Best Pract Res Clin Rheumatol. 2026 Jun 24:102159. doi: 10.1016/j.berh.2026.102159. Online ahead of print.

ABSTRACT

Fatigue is a common, debilitating, and challenging symptom in rheumatic diseases. Despite its clinical significance, the concept of fatigue remains difficult to define, and no universally accepted definition has yet been established. It is generally characterised by an overwhelming, persistent, and debilitating sense of exhaustion that impairs functional capacity and limits the performance of everyday activities. Reported prevalence rates of fatigue among patients with musculoskeletal disorders vary considerably, ranging from 35% to 82%. In this review, we examine the impact of fatigue on patients' quality of life, discuss available instruments for its assessment, and consider factors contributing to fatigue, including disease activity and psychological determinants. Furthermore, we summarise experimental studies that have sought to elucidate the biological mechanisms underlying fatigue. The management of fatigue, encompassing both pharmacological and non-pharmacological approaches, is also addressed. Overall, the available evidence concerning fatigue in rheumatic diseases remains limited, and further research is warranted to clarify the contribution of biological mechanisms-such as inflammation, hormonal alterations, and dysfunction of the autonomic nervous system-to the pathogenesis of fatigue.

PMID:42342507 | DOI:10.1016/j.berh.2026.102159