Reducing fatigue in pediatric rheumatic conditions: a systematic review

Abstract

Background Although fatigue is a prevalent distressing symptom in children and adolescents with Pediatric Rheumatic Conditions (PRCs), intervention studies designed for reducing fatigue in PRCs are limited. Aim To systematically review evidence regarding the efficacy of interventions intended to reduce fatigue in patients with PRCs. Methods Comprehensive electronic searches were performed in PubMed/ MEDLINE, Embase, Web of Science and Cinahl. The risk of bias was assessed using the ‘Revised Cochrane risk-of-bias tool for randomized trials’ and ‘Quality Assessment Tool for Before-After Studies With No Control Group’ for respectively studies with and without a control group. Results Ten out of 418 studies were included with a total of 240 participants (age range 5–23 years). Interventions included land-based and aquatic-based exercise therapy, prednisolone, vitamin-D and creatine supplementation, psychological therapy and a transition program into an adult rheumatology program. Fatigue was assessed with self-reported questionnaires in all included studies. Land-based exercise therapy was effective in one pre-post intervention study, whereas not effective in two randomized controlled trials. Aquatic-based exercise therapy was found more effective than land-based exercise therapy. Two placebo-controlled studies showed a significant positive effect in reducing subjective fatigue with prednisolone and vitamin-D. Creatine was not found effective. Cognitive therapy was effective in one pre-post intervention study, while one RCT did not show an effect in reducing fatigue. A transition program based on health education showed a small reducing effect, however, it was not clear if this was a significant effect. Six studies showed a high risk of bias, three studies a moderate risk, and one study had a low risk of bias. Conclusions Insufficient evidence is provided to substantiate the efficacy of current interventions to reduce fatigue in PRCs. The low number of studies, non-comparable interventions, risk of bias, and inconclusive outcomes of the included studies denote future research should focus on intervention studies aimed at the treatment of fatigue in children and adolescents with PRCs. Identification of possible underlying biological and psychosocial mechanisms as possible treatment targets to reduce complaints of fatigue in children and adolescents with PRCs is warranted.

Effectiveness of Early Physical Therapy Rehabilitation in Patient With Juvenile Rheumatoid Arthritis

“…Even in patients with severe inflammation, passive full range of motion exercises for all joints should be performed daily to prevent flexion contractures [6]. A systematic review of the evidence on the efficacy of interventions aimed at reducing fatigue in pediatric rheumatic condition (PRC) patients was conducted [5]. The small number of included studies, non-comparable interventions, and inconclusive results suggest that more research on the subject is needed.…”

“…The small number of included studies, non-comparable interventions, and inconclusive results suggest that more research on the subject is needed. To reduce fatigue complaints in children and adolescents with PRCs, potential underlying biological and psychosocial mechanisms must be identified as potential treatment targets [5,8]. A study was conducted to compare the effects of two different task-oriented activity training programs on activity performance and participation in children with juvenile idiopathic arthritis.…”

“…The primary stay of RA treatment is disease-modifying antirheumatic drugs (DMARDs). Approximately 40% to 50% of RA patients achieve remission or have low disease activity after treatment [5]. Immunosuppressive medications can be given in stages if necessary.…”

Juvenile idiopathic inflammatory myositis: an update on pathophysiology and clinical care

“…Some data are available on the efficacy of interventions to reduce fatigue in paediatric conditions such as JIIM, including land or aquatic-based exercise, medications and psychological interventions, which have been evaluated in a systematic review elsewhere 202 ; however, in this study, the efficacy of current interventions to reduce fatigue could not be established owing to insufficient evidence. Fatigue is multi-dimensional and does not necessarily always correlate with disease activity and is instead strongly associated with biological, lifestyle, psychological and social factors 202 . Further multidimensional intervention studies are needed to identify the best management of this troublesome symptom.…”

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

“…Fatigue has been identified by people living with chronic MSK conditions as a priority symptom which has a significant impact on quality of life 2–8. Pharmacological treatments are not licensed for the management of fatigue without concurrent disease activity, so the focus in clinical practice has been on non-pharmacological options 9 10.…”