EULAR: Physical activity, regular assessment recommended for fatigue in inflammatory RMD
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Key takeaways:
- Recommended interventions for fatigue in inflammatory rheumatic and musculoskeletal diseases include physical activity and psychoeducational interventions.
- Fatigue involves a wide spectrum of factors and should be monitored.
Fatigue in patients with inflammatory rheumatic and musculoskeletal diseases should be addressed with tailored physical activity, psychoeducational interventions or possibly immunomodulatory treatment, according to EULAR recommendations.
“Fatigue is prevalent in people with [inflammatory rheumatic and musculoskeletal diseases (I-RMDs)] and is one of the most challenging symptoms to cope with due to its invisible, pervasive and unpredictable nature,” Emma Dures, PhD, of the University of the West of England and Bristol Royal Infirmary, and colleagues wrote in Annals of the Rheumatic Diseases. “... However, there are no recommendations to support people with I-RMDs and health professionals with fatigue management.”
To develop recommendations managing fatigue in patients with inflammatory rheumatic and musculoskeletal diseases, Dures and colleagues convened a 26-member EULAR multidisciplinary task force. Members of the task force performed two systematic reviews of pharmacological and non-pharmacological interventions effective in fatigue management.
The task force formed overarching principles and recommendations based on its findings, supplemented with members’ own experience, and finalized them in a series of discussions and anonymous votes.
Based on general themes observed throughout all the recommendations, the task force developed and approved four overarching principles and four recommendations. The overarching principles are:
- Health professionals should be aware that fatigue encompasses multiple and mutually interacting biological, psychological and social factors.
- Fatigue should be monitored in patients with inflammatory rheumatic and musculoskeletal diseases, and management options should be offered as part of clinical care.
- Management of fatigue should be a shared decision between the patient and health and wellbeing professionals.
- Fatigue management should be based on the needs and preferences of the patient, as well as their clinical disease activity, comorbidities and other individual psychosocial and/or contextual factors.
According to the task force, the four recommendations are:
- Health professionals should incorporate regular assessment of fatigue severity, impact and coping strategies into clinical consultations.
- As part of their clinical care, patients with inflammatory rheumatic and musculoskeletal diseases and fatigue should be offered access to tailored physical activity interventions and encouraged to engage in long-term physical activity.
- Providers should also offer access to structured and tailored psychoeducational interventions to patients with fatigue as part of their clinical care.
- 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.
“These [overarching principles and recommendations] are premised on understanding fatigue as multifactorial and the need to communicate this to people with I-RMDs and to help them reflect on potential underlying drivers,” Dures and colleagues wrote. “Related to this is the understanding that fatigue is a long-term challenge for many people with I-RMDs, so access to support should be reviewed regularly. The task force recognizes that some health care systems, insurers and providers might challenge ongoing access to support provision. However, the consensus is to recommend optimal care.”
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