Managing fatigue in autoimmune diseases: biopsychosocial insights and public health implications

Abstract Background Fatigue is highly prevalent in autoimmune diseases, such as multiple sclerosis (MS) and rheumatoid arthritis (RA), yet it is rarely addressed in treatment. Therefore, we aimed to identify the biopsychosocial factors affecting fatigue to guide effective non-pharmacological interventions in these diseases. Methods We included 166 MS and 157 RA patients (75.3%/84.7% female; mean age 41±11.3/ 41±11.3/56.4±13.9 years; mean disease duration 11.6±7.1/19.5±9.5 years). All participants completed the Multidimensional Fatigue Inventory, Brief Illness Perception Questionnaire, General Health Questionnaire, 36-item Short Form Health Survey, and Morisky Medication Adherence Scales. Correlations and multiple linear regressions were used to analyse the data. Results RA and MS showed comparable fatigue levels. Bivariate analyses revealed significant associations between higher pain, severe depression, and more threatening illness perception with fatigue in both MS and RA, respectively. No associations were found between sex, disease duration, treatment adherence and fatigue. Multiple regression analyses revealed that pain (β=-.18; p ≤ 0.05/β=-.34; p ≤ 0.001) and illness perception (β=.50; p ≤ 0.001/β=.24; p ≤ 0.01) were significantly associated with fatigue in the final model, for both MS and RA. In addition, age (β=.13; p ≤ 0.05) and depression (β=.18; p ≤ 0.01) were also significantly associated with fatigue in MS. The explained variance in the final regression model was 46% for MS and 51% for RA. Conclusions Our findings highlight the importance of routinely assessing fatigue and integrating nonpharmacological interventions for fatigue management into clinical practice for autoimmune diseases. Public health efforts should focus on developing and implementing guidelines for multidisciplinary approaches to fatigue management in MS and RA, aiming to enhance patient quality of life while reducing healthcare costs. (Grants: VEGA:1/0608/23; APVV-22-0587) Key messages • Reducing fatigue in autoimmune conditions by addressing pain, depression, and illness perception may improve disease management and help to reduce the burden of disability-adjusted life years. • Non-pharmacological fatigue interventions may offer a low-cost path to better outcomes in autoimmune disease.