PAIN and fatigue are among the most disabling symptoms in systemic sclerosis, and new evidence highlights the promise of non-drug strategies to ease their impact on daily life. These symptoms are common, yet they remain underrecognized and undertreated by clinicians, leaving many patients struggling with diminished quality of life.
According to a new review, pain in systemic sclerosis has multiple sources, including musculoskeletal, neuropathic, vascular, gastrointestinal, and treatment-related factors. Fatigue, meanwhile, often stems from cardiopulmonary disease, malnutrition, endocrine issues, poor sleep, or psychological burden. This complexity means that symptoms are rarely explained by a single cause, making accurate diagnosis and comprehensive care essential.
Assessment of pain and fatigue requires more than clinical observation. Patient-reported outcome measures, physical examination, laboratory testing, and imaging provide a clearer picture of how symptoms manifest and evolve. These tools also help clinicians tailor strategies to the individual patient.
Non-pharmacological interventions offer encouraging results in improving function and symptom relief. Approaches such as physical rehabilitation, cognitive behavioral therapy, nutritional support, and mind-body practices have demonstrated particular promise. While high-quality evidence specific to systemic sclerosis is still limited, these strategies are increasingly recognized as important components of care.
The review emphasizes that effective management must be personalized and holistic, involving coordinated input from rheumatologists, nurses, physiotherapists, nutritionists, psychologists, and occupational therapists. Interdisciplinary care can help patients achieve better symptom control and improved quality of life. The authors also note significant unmet needs in research and practice, calling for further studies to strengthen the evidence base and expand treatment options.
By adopting a broader view of systemic sclerosis care that includes both clinical and lifestyle-based strategies, healthcare teams can better address the persistent challenges of pain and fatigue in this complex disease.
Reference: Bonomi F. Pain and fatigue in systemic sclerosis: Practical strategies for non-pharmacological management. J Scleroderma Relat Disord. 2025. doi: 10.1177/23971983251369577
