‘We want to work with you’: Physiatry referrals can help fatigue in autoimmune diseases
Click Here to Manage Email Alerts
SCOTTSDALE, Ariz. — Physical medicine and rehabilitation play an important role in recovering from fatigue symptoms in immune-mediated diseases, according to a speaker at the Basic and Clinical Immunology for the Busy Clinician symposium.
“Use your physiatry colleagues,” Monica Verduzco-Gutierrez, MD, of the University of Texas at San Antonio, told attendees during the hybrid meeting.
She later described physiatrists as, “doctors that are dedicated to the science of recovery.”
“We do really care across the board about how patients get better, especially in regard to their function,” Verduzco-Gutierrez said. “We’re your partners. We want to work with you. Refer your patients to physical medicine and rehabilitation when they’re available.”
According to Verduzco-Gutierrez, survey results from the Autoimmune Association indicate as many as 98% of patients with autoimmune disease report fatigue.
“This is something that you’re going to be seeing in your clinic and your offices,” she said.
Verduzco-Gutierrez had been part of a team that drafted a 2021 multidisciplinary consensus guidance statement on managing fatigue in patients with long COVID. The recommendations included holistically assessing sleep, mood, cardiopulmonary, autoimmune and endocrine criteria, as well as whether patients have been prescribed fatiguing medication, she said.
The guidance also includes what Verduzco-Gutierrez called the “four Ps,” which can be taught to patients or assessed in an after-visit summary:
- Pacing: Avoiding the “push and crash” cycle that is common in post-COVID-19 recovery.
- Prioritizing: Encourages a patient to focus and decide on which activities need to get done and which activities can be postponed to avoid overexertion and crashing.
- Positioning: Modifying activities to make them easier to perform.
- Planning: Encourages the patient to plan out their day or week to avoid overexertion and to recognize energy windows.
“Positioning is huge,” Verduzco-Gutierrez said, adding that patients have told her “the best thing” for them was “some shower chair or rollator — something that allowed them to sit and rest.”
Prehabilitation programs are a useful way of “optimizing” patients ahead of treatments and promoting better outcomes, Verduzco-Gutierrez added. “Prehab” programs, meanwhile, typically consist of not just exercise and strengthening, but also psychological aspects such as nutrition and smoking cessation, she said.
“They do this for CAR-T treatments, and now you’re going to be doing it on your autoimmune disease patients,” she said. “It’s preparing your patients for what can be potentially very disabling, and effect of their immune treatment.”
Validated symptom measures are key, she added. However, acknowledging that completing questionnaires can itself sometimes be tiring, Verduzco-Gutierrez pointed out the Brief Fatigue Inventory, which consists of nine 10-point scales to describe fatigue over the last 24 hours.
“Symptom measurement is going to be the difference between getting disability or getting declined,” she said.
Collapse
Verduzco-Gutierrez M. Rehabilitative Approaches to Fatigue in Immune-Mediated Diseases. Presented at Basic and Clinical Immunology for the Busy Clinician, Feb. 17-18, 2024; Scottsdale, Arizona (hybrid meeting).
Read more about
Click Here to Manage Email Alerts