2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases

Abstract

ObjectivesFatigue is prevalent in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and recognised as one of the most challenging symptoms to manage. The existence of multiple factors associated with driving and maintaining fatigue, and the evidence about what improves fatigue has led to a multifaceted approach to its management. However, there are no recommendations for fatigue management in people with I-RMDs. This lack of guidance is challenging for those living with fatigue and health professionals delivering clinical care. Therefore, our aim was to develop EULAR recommendations for the management of fatigue in people with I-RMDs.MethodsA multidisciplinary taskforce comprising 26 members from 14 European countries was convened, and two systematic reviews were conducted. The taskforce developed the recommendations based on the systematic review of evidence supplemented with taskforce members’ experience of fatigue in I-RMDs.ResultsFour overarching principles (OAPs) and four recommendations were developed. OAPs include health professionals’ awareness that fatigue encompasses multiple biological, psychological and social factors which should inform clinical care. Fatigue should be monitored and assessed, and people with I-RMDs should be offered management options. Recommendations include offering tailored physical activity and/or tailored psychoeducational interventions and/or, if clinically indicated, immunomodulatory treatment initiation or change. Patient-centred fatigue management should consider the individual’s needs and preferences, their clinical disease activity, comorbidities and other psychosocial and contextual factors through shared decision-making.ConclusionsThese 2023 EULAR recommendations provide consensus and up-to-date guidance on fatigue management in people with I-RMDs.

Factors influencing the outcomes of non-pharmacological interventions for managing fatigue across the lifespan of people living with musculoskeletal (MSK) conditions: a scoping review protocol

“…The European Alliance of Associations for Rheumatology (EULAR) recently funded a taskforce to examine the effectiveness of non-pharmacological interventions for fatigue in inflammatory rheumatic conditions and the resulting systematic review found strong evidence that some interventions are effective. 14 This informed the EULAR recommendations for the management of fatigue 21 and highlighted a need to better understand contextual factors and the mechanisms by which interventions are effective. 7 There is currently no comprehensive understanding of the factors which influence the success of an intervention.…”

Is there a role for novel supplements in the management of fatigue in rheumatic diseases?

“…In 2023, the European Alliance of Associations for Rheumatology (EULAR) published guidelines recommending the regular assessment of patients with rheumatic diseases for fatigue and providing structured management strategies to address fatigue. 8 Notably, the EULAR guidelines focus on non-pharmacological methods such as psychoeducation and physical therapies. In seeking other options to manage musculoskeletal complaints and take control of their disease, complementary and alternative medicines (CAM) are frequently used by patients despite a lack of evidence base behind such a treatment strategy.…”