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RA Fatigue — SCE Rheumatology MCQ

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ModerateRheumatoid ArthritisRA FatigueSCE Rheumatology

A 58-year-old woman with rheumatoid arthritis reports persistent, function-limiting fatigue. She has no clinically swollen joints, her CRP is normal and her DAS28-CRP is 2.4 on stable DMARD therapy. Haemoglobin and thyroid function are normal, and screening does not suggest depression. What is the most appropriate next approach?

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Correct answer: E — Undertake multidimensional assessment and offer tailored fatigue management

The correct answer is E. RA fatigue is multidimensional and may remain clinically important despite control of inflammatory disease. Assessment should explore pain, sleep disturbance, medication effects, physical inactivity or deconditioning, fibromyalgia, comorbidity and psychosocial or contextual factors. Tailored physical activity and psychoeducational interventions should be considered through shared decision-making. Immunomodulatory treatment should be changed when clinically indicated by disease activity, not solely because fatigue persists in otherwise convincing remission, so A is inappropriate. MRI-detected inflammation does not routinely explain residual fatigue or justify escalation, making C unsuitable. Modafinil is not established first-line therapy for RA fatigue, and simple reassurance without assessment or management, as in E, neglects a disabling patient-reported outcome.

Reference: Dures E, Farisoğulları B, Santos EJF, et al. 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases. Ann Rheum Dis. 2024;83:1260–1267. https://pubmed.ncbi.nlm.nih.gov/38050029/