2023 EULAR Recommendations on Management of Fatigue Save

A 2023 EULAR task force has made recommendations to the approach and management of fatigue in patients with inflammatory rheumatic and musculoskeletal diseases (I-RMDs).

Fatigue is a frequent symptom in rheumatic patients, yet its origins may vary. 

The EULAR task force included 26 clinicians, academics, and methodologists that conducted two systematic reviews and a Delphi process. The net result were 4 overarching principles and four recommendations were developed. These address the fact that fatigue may have multiple biological, psychological and social factors to be addressed. Recommendations include offering tailored physical activity and/or tailored psychoeducational interventions and/or, if clinically indicated, immunomodulatory treatment initiation or change. 

The level of evidence for these recommendations were very high.

Overarching principles    

• Fatigue encompasses multiple and mutually interacting biological, psychological and social factors.
• Fatigue should be monitored, and management options should be offered as part of their clinical care.    
• Management of fatigue should be a shared decision between the patient and health care professional.    
• Management of fatigue should be based on the patients needs and preferences, as well as their clinical disease activity, comorbidities and other individual psychosocial and/or contextual factors.    

Recommendations    

1. Health professionals should incorporate regular assessment of fatigue severity, impact and coping strategies into clinical consultations.    
2. As part of their clinical care, people with I-RMDs and fatigue should be offered access to tailored physical activity interventions and encouraged to engage in long-term physical activity.  
3. As part of their clinical care, people with I-RMDs and fatigue should be offered access to structured and tailored psychoeducational interventions. 
4. The presence or worsening of fatigue should trigger evaluation of inflammatory disease activity status and consideration of immunomodulatory treatment initiation or change, if clinically indicated.