Combating Fatigue in Young Patients with Rheumatic Diseases: A Review of Current Interventions

Source: Based on a systematic review published in Cureus (Awad Abdu Alla et al., 2025) 

The Burden of Fatigue in Pediatric Rheumatic Diseases

Fatigue is a common and significantly debilitating symptom for children and adolescents living with pediatric rheumatic diseases (PRDs), such as juvenile idiopathic arthritis (JIA), systemic lupus erythematosus (SLE), and juvenile dermatomyositis (JDM). This persistent tiredness goes beyond typical childhood fatigue, impacting daily activities, overall well-being, and quality of life. It stems from a complex interplay of factors, including chronic inflammation, pain, medication side effects, sleep disturbances, and emotional well-being. Despite its profound impact, fatigue in this population often remains underrecognized and undertreated.

Examining Current Fatigue-Reducing Strategies

A recent systematic review aimed to understand how effective current treatments are in reducing fatigue in young individuals with PRDs. The researchers followed strict guidelines (PRISMA) to analyze relevant studies from major scientific databases. Out of hundreds of initial records, only ten studies met the rigorous criteria for inclusion in the review.

The interventions explored in these studies varied widely, encompassing:

• Exercise Therapy: Both land-based (resistance and strength training, aerobic exercises) and aquatic-based physical therapy programs.
• Pharmacological Approaches: The use of prednisolone and vitamin D supplements.
• Nutritional Supplements: Creatine supplementation.
• Psychological Interventions: Counseling and a transition program designed for adolescents moving into adult rheumatology care.

Fatigue levels were consistently measured using self-reported questionnaires across all included studies.

Mixed Results and the Need for Further Research

The findings of the reviewed studies presented a mixed picture regarding the effectiveness of these interventions on fatigue.

• Land-based exercise: Two randomized controlled trials found no significant reduction in fatigue, while one pre-post study suggested a positive effect.
• Aquatic-based exercise: One study indicated that water-based therapy might be more beneficial for fatigue than land-based exercise.
• Prednisolone and Vitamin D: Two placebo-controlled trials showed that a combination of prednisolone and vitamin D significantly lessened subjective fatigue.
• Creatine: This supplement did not appear to have a beneficial effect on fatigue.
• Psychological Interventions: Cognitive-behavioral therapy and a transition program showed promise in reducing fatigue in some studies.

Overall, the available evidence does not strongly support the effectiveness of current interventions in consistently reducing fatigue in children and adolescents with PRDs. The limited number of studies, the variety of treatments investigated, potential biases in the research, and unclear outcomes highlight the urgent need for more robust research in this area.

Understanding the Complexity of Fatigue

The review emphasizes that fatigue in PRDs is likely a complex issue stemming not only from the disease itself and its treatment but also from the psychological and physical challenges of living with a chronic illness during formative years. Therefore, effective solutions may require addressing the intricate interplay between the body and mind.

The researchers point to a model of fatigue in juvenile idiopathic arthritis that suggests a combination of personal, disease-related, environmental, and general factors contribute to the development and persistence of fatigue. This underscores the potential benefit of multifaceted treatment approaches, such as cognitive-behavioral therapy, which can target both the psychological and physical aspects of fatigue. Evidence suggests that CBT has been helpful for fatigued adults with various chronic conditions, including rheumatoid arthritis, and for adolescents with chronic fatigue disorders. Other promising avenues for intervention include promoting relaxation, therapeutic touch, exercise, and patient education. Physical activity, for instance, may help reduce fatigue by decreasing inflammation, building muscle strength, and improving mental and functional abilities.

Limitations and Future Directions

The review acknowledges several limitations, including the small number of included studies, the heterogeneity of interventions and outcome measures, and methodological flaws in some studies. Fatigue was often a secondary outcome, potentially leading to underpowered analyses. The lack of consistent measurement tools and long-term follow-up also limits the strength of the conclusions.

These limitations highlight the critical need for future research that focuses primarily on fatigue as the main outcome in well-designed, larger, and standardized trials involving children and adolescents with PRDs. Identifying the underlying biological and psychological mechanisms contributing to fatigue in this population is crucial for developing targeted and effective therapies. Future research should also explore multifaceted interventions that address the various contributing factors to fatigue, considering the individual experiences of young patients with PRDs.

Conclusion

While some interventions show initial promise, there is a significant lack of strong evidence to guide the effective management of fatigue in pediatric rheumatic diseases. More focused and rigorous research is essential to identify and implement effective strategies that can alleviate this debilitating symptom and improve the lives of young individuals living with these chronic conditions.