Is fatigue the new frontier in rheumatology?
Click Here to Manage Email Alerts
Fatigue is not a new problem to rheumatologists, as we recognize it as one of the most common and difficult patient complaints that confronts us.
All too often, I think we consciously or subconsciously ascribe it to “fibromyalgia-ness,” a concept that most of us widely endorse regardless of a patient’s underlying diagnosis. Sadly, for our patients as well as ourselves, we have never developed simple solutions nor a seamless approach to this ubiquitous and formidable problem.
I have a long history with patient-reported fatigue. In the 1990s, a retroviral hypothesis was generated as a possible etiology for chronic fatigue syndrome — or what we now refer to as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) — and I started an active research and clinical program and saw hundreds of patients from far and wide. I will admit it was both difficult and chilling, as well as rewarding.
While the retroviral hypothesis fizzled, the patients did not go away and, in the absence of any approved therapies or even likely candidate therapies, all I had to offer them was my time, my ear and my voice. I learned that curing is not always possible but may not necessarily be the singular goal for some patients. Being heard — truly heard — is often healing in its own way.
Fast forward to today and fatigue is hot! We now recognize it as one of the most common limitations to our patients’ quality of life with a growing number of our targeted therapies including labeling for improving fatigue, which means it’s being studied. Fatigue often dominates the concern of patients with rheumatoid arthritis, lupus, Sjögren’s, other forms of inflammatory arthritis and, of course, fibromyalgia. Some studies have shown patients often value a day without fatigue as much as a day without pain. There are also now a growing number of investigators and centers dedicated to unraveling fatigue with exciting emerging data that incriminate multiple pathways ranging from sleep, psychoneuroimmunology, cardiopulmonary health and metabolic dysfunction.
For now, I am enjoying the output of high-quality science and am particularly interested in investigating the effects of mind-body practices such as tai chi, qi gong and yoga adapted for fatigue states. There are growing data that such modalities have relevant scientific underpinnings, and this must be built upon. Even more practically, we should not shy away from investigating modalities that have been used for centuries, perhaps based on different scientific principles, but nonetheless have brought vitality to millions. In the end, science is great and the data will be the data. I look forward to the next chapter on fatigue.
What’s your take? Share your thoughts with us at calabrl@ccf.org or at rheumatology@healio.com.
- For more information:
- Leonard H. Calabrese, DO, is the Chief Medical Editor, Healio Rheumatology, and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic.
Collapse
Read more about
Click Here to Manage Email Alerts