Effectiveness of Fatigue-Reducing Interventions in Pediatric Rheumatic Diseases: A Systematic Review

Abstract

There are few intervention trials aimed at lowering fatigue in pediatric rheumatic conditions (PRCs), despite the fact that it is a common and upsetting symptom in these patients. The study's primary goal is to thoroughly examine the data pertaining to the effectiveness of treatments meant to lessen fatigue in PRC patients. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search for relevant studies across four different databases (PubMed, Web of Science, Scopus, and Google Scholar). A total of 493 records were identified through database searches, and after removing 196 duplicates, 297 unique studies remained for screening. Following title screening and eligibility assessment, 45 studies were excluded for various reasons, and 10 studies met the inclusion criteria for this systematic review. The interventions included exercise treatment on land and in water, prednisolone, vitamin D and creatine supplements, psychological counseling, and a program for transitioning into a mature rheumatology program. Every included study measured fatigue using self-reported questionnaires. Two randomized controlled studies found land-based exercise treatment to be ineffective, while one pre-post intervention research found it to be useful. Compared to land-based exercise therapy, aquatic-based physical therapy was found to be more beneficial. Prednisolone combined with vitamin D significantly reduced subjective fatigue in two placebo-controlled trials. Creatine did not seem to be beneficial. The effectiveness of the present therapies to lessen fatigue in PRCs is not sufficiently supported by the available data. Future research should focus on intervention studies targeted at treating fatigue in adolescents and children with PRCs, as indicated by the small number of investigations, non-comparable therapies, risk of bias, and unclear outcomes of the included studies. It is necessary to identify potential underlying biological and psychological pathways as potential therapy targets in order to lessen fatigue symptoms in kids and teenagers with PRCs.

Keywords: adolescents; children; fatigue; interventions; pediatrics.

Figure 1. PRISMA Flowchart

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Figure 2. Risk of Bias Assessment of the Included Studies Using the Cochrane Risk of Bias 2 (RoB 2) Tool

The five evaluated domains are represented along the x-axis, while the studies are listed on the y-axis. Color coding indicates the level of bias: green (low risk), yellow (some concerns), orange (moderate risk), and red (high risk). Higher bias levels in measurement and reporting domains suggest potential methodological limitations affecting study reliability.