EULAR 2023 Recommendations on Fatigue Save

Fatigue is highly prevalent in inflammatory rheumatic and musculoskeletal diseases (I-RMDs) patients, is often unaddressed and yet it has significant effects on patient quality of life.

Multiple factors appear to drive and maintain fatigue, but the approach to evaluation and management is unclear.

A EULAR task force set out to develop recommendations for the management of fatigue in people with I-RMDs. The multidisciplinary taskforce included 26 members from 14 European countries who oversaw two systematic reviews and developed consensus recommendations based on the systematic review of evidence supplemented with taskforce members’ experience of fatigue in I-RMDs.

The task force set out to answer these questions:

• Which pharmacological interventions are efficacious in reducing fatigue (in a broad sense) in people with I-RMDs?
• Which non-pharmacological interventions are efficacious in reducing fatigue (in a broad sense) in people with I-RMDs?
• Which pharmacological and non-pharmacological interventions are safe in reducing fatigue in people with I-RMDs?

Their recommendations included 4 overarching principals and 4 recommendations:

Overarching principles

• Health professionals should be aware that fatigue encompasses multiple and mutually interacting biological, psychological and social factors
• In people with I-RMDs, 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 person with an I-RMD and health and well-being professionals.
• Management of fatigue should be based on the needs and preferences of people with I-RMDs, 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.