Cited by 221Rheumatoid Arthritis Research and TherapiesMusculoskeletal pain and rehabilitationCancer survivorship and care

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Non-pharmacological interventions for fatigue in rheumatoid arthritis

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Cramp, Fiona, Hewlett, Sarah, Almeida, Celia, Kirwan, John R, Choy, Ernest HS, Chalder, Trudie, Pollock, Jon, Christensen, Robin·2013·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd008322.pub2PMC PMC11748118

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Abstract

BACKGROUND: Fatigue is a common and potentially distressing symptom for people with rheumatoid arthritis with no accepted evidence based management guidelines. Non-pharmacological interventions, such as physical activity and psychosocial interventions, have been shown to help people with a range of other long-term conditions to manage subjective fatigue. OBJECTIVES: To evaluate the benefit and harm of non-pharmacological interventions for the management of fatigue in people with rheumatoid arthritis. This included any intervention that was not classified as pharmacological in accordance with European Union (EU) Directive 2001/83/EEC. SEARCH METHODS: The following electronic databases were searched up to October 2012, Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; AMED; CINAHL; PsycINFO; Social Science Citation Index; Web of Science; Dissertation Abstracts International; Current Controlled Trials Register; The National Research Register Archive; The UKCRN Portfolio Database. In addition, reference lists of articles identified for inclusion were checked for additional studies and key authors were contacted. SELECTION CRITERIA: Randomised controlled trials were included if they evaluated a non-pharmacological intervention in people with rheumatoid arthritis with self-reported fatigue as an outcome measure. DATA COLLECTION AND ANALYSIS: Two review authors selected relevant trials, assessed risk of bias and extracted data. Where appropriate, data were pooled using meta-analysis with a random-effects model. MAIN RESULTS: Twenty-four studies met the inclusion criteria, with a total of 2882 participants with rheumatoid arthritis. Included studies investigated physical activity interventions (n = 6 studies; 388 participants), psychosocial interventions (n = 13 studies; 1579 participants), herbal medicine (n = 1 study; 58 participants), omega-3 fatty acid supplementation (n = 1 study; 81 participants), Mediterranean diet (n = 1 study; 51 participants), reflexology (n = 1 study; 11 participants) and the provision of Health Tracker information (n = 1 study; 714 participants). Physical activity was statistically significantly more effective than the control at the end of the intervention period (standardized mean difference (SMD) -0.36, 95% confidence interval (CI) -0.62 to -0.10; back translated to mean difference of 14.4 points lower, 95% CI -4.0 to -24.8 on a 100 point scale where a lower score means less fatigue; number needed to treat for an additional beneficial outcome (NNTB) 7, 95% CI 4 to 26) demonstrating a small beneficial effect upon fatigue. Psychosocial intervention was statistically significantly more effective than the control at the end of the intervention period (SMD -0.24, 95% CI -0.40 to -0.07; back translated to mean difference of 9.6 points lower, 95% CI -2.8 to -16.0 on a 100 point scale, lower score means less fatigue; NNTB 10, 95% CI 6 to 33) demonstrating a small beneficial effect upon fatigue. For the remaining interventions meta-analysis was not possible and there was either no statistically significant difference between trial arms or findings were not reported. Only three studies reported any adverse events and none of these were serious, however, it is possible that the low incidence was in part due to poor reporting. The quality of the evidence ranged from moderate quality for physical activity interventions and Mediterranean diet to low quality for psychosocial interventions and all other interventions. AUTHORS' CONCLUSIONS: This review provides some evidence that physical activity and psychosocial interventions provide benefit in relation to self-reported fatigue in adults with rheumatoid arthritis. There is currently insufficient evidence of the effectiveness of other non-pharmacological interventions.

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Authors: Cramp, F., Hewlett, S., Almeida, C., Kirwan, J. R., Choy, E. H., Chalder, T., Pollock, J., & Christensen, R.
Affiliations: University of the West of England (GB)
Bristol Royal Infirmary (GB)
Cardiff University (GB)
King's College London (GB)
Copenhagen University Hospital (DK)
ORCID: Cramp, Fiona
Hewlett, Sarah
Almeida, Celia
Kirwan, John R
Choy, Ernest HS
Chalder, Trudie
Pollock, Jon
Christensen, Robin
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2013-08-23
Volume: 2013
Issue: 8
Pages: CD008322-CD008322
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd008322.pub2
PMC: PMC11748118
OpenAlex: W1916406953
Cited by: 221
References: 106
Citations by year: 2026: 4 · 2025: 10 · 2024: 19 · 2023: 18 · 2022: 17 · 2021: 22 · 2020: 19 · 2019: 26 · 2018: 24 · 2017: 18 · 2016: 12 · 2015: 24 · 2014: 7
FWCI: 2.33
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Bristol Research (University of Bristol) (submittedVersion)
Explore Bristol Research (submittedVersion)
UWE Research Repository (UWE Bristol) (submittedVersion, cc-by)
Topics: Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords: rheumatoid arthritis, non-pharmacological treatment, physical activity, psychosocial interventions, cognitive behavioral therapy, relaxation training, herbal medicine, omega-3 fatty acids, Mediterranean diet, reflexology, fatigue management, symptom burden, quality of life, anxiety, sleep disorders, risk of bias, harm, cost-effectiveness
MeSH terms: Adult, Arthritis, Rheumatoid, Exercise Therapy, Fatigue, Humans, Middle Aged, Psychotherapy, Reflexotherapy, Fatty Acids, Omega-3, Diet, Mediterranean, Pain Management

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