From the Guidelines
Fatigue management should prioritize a multifaceted approach, including tailored physical activity, psychoeducational interventions, and immunomodulatory treatment, as recommended by the 2023 EULAR guidelines 1. To address fatigue, it is essential to first identify and treat any underlying medical conditions such as anemia, thyroid disorders, sleep apnea, or depression. Lifestyle modifications are crucial, including:
- Aiming for 7-9 hours of quality sleep nightly
- Maintaining regular sleep-wake cycles
- Practicing good sleep hygiene by avoiding screens before bedtime Regular moderate exercise, starting with 15-30 minutes daily and gradually increasing, can boost energy levels by improving cardiovascular function and releasing endorphins 1. Nutrition plays a key role, with recommendations to:
- Eat regular balanced meals with complex carbohydrates, lean proteins, and healthy fats
- Stay well-hydrated with 2-3 liters of water daily Stress management techniques like meditation, deep breathing, or yoga can help reduce fatigue. If fatigue persists despite these measures, consulting a healthcare provider is necessary, as they may recommend blood tests to check for vitamin deficiencies (particularly B12, D, and iron) or other medical conditions 1. Supplements like iron (if deficient), vitamin B12 (1000mcg daily), or CoQ10 (100-200mg daily) may be beneficial in specific cases but should only be taken under medical supervision. Persistent unexplained fatigue lasting more than two weeks warrants medical evaluation to rule out serious conditions. Healthcare providers should be aware of the multiple biological, psychological, and social factors that contribute to fatigue and inform clinical care accordingly 1. 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 1. The clinical team should decide when referral to an appropriately trained professional is needed, and comorbidities such as cardiac, pulmonary, renal, hepatic, neurologic, endocrine dysfunction, and infection should be reviewed and assessed 1.
From the Research
Definition and Classification of Fatigue
- Fatigue is a common presenting symptom in primary care that negatively impacts work performance, family life, and social relationships 2.
- It can be classified as secondary to other medical conditions, physiologic, or chronic 2, 3.
Causes and Diagnosis of Fatigue
- The differential diagnosis of fatigue includes lifestyle issues, physical conditions, mental disorders, and treatment side effects 2.
- A comprehensive history and cardiopulmonary, neurologic, and skin examinations help guide the workup and diagnosis 3.
- Iron deficiency is one of the most common causes of anemia and can also cause fatigue, hair loss, and restless legs 4.
Treatment and Management of Fatigue
- Treatment of all types of fatigue should include a structured plan for regular physical activity, such as walking, and may include caffeine and modafinil for episodic situations requiring alertness 2.
- Cognitive behavior therapy, exercise therapy, and acupuncture may help with some of the fatigue associated with chronic conditions 3.
- Iron supplementation can reduce self-reported fatigue in iron-deficient non-anaemic adults, but may not improve objective measures of physical capacity 5.
- Iron supplementation can also improve symptoms related to iron deficiency, such as restless legs syndrome, chronic fatigue syndrome, and sleeping disorders 6.
Specific Conditions Related to Fatigue
- Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic, severe, and potentially debilitating disorder with demonstrated inflammatory, neurologic, immunologic, and metabolic abnormalities 3.
- ME/CFS has a poor prognosis, with no proven treatment or cure, and exercise can be harmful to patients with ME/CFS because it can trigger postexertional malaise 3.