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

Dures, Emma; Farisoğulları, Bayram; Santos, Eduardo José Ferreira; Molto, Anna; Feldthusen, Caroline; Harris, Claire; Elling-Audersch, Corinna; Connolly, Deirdre; Elefante, Elena; Estévez-López, Fernando; Bini, Ilaria; Primdahl, Jette; Hoeper, Kirsten; Urban, Marie; van de Laar, Mart A F J; Redondo, Marta; Böhm, Peter; Amarnani, Raj; Hayward, Rhys; Geenen, Rinie; Rednic, Simona; Pettersson, Susanne; Thomsen, Tanja; Uhlig, Till; Ritschl, Valentin; Machado, Pedro M.

Abstract

Objectives Fatigue 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. Methods A 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. Results Four 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. Conclusions These 2023 EULAR recommendations provide consensus and up-to-date guidance on fatigue management in people with I-RMDs.

• Journal Article Type: Article
• Acceptance Date: Nov 1, 2023
• Online Publication Date: Nov 22, 2023
• Publication Date: Sep 30, 2024
• Deposit Date: Nov 23, 2023
• Publicly Available Date: Nov 28, 2023
• Journal: Annals of the Rheumatic Diseases
• Print ISSN: 0003-4967
• Electronic ISSN: 1468-2060
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 83
• Issue: 10
• Pages: 1260-1267
• DOI: https://doi.org/10.1136/ard-2023-224514
• Keywords: therapeutics, health services research, rehabilitation
• Public URL: https://uwe-repository.worktribe.com/output/11458571