Reducing fatigue in patients with inflammatory rheumatic diseases

Telephone-based physical exercise and cognitive-behavioral interventions improve the severity and impact of fatigue in patients with some form of inflammatory rheumatic disease. This is the finding of the LIFT study (Lessening the Impact of Fatigue in Inflammatory Rheumatic Disease Trial) published in The Lancet Rheumatology. LIFT1 is the largest clinical trial in the world to test these fatigue-specific interventions in populations with heterogeneous diagnoses of inflammatory rheumatic disease (IRM). It is also the first to test them remotely. Read: POP QUIZ: DMARD tapering in rheumatoid arthritis Methodology LIFT is a multi-center, randomized, controlled, open-label, parallel-group trial conducted between September 2017 and September 2019 with 367 participants with rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis, or other MRIs. Participants (mean age: 57.5 years ± 12.7; women, n = 274) were randomly assigned to receive the personalized exercise program (PEP, n = 124) or cognitive-behavioral intervention (CCI, n = 121) or usual care alone (SHS, n = 122). Primary measures were obtained from the Chalder Fatigue Scale (0 = low, 33 = high) and Fatigue Severity Scale (1 = low, 9 = high). Secondary measures included quality of life, pain intensity, sleep disturbances, anxiety and depression. Principle results After 56 weeks, both PEP and ICC reduced the intensity of fatigue as measured by the Chalder scale (PEP: adjusted mean difference -3.03, 95% CI: -5.05 to -1.02 , p = 0.0007; ICC -2.36, 95% CI: -4.28 to -0.44, p = 0.0058) and the impact of fatigue measured by the Fatigue Severity Scale (PEP -0.64, 95% CI: -0.95 to -0.33, p < 0.0001; ICC -0.58, 95% CI: -0.87 to -0.28, p < 0 .0001) compared to SHS. Some secondary measures were also significantly improved (e.g., sleep disturbance, depression) and others were not (pain, anxiety). But overall, both types of intervention improved overall well-being. Read: New Canadian guidelines for managing rheumatoid arthritis with DMARDs Discussion elements The authors point out that meta-analyses2 of physical activity and psychosocial interventions have yielded only modest results in reducing fatigue. However, small trials in rheumatoid arthritis have reported improvement in fatigue and its overall impact3,4. They also point out that in real practice, rheumatologists prioritize the treatment of inflammation at the expense of alternative approaches for fatigue. Based on the results of the LIFT trial, physical exercise and cognitive-behavioral interventions should be considered a key component of the management of RIMs in routine clinical practice. References Bachmair, E.M. et coll. (2022). Remotely delivered cognitive behavioural and personalised exercise interventions for fatigue severity and impact in inflammatory rheumatic diseases (LIFT): a multicentre, randomised, controlled, open-label, parallel-group trial. The Lancet Rheumatology 4(8), e534-e545. Cramp, F. et coll. (2013). Non-pharmacological interventions for fatigue in rheumatoid arthritis. Cochrane Database Syst Rev. 8, CD008322. Hewlett, S. et coll. (2019). Group cognitive-behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations. Health Technol Assess 23, 1-130. Katz, P. et coll. (2018). Physical activity to reduce fatigue in rheumatoid arthritis: a randomized controlled trial. Arthritis Care Res (Hoboken) 70: 1-10. This article has been translated from its original French and originally appeared on our sister site Profession Santé. Read: Multiple Sclerosis or not? MS-allied diseases and conditions to rule out

Reducing fatigue in patients with inflammatory rheumatic diseases

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