Nonpharmacological Interventions Effective for Managing Fatigue in Inflammatory Rheumatic and Musculoskeletal Diseases

Physical activity, exercise, and psychoeducational interventions are safe and effective for managing fatigue among patients with inflammatory rheumatic and musculoskeletal diseases (I-RMDs), according to results of a systematic review and meta-analysis published in RMD Open.

Investigators aimed to determine the efficacy and safety of nonpharmacological interventions for reducing fatigue among patients with I-RMDs.

The investigators conducted a systematic review and meta-analysis, including studies with patients aged at least 18 years diagnosed with I-RMDs who were prescribed nondrug interventions by their healthcare providers. Patients treated with placebo or usual/standard care comprised the comparator/control group.

The main study outcome was fatigue, as assessed by self-reported outcome measures.

A total of 82 studies were included in the systematic review, with 55 randomized controlled trials (RCTs) included in the meta-analysis. The majority of the included RCTs were of moderate to high quality, though 4 were of low quality. No publication bias was found.

Results of the meta-analysis revealed exercise or physical activity was effective for reducing fatigue among patients with spondyloarthritis (standardized mean difference [SMD], -0.94; 95% CI, -1.23 to -0.66; P <.001), systemic lupus erythematosus (SLE) (SMD, -0.54; 95% CI, -1.07 to -0.01; P =.04), and rheumatoid arthritis (RA) (SMD, -0.23; 95% CI, -0.37 to -0.10; P <.001), compared with standard care.

No significant reduction in fatigue was found among patients with Sjögren syndrome (SMD, -0.83; 95% CI, -2.13 to 0.47; P =.21) or systemic sclerosis (SMD, -0.66; 95% CI, -1.33 to 0.02; P =.06) when treated with exercise or physical activity vs standard care.

Psychoeducational interventions were effective for reducing fatigue among patients with RA (SMD, -0.32; 95% CI, -0.48 to -0.16; P <.001) but not among those with SLE (SMD, -0.19; 95% CI, -0.46 to 0.09; P =.18).

No significant reductions in fatigue among patients with RA were found in follow-up models assessing multicomponent interventions (physical activity or exercise + psychoeducational intervention) (SMD, -0.20; 95% CI, -0.53 to 0.14; P =.24) and consultations (SMD, -0.05; 95% CI, -0.29 to 0.20; P =.71), compared with the control group.

The investigators noted several nonpharmacological interventions not included in the meta-analysis may offer reduction of fatigue safely, including: traditional Chinese medicine, dietary modifications, balneotherapy, transcranial direct current stimulation, transcutaneous auricular vagus nerve stimulation, whole body vibration, and aromatherapy.

While the majority of studies did not report on safety of the nonpharmacological interventions, among the 31 that did, no serious or clinically significant adverse events were reported.

Study limitations included few RCTs reporting fatigue as the primary outcome, a lack of standardization and validation of fatigue measures, difficulty with blinding among the included studies, and potential clinical heterogeneity.

The study authors noted, “Safety results were reassuring. However, safety information

was often lacking in the retrieved studies and mentioning safety in detail in future non-pharmacological interventions addressing fatigue is advisable. Even if no adverse events or side effects are observed, this should be clearly reported in future studies.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Rheumatology Advisor