Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Non-Pharmacological Interventions for Fatigue in Rheumatoid Arthritis: A Cochrane Review.

Cramp1,  Fiona, Hewlett1,  Sarah, Almeida1,  Celia, Kirwan2,  John R., Choy3,  Ernest, Chalder4,  Trudie, Pollock1,  Jon

University of the West of England, Bristol, United Kingdom
University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
Cardiff University, Cardiff, ENGLAND, United Kingdom
Department of Psychological Medicine, London, United Kingdom
Copenhagen, Denmark


Fatigue is a common and potentially distressing symptom for patients 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 manage subjective fatigue. The purpose of the review was to evaluate the effectiveness and safety of non-pharmacological interventions for the management of fatigue in people with rheumatoid arthritis.


Randomised controlled trials were included that evaluated a non-pharmacological intervention in people with rheumatoid arthritis, with self-reported fatigue as an outcome measure. To identify relevant studies the following electronic databases were searched: Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Current Controlled Trials Register; The National Research Register Archive; The UKCRN Portfolio Database; MEDLINE; EMBASE; AMED; CINAHL; PsycINFO; Social Science Citation Index; Web of Science; Dissertation Abstracts International. In addition reference lists of articles identified for inclusion were checked for additional studies and key authors were contacted. Two reviewers selected relevant trials, assessed methodological quality and extracted data. Where appropriate, data were pooled using meta-analysis with a random-effects model.


Nineteen studies met the inclusion criteria with a total of 2240 participants with rheumatoid arthritis. Included studies investigated physical activity interventions (k=5), psychosocial interventions (k=10), herbal medicine (k=1), omega-3 fatty acid supplementation (k=1), Mediterranean diet (k=1) and the provision of Health Tracker information (k=1). The quality of the studies varied from low to moderate. Meta-analyses of available data demonstrated that physical activity was statistically more effective than the control with a small effect (SMD -0.29, 95% CIs -0.53 to -0.05) and psychosocial interventions were statistically more effective than the controls with a marginal effect (SMD -0.14, 95% CIs -0.28 to 0.00).


This review provides some evidence that physical activity and psychosocial interventions may 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. Further high quality research is still required to confirm the optimal non-pharmacological interventions and inform future clinical guidelines. Better understanding of the mechanisms of fatigue would also help to further develop effective interventions.

To cite this abstract, please use the following information:
Cramp, Fiona, Hewlett, Sarah, Almeida, Celia, Kirwan, John R., Choy, Ernest, Chalder, Trudie, et al; Non-Pharmacological Interventions for Fatigue in Rheumatoid Arthritis: A Cochrane Review. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1557

Abstract Supplement

Meeting Menu