Els van de Vijver

90 Biological factors related to fatigue Disease activity All included studies observed a positive correlation between disease activity and fatigue, but the scoring systems used to discriminate active disease from disease remission differed among the papers. The team from Chicago and Texas used the Paediatric Crohn’s Disease Activity Index (PCDAI) and defined disease remission as a score < 10. They reported that children with active Crohn’s disease had significantly more symptoms of general fatigue (“feeling tired”) and sleep/rest fatigue (“feeling tired when waking up”) than children and teenagers in remission.(6) The Finnish study among 160 children and teenagers used a visual analogue scale (VAS) to measure disease activity. Children with severe IBD (VAS scores above 3) had significantly more trouble falling asleep (41% vs 22%), felt significantly more overtired (80% vs 44%) and had significantly longer sleep duration than adolescents with less active disease (VAS score below 3). In that study, the results of the self-reported questionnaires and the parent reports were very similar when the adolescents had higher VAS scores, but this was less true in the parent-adolescent pairs with mild IBD symptoms.(10, 16) Medication The research team from Chicago and Texas evaluated the association between fatigue and medication and concluded that the use of mesalamine, thiopurine or anti-TNF were not predictors of fatigue as measured with the PedsQL Fatigue Scale.(6) Psychobehavioral factors related to IBD Family support A group from Detroit found a significant association between fatigue and dysfunction in the family.(14) The researchers used the McMaster Family Assessment Device (18). They also evaluated two additional items created by the authors themselves, which assessed the frequency of IBD-related pain and IBD-related fatigue over the past 3 months. They found that maternal positive affect, including being attentive, active, and interested, was inversely related to fatigue but the association was not significant. Fathers were not included in the study because they almost never accompanied their children to the clinic, Chapter 5 90