News Release

New: Fatigue in inflammatory RMD

New recommendations for management

Peer-Reviewed Publication

European Alliance of Associations for Rheumatology (EULAR)

Fatigue is common in people with inflammatory rheumatic and musculoskeletal diseases (RMD). The causes of fatigue are not well understood, and it is likely that they vary between people and over time. From a patient perspective, fatigue has a significant and detrimental impact on daily life, and it is a priority to address.

Although our appreciation of the impact of fatigue has grown in recent years, it is complex to manage. We have evidence about some approaches that can help, but we have not had any recommendations to guide health professionals and patients. As a result, fatigue care and support is often variable and fragmented.

To address this, EULAR has drafted new recommendations for fatigue management in people with an Inflammatory RMD. The work was presented at the 2023 EULAR congress and will be published in November 2023 in the Annals of Rheumatic Diseases. The work was supported by two systematic literature reviews, which explored the efficacy of pharmacological and non-pharmacological interventions aimed at reducing the severity and impact of fatigue and helping people to develop good coping strategies.

The new publication includes four overarching principles and four recommendations. The principles say that healthcare professionals should be aware that fatigue is related to the dynamic interaction of biological, psychological, and social factors. People with an Inflammatory RMD, should have their fatigue monitored, and management options should be offered as part of their clinical care. The chosen management approach should be based on a shared decision between the person with an Inflammatory RMD and their healthcare professionals. Finally, fatigue management should be based on the needs and preferences of the individual with an Inflammatory RMD. It should consider their disease activity, any other health conditions that they have, and individual psychosocial and contextual factors.

The recommendations look specifically at when fatigue should be assessed and focus on two key types of intervention: physical activity and psychoeducation – both of which have been shown to be helpful. At this point, there is limited evidence for other interventions.

EULAR hopes these recommendations will provide a starting point for managing fatigue in people with an Inflammatory RMD and encourage healthcare teams to support their patients in identifying and addressing fatigue.


Dures E, Farisoğulları B, Santos EJF, et al2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases Annals of the Rheumatic Diseases Published Online First: 22 November 2023. doi: 10.1136/ard-2023-224514


EULAR is the European umbrella organisation representing scientific societies, health professional associations and organisations for people with rheumatic and musculoskeletal diseases (RMDs). EULAR aims to reduce the impact of RMDs on individuals and society, as well as improve RMD treatments, prevention, and rehabilitation. To this end, EULAR fosters excellence in rheumatology education and research, promotes the translation of research advances into daily care, and advocates for the recognition of the needs of those living with RMDs by EU institutions.



EULAR Communications,


Notes to Editors

EULAR Recommendations

EULAR School of Rheumatology

EULAR Press Releases


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