Longitudinal Dynamics of Pain, Fatigue, Anxiety-Depression, Sleep, and Functional Limitation in Older Adults with Rheumatoid Arthritis: A Cross-Lagged Panel Network Analysis
Abstract
Purpose To investigate the longitudinal dynamics of five symptoms –pain (P), fatigue (F), anxiety-depression (A), sleep disturbance (S), functional limitation (FL)- in older patients with rheumatoid arthritis (RA), to identify longitudinal predictive relationships among these symptoms, and to inform individualized symptom management. Methods A prospective longitudinal study enrolled eligible RA patients from August 2025 to February 2026. Five symptoms were assessed at hospitalization (T1) and one month after discharge (T2). Cross-sectional networks compared inpatient and outpatient symptom covariation, and Cross-Lagged Panel Network (CLPN) analysis evaluated longitudinal predictive associations and network stability. Results A total of 177 participants completed data collection. All edges in the cross-sectional networks were positive. The most central symptoms at both T1 and T2, as indicated by expected influence, were functional limitation and fatigue. CLPN analysis revealed that fatigue was the only symptom with significant longitudinal predictive effects: it positively predicted subsequent sleep disturbance (β = 0.250, 95% CI [0.038, 0.621]) and functional limitation (β = 0.045, 95% CI [0.016, 0.068]) at T2. Anxiety-depression had the highest in-expected influence (In‑EI = 0.819), indicating that it was most susceptible to being predicted by other symptoms. Network stability was satisfactory (CS coefficients > 0.6 for both Out‑EI and In‑EI). Conclusion During the transition from inpatient to outpatient care in older RA patients, fatigue emerges as the primary longitudinal predictor of subsequent sleep disturbance and functional limitation, whereas anxiety-depression exhibited the highest susceptibility to being predicted by other symptoms. These findings may inform future symptom management strategies and generate hypotheses for interventional research.