Summary of treatment of fatigue in RA
| Pharmacologic treatment | Non-pharmacologic treatment | |
|---|---|---|
| Targeting disease activity | DMARDs (csDMARDs, bDMARDs, tsDMARDs) Corticosteroids | |
| Reducing medication side effects | Adjusting DMARDs (such as methotrexate, sulfasalazine), Corticosteroids | |
| Improving fatigue in other ways | Physical activity/exercise Whether it needs to be supervised by a therapist or not is uncertain The intensity of exercise is uncertain | |
| Behavioural modification Motivational interviewing, self-management programme with reminders Cognitive-behavioural therapy(CBT) | ||
| Possible benefits | Treating depression/pain Improving sleep | Improving sleep hygeine Maintaining work Treating depression/poor mood using non-pharmacologic treatments (eg, counselling, journaling, CBT) Treating pain using non-pharmacologic modalities (eg, heat, splinting, range of motion, resting, TENS) |
| Uncertain benefits | Health tracking Counting steps (wearable devices) Dietary modification (Mediterranean diet) Omega-3 supplements Reflexology | |
| Awareness and treatment of comorbidities* | Identification and treatment of comorbidities Treatment of -uncontrolled diabetes mellitus -hypothyroidism -anemia -hypoxia from ILD, COPD | Treatment of sleep apnea with CPAP |
*Examples provided, not an exhaustive list of causes of fatigue in patients with RA. bDMARDs, biologic DMARDs; COPD, chronic obstructive pulmonary disease; CPAP, continuous positive airway pressure; csDMARDs, conventional synthetic DMARDs; DMARDs, disease-modifying antirheumatic drugs; ILD, interstitial lung disease; RA, rheumatoid arthritis; TENS, transcutaneous electrical nerve stimulation; tsDMARDs, targeted synthetic DMARD.