A new systematic review has found limited and inconsistent evidence for the effectiveness of current fatigue-reducing interventions in children and adolescents with pediatric rheumatic diseases (PRDs), underscoring the urgent need for more rigorous and targeted clinical research.
Fatigue, a distressing and pervasive symptom in pediatric rheumatic conditions like juvenile idiopathic arthritis, lupus, and dermatomyositis, remains poorly managed in clinical practice. Despite its impact on quality of life, few interventions have been tested specifically for fatigue relief in these patients. This review aimed to synthesize available data to guide treatment decisions and future research.
Researchers conducted a comprehensive search across four major databases and identified 493 studies, narrowing the field to 10 that met inclusion criteria. Interventions assessed included land- and water-based exercise, pharmacological treatments such as prednisolone and vitamin D, creatine supplementation, psychological counseling, and transitional care programs. All studies relied on patient-reported fatigue measures.
Evidence was mixed. Two randomized controlled trials (RCTs) found land-based exercise ineffective, though one smaller study reported positive effects. In contrast, aquatic physical therapy appeared more beneficial. Prednisolone combined with vitamin D reduced fatigue in two placebo-controlled trials, while creatine showed no significant effect. Psychological and transitional interventions were included but lacked consistent outcome clarity.
Overall, the review concluded that existing therapies for fatigue in PRDs are not well-supported by current evidence. Small sample sizes, varying intervention types, and methodological limitations—including risk of bias—limit the generalizability of findings. The subjective nature of fatigue, compounded by the absence of standardized assessment tools, further complicates treatment evaluation.
The authors emphasize the need for more targeted intervention studies, particularly those addressing underlying biological and psychological contributors to fatigue. A multidisciplinary approach involving medical, psychological, and physical therapy may ultimately provide the most promise, but high-quality evidence remains lacking.
For pediatric rheumatologists and allied health professionals, the review highlights both a clinical challenge and a research opportunity: addressing one of the most burdensome yet understudied symptoms affecting young patients with PRDs.
Reference:
Shaikh R et al. Effectiveness of Fatigue-Reducing Interventions in Pediatric Rheumatic Diseases: A Systematic Review. Cureus. 2025. doi: 10.7759/cureus.83056.
