Targeting fatigue specific factors in rheumatic inflammatory diseases: A cognitive behavioural approach

Objectives: Fatigue is common and debilitating in rheumatic inflammatory disease. The multifactorial, persistent, invisible, subjective and unpredictable nature of this problem challenge patients’ beliefs in their ability to influence and manage the physical and mental symptoms of fatigue. The objective of this study was to evaluate a new, cognitive behavioural approach, addressing key factors in maintaining and exacerbating symptoms of fatigue. Methods: The study is an observational longitudinal pilot study with observations at three time-points including patients with rheumatic inflammatory disease who had persistent fatigue, recruited from a rheumatology outpatient clinic. A cognitive behavioural approach was developed and applied. Levels of fatigue, pain, and depressive symptoms were measured at baseline, immediately after the intervention, and three months post intervention. ClinicalTrials.gov: NCT03216616. July 13, 2017. Results: The study population included 40 participants with rheumatic inflammatory disease and persistent fatigue. Mean disease duration was 14 (11) years (SD), and mean age was 45 (10) years (SD). Repeated measure Analysis of variance showed statistically significant improvement in self-reported fatigue and depressive symptoms immediately after the intervention and at 3 months follow-up. There was no change in pain (Visual Analogue Scale) during follow-up. Conclusions: The results indicate a promising beneficial effect of this pragmatic cognitive behavioural intervention targeting fatigue and depressive symptoms, sustained 3 months post treatment. The efficacy should be confirmed in a randomized controlled clinical