Table 1

Summary of treatment of fatigue in RA

Pharmacologic treatmentNon-pharmacologic treatment
Targeting disease activityDMARDs (csDMARDs, bDMARDs, tsDMARDs) Corticosteroids
Reducing medication side effectsAdjusting DMARDs (such as methotrexate, sulfasalazine), Corticosteroids
Improving fatigue in other waysPhysical 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 benefitsTreating 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 benefitsHealth tracking
Counting steps (wearable devices)
Dietary modification (Mediterranean diet)
Omega-3 supplements
Awareness and treatment of comorbidities*Identification and treatment of comorbidities
Treatment of
-uncontrolled diabetes mellitus
-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.