Published in: Health and Quality of Life Outcomes | Issue 1/2015

Login to get access

Abstract

Objectives

Fatigue is frequent in rheumatic diseases. Fatigue expression and consequences may be modified by cultural differences. Our objective was to increase the understanding of the fatigue experience and characteristics among Egyptian, Muslim patients with rheumatic diseases.

Methods

Prospective monocentric qualitative study based on conventional qualitative content analysis, inductive reasoning, grounded theory. Egyptian patients with rheumatoid arthritis (RA), fibromyalgia or axial spondyloarthritis (AxSpA) were asked about fatigue, its patterns, consequences and self-management.

Results

Of the 60 patients interviewed, 20 patients had each disease (RA, fibromyalgia and AxSpA); median ages ranged from 34 to 40 years. Patients were mainly male (N = 40, 66 %), had 3 to 7 years (mean) of disease duration and had moderate disease activity. Some aspects of the patients’ experience of fatigue may be specific to the Egyptian and Muslim culture such as the description of fatigue as a physical more than a mental impact of the disease, the response to the effect of fatigue on sexual function and the gender specific (women more than men) limitation of social activities due to fatigue which was more obvious in our study than other previous studies. Other aspects of patients’ experience of fatigue like overlap between the patients’ perception of fatigue and pain and coping strategies were similar to the findings in previous studies.

Conclusion

This study gives insights regarding fatigue in rheumatic diseases in an Arabic and Muslim culture. Similarities and differences with previous studies were noted and should be taken into account when assessing these patients.
Literature
1.
go back to reference Wolfe F, Hawley DJ, Wilson K. The prevalence and meaning of fatigue in rheumatic disease. J Rheumatol. 1996;23:1407–17.PubMed Wolfe F, Hawley DJ, Wilson K. The prevalence and meaning of fatigue in rheumatic disease. J Rheumatol. 1996;23:1407–17.PubMed
2.
go back to reference Lisitsyna TA, Veltishchev DY, Gerasimov AN, Seravina OF, Kovalevskaya OB, Zeltyn AE, et al. The magnitude of fatigue and its association with depression, pain, and inflammatory activity in rheumatoid arthritis. Ter Arkh. 2013;85:8–15.PubMed Lisitsyna TA, Veltishchev DY, Gerasimov AN, Seravina OF, Kovalevskaya OB, Zeltyn AE, et al. The magnitude of fatigue and its association with depression, pain, and inflammatory activity in rheumatoid arthritis. Ter Arkh. 2013;85:8–15.PubMed
3.
go back to reference IbnYacoub Y, Amine B, Laatiris A, Abouqal R, Hajjaj-Hassouni N. Assessment of fatigue in Moroccan patients with ankylosing spondylitis. Clin Rheumatol. 2010;29:1295–9.CrossRef IbnYacoub Y, Amine B, Laatiris A, Abouqal R, Hajjaj-Hassouni N. Assessment of fatigue in Moroccan patients with ankylosing spondylitis. Clin Rheumatol. 2010;29:1295–9.CrossRef
4.
go back to reference Haywood KL, Packham JC, Jordan KP. Assessing fatigue in ankylosing spondylitis: the importance of frequency and severity. Rheumatology (Oxford). 2014;53:552–6.CrossRef Haywood KL, Packham JC, Jordan KP. Assessing fatigue in ankylosing spondylitis: the importance of frequency and severity. Rheumatology (Oxford). 2014;53:552–6.CrossRef
5.
go back to reference Pollard LC, Choy EH, Gonzalez J, Khoshaba B, Scott DL. Fatigue in rheumatoid arthritis reflects pain, not disease activity. Rheumatology (Oxford). 2006;45:885–9.CrossRef Pollard LC, Choy EH, Gonzalez J, Khoshaba B, Scott DL. Fatigue in rheumatoid arthritis reflects pain, not disease activity. Rheumatology (Oxford). 2006;45:885–9.CrossRef
6.
go back to reference Crawford BK, Piault EC, Lai C, Bennett RM. Assessing fibromyalgia-related fatigue: content validity and psychometric performance of the Fatigue Visual Analog Scale in adult patients with fibromyalgia. Clin Exp Rheumatol. 2011;15:S34–43. Crawford BK, Piault EC, Lai C, Bennett RM. Assessing fibromyalgia-related fatigue: content validity and psychometric performance of the Fatigue Visual Analog Scale in adult patients with fibromyalgia. Clin Exp Rheumatol. 2011;15:S34–43.
7.
go back to reference Vincent A, Benzo RP, Whipple MO, McAllister SJ, Erwin PJ, Saligan LN. Beyond pain in fibromyalgia: insights into the symptom of fatigue. Arthritis Res Ther. 2013;15:221.PubMedCentralCrossRefPubMed Vincent A, Benzo RP, Whipple MO, McAllister SJ, Erwin PJ, Saligan LN. Beyond pain in fibromyalgia: insights into the symptom of fatigue. Arthritis Res Ther. 2013;15:221.PubMedCentralCrossRefPubMed
8.
go back to reference Huyser BA, Parker JC, Thoreson R, Smarr KL, Johnson JC, Hoffman R. Predictors of subjective fatigue among individuals with rheumatoid arthritis. Arthritis Rheum. 1998;41:2230–7.CrossRefPubMed Huyser BA, Parker JC, Thoreson R, Smarr KL, Johnson JC, Hoffman R. Predictors of subjective fatigue among individuals with rheumatoid arthritis. Arthritis Rheum. 1998;41:2230–7.CrossRefPubMed
9.
go back to reference Calin A, Edmunds L, Kennedy L. Fatigue in ankylosing spondylitis: Why is it ignored? J Rheumatol. 1993;20:991–5.PubMed Calin A, Edmunds L, Kennedy L. Fatigue in ankylosing spondylitis: Why is it ignored? J Rheumatol. 1993;20:991–5.PubMed
10.
go back to reference Missaoui B, Revel M. Fatigue in ankylosing spondylitis. Ann Readapt Med Phys. 2006;49:305–8. 389–91.CrossRefPubMed Missaoui B, Revel M. Fatigue in ankylosing spondylitis. Ann Readapt Med Phys. 2006;49:305–8. 389–91.CrossRefPubMed
11.
go back to reference Hewlett S, Cockshott Z, Byron M, Kitchen K, Tipler S, Pope D, et al. Patients’ perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored. Arthritis Rheum. 2005;53:697–702.CrossRefPubMed Hewlett S, Cockshott Z, Byron M, Kitchen K, Tipler S, Pope D, et al. Patients’ perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored. Arthritis Rheum. 2005;53:697–702.CrossRefPubMed
12.
go back to reference Chafia D. Evolution of fatigue in rheumatoid arthritis treated with rituximab. Ann Rheum Dis. 2014;2:73. Chafia D. Evolution of fatigue in rheumatoid arthritis treated with rituximab. Ann Rheum Dis. 2014;2:73.
13.
go back to reference Corominas H, Alegre de Miguel C, Rodríguez-Gomez M, Marras Fernandez-Cid C, Maceiras-Pan F, On behalf of the ACT-AXIS Study Group. ACT-AXIS STUDY: Impact of ROACTEMRA® (TOCILIZUMAB) on fatigue and related factors in patients with rheumatoid arthritis in daily clinical practice in Spain. Ann Rheum Dis. 2014;2:73. Corominas H, Alegre de Miguel C, Rodríguez-Gomez M, Marras Fernandez-Cid C, Maceiras-Pan F, On behalf of the ACT-AXIS Study Group. ACT-AXIS STUDY: Impact of ROACTEMRA® (TOCILIZUMAB) on fatigue and related factors in patients with rheumatoid arthritis in daily clinical practice in Spain. Ann Rheum Dis. 2014;2:73.
14.
go back to reference Gossec L, Berenbaum F, Chauvin P, Lamiraud K, Russo-Marie F, Joubert J, et al. Reporting of patient-perceived impact of rheumatoid arthritis and axial spondyloarthritis over 10 years: a systematic literature review. Rheumatology (Oxford). 2014;53:1274–81.CrossRef Gossec L, Berenbaum F, Chauvin P, Lamiraud K, Russo-Marie F, Joubert J, et al. Reporting of patient-perceived impact of rheumatoid arthritis and axial spondyloarthritis over 10 years: a systematic literature review. Rheumatology (Oxford). 2014;53:1274–81.CrossRef
15.
go back to reference Dernis-Labous E, Messow M, Dougados M. Assessment of fatigue in the management of patients with ankylosing spondylitis. Rheumatology (Oxford). 2003;42:1523–8.CrossRef Dernis-Labous E, Messow M, Dougados M. Assessment of fatigue in the management of patients with ankylosing spondylitis. Rheumatology (Oxford). 2003;42:1523–8.CrossRef
16.
go back to reference Hewlett S, Dures E, Almeida C. Measures of fatigue: Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF MDQ), Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scales (BRAF NRS) for severity, effect, and coping, Chalder Fatigue Questionnaire (CFQ), Checklist Individual Strength (CIS20R and CIS8R), Fatigue Severity Scale (FSS), Functional Assessment Chronic Illness Therapy (Fatigue) (FACIT-F), Multi-Dimensional Assessment of Fatigue (MAF), Multi-Dimensional Fatigue Inventory (MFI), Pediatric Quality Of Life (PedsQL) Multi-Dimensional Fatigue Scale, Profile of Fatigue (ProF), Short Form 36 Vitality Subscale (SF-36 VT), and Visual Analog Scales (VAS). Arthritis Care Res (Hoboken). 2011;63:263–86.CrossRef Hewlett S, Dures E, Almeida C. Measures of fatigue: Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF MDQ), Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scales (BRAF NRS) for severity, effect, and coping, Chalder Fatigue Questionnaire (CFQ), Checklist Individual Strength (CIS20R and CIS8R), Fatigue Severity Scale (FSS), Functional Assessment Chronic Illness Therapy (Fatigue) (FACIT-F), Multi-Dimensional Assessment of Fatigue (MAF), Multi-Dimensional Fatigue Inventory (MFI), Pediatric Quality Of Life (PedsQL) Multi-Dimensional Fatigue Scale, Profile of Fatigue (ProF), Short Form 36 Vitality Subscale (SF-36 VT), and Visual Analog Scales (VAS). Arthritis Care Res (Hoboken). 2011;63:263–86.CrossRef
17.
go back to reference Garip Y, Eser F, Aktekin LA, Bodur H. Fatigue in rheumatoid arthritis: association with severity of pain, disease activity and functional status. Acta Reumatol Port. 2011;36:364–9.PubMed Garip Y, Eser F, Aktekin LA, Bodur H. Fatigue in rheumatoid arthritis: association with severity of pain, disease activity and functional status. Acta Reumatol Port. 2011;36:364–9.PubMed
18.
go back to reference Ulus Y, Akyol Y, Tander B, Durmus D, Bilgici A, Kuru O. Sleep quality in fibromyalgia and rheumatoid arthritis: associations with pain, fatigue, depression, and disease activity. Clin Exp Rheumatol. 2011;29 Suppl 69:S92–6.PubMed Ulus Y, Akyol Y, Tander B, Durmus D, Bilgici A, Kuru O. Sleep quality in fibromyalgia and rheumatoid arthritis: associations with pain, fatigue, depression, and disease activity. Clin Exp Rheumatol. 2011;29 Suppl 69:S92–6.PubMed
19.
go back to reference Inanc N, Yilmaz-Oner S, Can M, Sokka T, Direskeneli H. The role of depression, anxiety, fatigue, and fibromyalgia on the evaluation of the remission status in patients with rheumatoid arthritis. J Rheumatol. 2014;41:1755–60.CrossRefPubMed Inanc N, Yilmaz-Oner S, Can M, Sokka T, Direskeneli H. The role of depression, anxiety, fatigue, and fibromyalgia on the evaluation of the remission status in patients with rheumatoid arthritis. J Rheumatol. 2014;41:1755–60.CrossRefPubMed
20.
go back to reference Carr A, Hewlett S, Hughes R, Mitchell H, Ryan S, Carr M, et al. Rheumatology outcomes: the patient’s perspective. J Rheumatol. 2003;30:880–3.PubMed Carr A, Hewlett S, Hughes R, Mitchell H, Ryan S, Carr M, et al. Rheumatology outcomes: the patient’s perspective. J Rheumatol. 2003;30:880–3.PubMed
21.
go back to reference Niu NN, Collins JE, Thornhill TS, Alcantara Abreu L, Ghazinouri R, Okike K, et al. Pre-operative status and quality of life following total joint replacement in a developing country: a prospective pilot study. Open Ortho J. 2011;14:307–14.CrossRef Niu NN, Collins JE, Thornhill TS, Alcantara Abreu L, Ghazinouri R, Okike K, et al. Pre-operative status and quality of life following total joint replacement in a developing country: a prospective pilot study. Open Ortho J. 2011;14:307–14.CrossRef
22.
go back to reference Kumar K, Gordon C, Barry R, Shaw K, Horne R, Raza K. ‘It’s like taking poison to kill poison but I have to get better’: a qualitative study of beliefs about medicines in RA and SLE patients of South Asian origin. Lupus. 2011;20:837–44.CrossRefPubMed Kumar K, Gordon C, Barry R, Shaw K, Horne R, Raza K. ‘It’s like taking poison to kill poison but I have to get better’: a qualitative study of beliefs about medicines in RA and SLE patients of South Asian origin. Lupus. 2011;20:837–44.CrossRefPubMed
23.
go back to reference Kumar K, Gordon C, Toescu V, et al. Beliefs about medicines in patients with RA and SLE: a comparison between patients of South Asian and White British origin. Rheumatology. 2008;47:690–7.CrossRefPubMed Kumar K, Gordon C, Toescu V, et al. Beliefs about medicines in patients with RA and SLE: a comparison between patients of South Asian and White British origin. Rheumatology. 2008;47:690–7.CrossRefPubMed
24.
go back to reference Repping-Wuts H, Uitterhoeve R, van Riel P, vanAchterberg T. Fatigue as experienced by patients with rheumatoid arthritis (RA): a qualitative study. Int J Nurs Stud. 2008;45:995–1002.CrossRefPubMed Repping-Wuts H, Uitterhoeve R, van Riel P, vanAchterberg T. Fatigue as experienced by patients with rheumatoid arthritis (RA): a qualitative study. Int J Nurs Stud. 2008;45:995–1002.CrossRefPubMed
25.
go back to reference Hifinger M, Putrik P, Ramiro S, Keszei AP Hmamouchi I, Dougados M, Gossec L, et al. In addition to individual demographic and clinical measures, levels of fatigue are dependent on country of residence. An analysis among 3920 patients from 17 countries (the COMORA study). Ann Rheum Dis Suppl. 2014;Suppl 2:73. Hifinger M, Putrik P, Ramiro S, Keszei AP Hmamouchi I, Dougados M, Gossec L, et al. In addition to individual demographic and clinical measures, levels of fatigue are dependent on country of residence. An analysis among 3920 patients from 17 countries (the COMORA study). Ann Rheum Dis Suppl. 2014;Suppl 2:73.
26.
go back to reference Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham 3rd CO, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69:1580–8.CrossRefPubMed Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham 3rd CO, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69:1580–8.CrossRefPubMed
27.
go back to reference Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010;62:600–10.CrossRef Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010;62:600–10.CrossRef
28.
go back to reference Rudwaleit M, van der Heijde D, Landewe’ R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68:777–83.CrossRefPubMed Rudwaleit M, van der Heijde D, Landewe’ R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68:777–83.CrossRefPubMed
29.
go back to reference Douglas D. Grounded theories of management: A methodological review. Manage Res News. 2003;26:44–60.CrossRef Douglas D. Grounded theories of management: A methodological review. Manage Res News. 2003;26:44–60.CrossRef
30.
go back to reference Gossec L, Paternotte S, Aanerud GJ, Balanescu A, Boumpas DT, Carmona L, et al. Finalisation and validation of the rheumatoid arthritis impact of disease score, a patient-derived composite measure of impact of rheumatoid arthritis: a EULAR initiative. Ann Rheum Dis. 2011;70:935–42.CrossRefPubMed Gossec L, Paternotte S, Aanerud GJ, Balanescu A, Boumpas DT, Carmona L, et al. Finalisation and validation of the rheumatoid arthritis impact of disease score, a patient-derived composite measure of impact of rheumatoid arthritis: a EULAR initiative. Ann Rheum Dis. 2011;70:935–42.CrossRefPubMed
31.
go back to reference Prevoo ML, van‘t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38:44–8.CrossRefPubMed Prevoo ML, van‘t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38:44–8.CrossRefPubMed
32.
go back to reference Calin A, Nakache JP, Gueguen A, Zeidler H, Mielants H, Dougados M. Defining disease activity in ankylosing spondylitis: Is a combination of variables (Bath Ankylosing Spondylitis Index) an appropriate instrument? Rheumatology. 1999;38:878–82.CrossRefPubMed Calin A, Nakache JP, Gueguen A, Zeidler H, Mielants H, Dougados M. Defining disease activity in ankylosing spondylitis: Is a combination of variables (Bath Ankylosing Spondylitis Index) an appropriate instrument? Rheumatology. 1999;38:878–82.CrossRefPubMed
33.
go back to reference Burckhardt CS, Clark SR, Bennett RM. The Fibromyalgia Impact Questionnaire (FIQ): development and validation. J Rheumatol. 1991;18:728.PubMed Burckhardt CS, Clark SR, Bennett RM. The Fibromyalgia Impact Questionnaire (FIQ): development and validation. J Rheumatol. 1991;18:728.PubMed
34.
go back to reference Minichiello V, Aroni R, Timewell E, Alexander L. In-depth interviewing: principles, techniques, analysis. Melbourne, Australia: Longman; 1995. Minichiello V, Aroni R, Timewell E, Alexander L. In-depth interviewing: principles, techniques, analysis. Melbourne, Australia: Longman; 1995.
35.
go back to reference Jacelon CS, O’Dell KK. Case and grounded theory as qualitative research methods. Urol Nurs. 2005;25:49–52.PubMed Jacelon CS, O’Dell KK. Case and grounded theory as qualitative research methods. Urol Nurs. 2005;25:49–52.PubMed
36.
go back to reference Crabtree B, Miller W. Doing Qualitative Research. SAGE. 1999;406. Crabtree B, Miller W. Doing Qualitative Research. SAGE. 1999;406.
37.
go back to reference Naegeli AN, Flood E, Tucker J, Devlen J, Edson-Heredia E. The patient experience with fatigue and content validity of a measure to assess fatigue severity: qualitative research in patients with ankylosing spondylitis (AS). Health Qual Life Outcomes. 2013;11:192.PubMedCentralCrossRefPubMed Naegeli AN, Flood E, Tucker J, Devlen J, Edson-Heredia E. The patient experience with fatigue and content validity of a measure to assess fatigue severity: qualitative research in patients with ankylosing spondylitis (AS). Health Qual Life Outcomes. 2013;11:192.PubMedCentralCrossRefPubMed
38.
go back to reference Power JD, Badley EM, French MR, Wall AJ, Hawker GA. Fatigue in osteoarthritis: a qualitative study. BMC Musculoskelet Disord. 2008;13:63.CrossRef Power JD, Badley EM, French MR, Wall AJ, Hawker GA. Fatigue in osteoarthritis: a qualitative study. BMC Musculoskelet Disord. 2008;13:63.CrossRef
39.
go back to reference Ryan S, Hill J, Thwaites C, Dawes P. Assessing the effect of fibromyalgia on patients’ sexual activity. Nurs Stand. 2008;23:35–41.CrossRefPubMed Ryan S, Hill J, Thwaites C, Dawes P. Assessing the effect of fibromyalgia on patients’ sexual activity. Nurs Stand. 2008;23:35–41.CrossRefPubMed
40.
go back to reference El Miedany Y, El Gaafary M, El Aroussy N, Youssef S, Ahmed I. Sexual dysfunction in rheumatoid arthritis patients: Arthritis and beyond. Clin Rheumatol. 2012;31:601–6.CrossRefPubMed El Miedany Y, El Gaafary M, El Aroussy N, Youssef S, Ahmed I. Sexual dysfunction in rheumatoid arthritis patients: Arthritis and beyond. Clin Rheumatol. 2012;31:601–6.CrossRefPubMed
41.
go back to reference Gallinaro AL, Akagawa LL, Otuzi MH, Sampaio-Barros PD, Gonçalves CR. Sexual activity in ankylosing spondylitis. Rev Bras Reumatol. 2012;52:887–91.CrossRefPubMed Gallinaro AL, Akagawa LL, Otuzi MH, Sampaio-Barros PD, Gonçalves CR. Sexual activity in ankylosing spondylitis. Rev Bras Reumatol. 2012;52:887–91.CrossRefPubMed
42.
go back to reference Brophy S, Calin A. Definition of disease flare in ankylosing spondylitis: The patients’ perspective. J Rheumatol. 2002;29:954–8.PubMed Brophy S, Calin A. Definition of disease flare in ankylosing spondylitis: The patients’ perspective. J Rheumatol. 2002;29:954–8.PubMed
43.
go back to reference Humphrey L, Arbuckle R, Mease P, Williams DA, Samsoe BD, Gilbert C. Fatigue in fibromyalgia: a conceptual model informed by patient interviews. BMC Musculoskelet Disord. 2010;11:216.PubMedCentralCrossRefPubMed Humphrey L, Arbuckle R, Mease P, Williams DA, Samsoe BD, Gilbert C. Fatigue in fibromyalgia: a conceptual model informed by patient interviews. BMC Musculoskelet Disord. 2010;11:216.PubMedCentralCrossRefPubMed
44.
go back to reference Davies H, Brophy S, Dennis M, Cooky R, Irvine E, Siebert S. Patient perspectives of managing fatigue in Ankylosing Spondylitis, and views on potential interventions: a qualitative study. BMC Musculoskelet Disord. 2013;14:163.PubMedCentralCrossRefPubMed Davies H, Brophy S, Dennis M, Cooky R, Irvine E, Siebert S. Patient perspectives of managing fatigue in Ankylosing Spondylitis, and views on potential interventions: a qualitative study. BMC Musculoskelet Disord. 2013;14:163.PubMedCentralCrossRefPubMed
45.
go back to reference Arnold LM, Crofford LJ, Mease PJ, Burgess SM, Palmer SC, Abetz L, et al. Patient perspectives on the impact of fibromyalgia. Patient Educ Couns. 2008;73:114–20.PubMedCentralCrossRefPubMed Arnold LM, Crofford LJ, Mease PJ, Burgess SM, Palmer SC, Abetz L, et al. Patient perspectives on the impact of fibromyalgia. Patient Educ Couns. 2008;73:114–20.PubMedCentralCrossRefPubMed
46.
go back to reference Mengshoel AM. Living with a fluctuating illness of ankylosing spondylitis: a qualitative study. Arthritis Rheum. 2008;15;59:1439–44.CrossRef Mengshoel AM. Living with a fluctuating illness of ankylosing spondylitis: a qualitative study. Arthritis Rheum. 2008;15;59:1439–44.CrossRef
47.
go back to reference Okasha T, Elkholy H, El-Ghamry R. Overview of the family structure in Egypt and its relation to psychiatry. Int Rev Psychiatry. 2012;24:162–5.CrossRefPubMed Okasha T, Elkholy H, El-Ghamry R. Overview of the family structure in Egypt and its relation to psychiatry. Int Rev Psychiatry. 2012;24:162–5.CrossRefPubMed
48.
go back to reference Farren W, Goodacre L, Stigant M. Fatigue in ankylosing spondylitis: causes, consequences and self-management. Musculoskeletal care. 2013;11:39–50.CrossRefPubMed Farren W, Goodacre L, Stigant M. Fatigue in ankylosing spondylitis: causes, consequences and self-management. Musculoskeletal care. 2013;11:39–50.CrossRefPubMed
Metadata
Title
Fatigue in Egyptian patients with rheumatic diseases: a qualitative study
Authors
Mohamed Mortada
Amal Abdul-Sattar
Laure Gossec
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2015
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-015-0304-7

Other articles of this Issue 1/2015

Health and Quality of Life Outcomes 1/2015 Go to the issue