Fatigue as a Feature of Rheumatic and Musculoskeletal Diseases: A Narrative Review for Clinical Practice

Abstract

Fatigue is a prevalent and debilitating symptom in patients with rheumatic and musculoskeletal  diseases (RMDs), yet it remains inadequately addressed in clinical practice. This narrative  review synthesises evidence from a comprehensive scoping review of 134 reviews examining  fatigue across rheumatoid arthritis, spondyloarthritis, osteoarthritis, and fibromyalgia,  supplemented by recent mechanistic, measurement, and intervention studies. No universally  agreed definition of fatigue exists, though subtypes include physical and mental fatigue. Twentyfive self-reported measurement instruments have been identified, with PROMIS (Patient Reported  Outcomes Measurement Information System) Fatigue most frequently selected by patients (77.9%  uptake). Key determinants include pain, physical function, depressive symptoms, female sex,  and stress. Fatigue significantly impacts work performance, physical activity, social functioning,  and quality of life. Non-pharmacological interventions (exercise, cognitive-behavioural therapy)  demonstrate small effect sizes whilst pharmacological interventions in the form of different  biologics and JAK inhibitors show clinically meaningful effects. Fatigue in RMDs is a complex,  multidimensional phenomenon requiring tailored management approaches. Rheumatologists  must recognise fatigue as a cardinal symptom warranting systematic assessment and individualised  intervention strategies.

Green Life Med. Col. J 2026;11(2): 54-59