New guidelines offer hope for fatigue management in people with inflammatory RMD

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Fatigue is common in people with inflammatory rheumatic and musculoskeletal diseases (RMD). The causes of fatigue are not well understood, and likely vary between people and over time. From the patient’s perspective, fatigue has a significant and detrimental impact on daily life and addressing it is a priority.

Although our understanding of the impact of fatigue has grown in recent years, managing it is complex. We have evidence of some approaches that may help, but we have no recommendations to guide health professionals and patients. As a result, fatigue care and support is often variable and fragmented.

To address this, EULAR has drafted new recommendations for the management of fatigue in people with inflammatory RMD. The work was presented at the 2023 EULAR Congress and will be published in November 2023 History of arthritis. The work was supported by two systematic literature reviews, which explored the effectiveness of pharmacological and non-pharmacological interventions aimed at reducing the severity and impact of fatigue and helping people develop better coping strategies.

The new publication includes four overarching principles and four recommendations. The principles state that healthcare professionals should be aware that fatigue is related to a dynamic interaction of biological, psychological and social factors. People with inflammatory RMD should have their fatigue monitored and offered management options as part of their clinical care. The management method chosen should be based on a shared decision between the person with inflammatory RMD and their healthcare professional. Finally, fatigue management should be based on the needs and preferences of the individual with an inflammatory RMD. This should take into account their disease activity, their other health conditions and individual psychosocial and contextual factors.

The recommendations specifically address when fatigue should be assessed and focus on two main types of intervention: physical activity and psychoeducation – both of which have been shown to be helpful. At this point, there is limited evidence for other interventions.

EULAR hopes that these recommendations will provide a starting point for the management of fatigue in people with inflammatory RMD and encourage healthcare teams to help identify and address fatigue in their patients.


Journal Reference:

Deurs, E., etc. (2023). 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases. History of arthritis.

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