Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug;9(3):e003350.
doi: 10.1136/rmdopen-2023-003350.

Efficacy of non-pharmacological interventions: a systematic review informing the 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases

Eduardo José Ferreira Santos #  1   2 , Bayram Farisogullari #  3 , Emma Dures  4   5 , Rinie Geenen  6 , Pedro M Machado  7   8   9 ; EULAR taskforce on recommendations for the management of fatigue in people with inflammatory rheumatic diseases
Collaborators, Affiliations

Efficacy of non-pharmacological interventions: a systematic review informing the 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases

Eduardo José Ferreira Santos et al. RMD Open. 2023 Aug.

Erratum in

Abstract

Objective: To identify the best evidence on the efficacy of non-pharmacological interventions in reducing fatigue in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and to summarise their safety in the identified studies to inform European Alliance of Associations for Rheumatology recommendations for the management of fatigue in people with I-RMDs.

Methods: Systematic review of randomised controlled trials (RCTs) including adults with I-RMDs conducted according to the Cochrane Handbook. Search strategy ran in Medline, Embase, Cochrane Library, CINAHL Complete, PEDro, OTseeker and PsycINFO. Assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. Data were pooled in meta-analyses.

Results: From a total of 4150 records, 454 were selected for full-text review, 82 fulfilled the inclusion criteria and 55 RCTs were included in meta-analyses. Physical activity or exercise was efficacious in reducing fatigue in rheumatoid arthritis (RA) (standardised mean differences (SMD)=-0.23, 95% CI=-0.37 to -0.1), systemic lupus erythematosus (SLE) (SMD=-0.54, 95% CI=-1.07 to -0.01) and spondyloarthritis (SMD=-0.94, 95% CI=-1.23 to -0.66); reduction of fatigue was not significant in Sjögren's syndrome (SMD=-0.83, 95% CI=-2.13 to 0.47) and systemic sclerosis (SMD=-0.66, 95% CI=-1.33 to 0.02). Psychoeducational interventions were efficacious in reducing fatigue in RA (SMD=-0.32, 95% CI=-0.48 to -0.16), but not in SLE (SMD=-0.19, 95% CI=-0.46 to 0.09). Follow-up models in consultations (SMD=-0.05, 95% CI=-0.29 to 0.20) and multicomponent interventions (SMD=-0.20, 95% CI=-0.53 to 0.14) did not show significant reductions of fatigue in RA. The results of RCTs not included in the meta-analysis suggest that several other non-pharmacological interventions may provide a reduction of fatigue, with reassuring safety results.

Conclusions: Physica activity or exercise and psychoeducational interventions are efficacious and safe for managing fatigue in people with I-RMDs.

Keywords: Arthritis; Autoimmune Diseases; Inflammation; Physical Therapy Modalities; Rehabilitation.

PubMed Disclaimer

Conflict of interest statement

Competing interests: PMM has received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript, and is supported by the National Institute for Health Research (NIHR), University College London Hospitals (UCLH), Biomedical Research Centre (BRC). EJFS, BF, RG and ED have no disclosures to report.

Figures

Figure 1
Figure 1
Flow chart of the study selection and inclusion process.
Figure 2
Figure 2
Risk of bias summary graph for included clinical trials. Review authors’ judgements about each risk of bias item presented as percentages across all included studies using the Cochrane RoB tool. RoB, risk of bias.
Figure 3
Figure 3
Meta-analyses summary. SMD, standardised mean differences.
See this image and copyright information in PMC

References

    1. WHO Scientific Group on the Burden of Musculoskeletal Conditions at the Start of the New Millennium . The burden of musculoskeletal conditions at the start of the new millenium: report of a WHO scientific group Geneve: World Health Organization; 2003.
    1. Santos EJF, Duarte C, da Silva JAP, et al. The impact of fatigue in rheumatoid arthritis and the challenges of its assessment. Rheumatology (Oxford) 2019;58(Suppl 5):v3–9. 10.1093/rheumatology/kez351 - DOI - PMC - PubMed
    1. Kirwan JR, Minnock P, Adebajo A, et al. Patient perspective: fatigue as a recommended patient centered outcome measure in rheumatoid arthritis. J Rheumatol 2007;34:1174–7. - PubMed
    1. Hewlett S, Cockshott Z, Byron M, et al. Patients' perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored. Arthritis Rheum 2005;53:697–702. 10.1002/art.21450 - DOI - PubMed
    1. Dures E, Rooke C, Hammond A, et al. Training and delivery of a novel fatigue intervention: a qualitative study of rheumatology health-care professionals' experiences. Rheumatol Adv Pract 2019;3:rkz032. 10.1093/rap/rkz032 - DOI - PMC - PubMed

Publication types