2023 EULAR RECOMMENDATIONS FOR THE MANAGEMENT OF FATIGUE IN PEOPLE WITH INFLAMMATORY RHEUMATIC AND MUSCULOSKELETAL DISEASES

E. Dures, B. Farisogullari, E. Santos, A. Moltó, C. Feldthusen, C. Harris, C. Elling-Audersch, D. Connolly, E. Elefante, F. Estevez-Lopez, I. Bini, J. Primdahl, K. Hoeper, M. Urban, M. V. D. Laar, M. Redondo, P. Böhm, R. Amarnani, R. Hayward, R. Geenen, S. Rednic, S. Pettersson, T. Thomsen, T. Uhlig, V. Ritschl, P. MachadoBristol Royal Infirmary, Academic Rheumatology, Bristol, United Kingdom University of the West of England, Faculty of Health and Applied Sciences, Bristol, United Kingdom Hacettepe University, Faculty of Medicine, Division of Rheumatology, Department of Internal Medicine, Ankara, Turkey Nursing School of Coimbra (ESEnfC), Health Sciences Research Unit: Nursing (UICISA: E), Coimbra, Portugal Hospital Cochin, Rheumatology Department, Paris, France Institute of Neuroscience and Physiology, University of Gothenburg, Department of Health and Rehabilitation, Unit of Physiotherapy, Sahlgrenska Academy, Gothenburg, Sweden Northwick Park Hospital, London North West University Healthcare NHS Trust, Department of Rheumatology, London, United Kingdom Deutsche Rheuma-Liga Bundesverband e.V., Patient Research Partner, Bonn, Germany School of Medicine, Trinity College Dublin, Discipline of Occupational Therapy, Dublin, Ireland Azienda Ospedaliero-Universitaria Pisana, Rheumatology Unit, Pisa, Italy Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, United States of America Faculty of Education Sciences, CERNEP Research Center, University of Almería, Department of Education, Almería, Spain EULAR, Young PARE, Zürich, Switzerland Anmar, Young, Rome, Italy University of Southern Denmark, Department of Regional Health Research, Odense, Denmark University Hospital of Southern Denmark, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark Hannover Medical School, Department of Rheumatology and Immunology, Hannover, Germany University Hospitals Bristol, Research Design Service, Bristol, United Kingdom University of Twente, Department of Psychology, Health and Technology, Enschede, Netherlands Camilo José Cela University, Faculty of Heath Sciences, Madrid, United Kingdom German League against rheumatism, Forschungspartner, Bonn, Germany Barts Health NHS Trust, Barts Health Rheumatology Service, London, United Kingdom Utrecht University, Department of Psychology, Utrecht, Netherlands University of Medicine and Pharmacy Iuliu Hatieganu Cluj, Department Rheumatology, Cluj, Romania Karolinska University hospital, Rheumatology Unit, Stockholm, Sweden Karolinska Institute, Division of Rheumatology, Department of Medicine Solna, Stockholm, Sweden University of Copenhagen, Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases VRR, Rigshospitalet, Copenhagen, Denmark Diakonhjemmet Hospital, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Oslo, Norway Medical University of Vienna, Institute for Outcomes Research, Center for Medical Data Science, Vienna, Austria University College London, Centre for Rheumatology & Department of Neuromuscular Diseases, London, United Kingdom University College London Hospitals NHS Foundation Trust, National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, London, United Kingdom  Background Fatigue is prevalent in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and recognised as one of the most challenging symptoms to manage [1]. The existence of multiple factors associated with fatigue, the lack of clarity around underlying pathophysiological mechanisms and the limited evidence about what helps have led to a multifaceted and often fragmented approach to symptom management. However, there are no recommendations for fatigue management in people with I-RMDs, and this lack of guidance has been challenging for those living with fatigue as well as for healthcare professionals delivering clinical care. Objectives To develop EULAR recommendations for the management of fatigue in people with I-RMDs. Methods A multi-disciplinary taskforce comprising 26 members from 14 European countries was convened and two systematic reviews were conducted. The taskforce developed recommendations based on evidence from the systematic reviews and taskforce members’ personal and professional experience of fatigue in I-RMDs. Results Four overarching principles and four recommendations were developed (Table 1), including health professionals’ awareness that fatigue should be monitored and assessed and that people with I-RMDs should be offered management options. Shared decisions about fatigue management should consider the needs and preferences of individuals, their clinical disease activity, comorbidities and other psychosocial and contextual factors (Table 1). Conclusion These 2023 EULAR recommendations provide consensus and up-to-date guidance on the management of fatigue in people with I-RMDs. Reference [1]Dures E, et al. Fatigue in inflammatory arthritis. Best Pract Res Clin Rheumatol 2020;34. Table 1. EULAR overarching principles and recommendations for the management of fatigue in people with I-RMDs. Overarching principles 1. Health professionals should be aware that fatigue encompasses multiple and mutually interacting biological, psychological and social factors. 2. In people with I-RMDs, fatigue should be monitored, and management options should be offered as part of their clinical care. 3. Management of fatigue should be a shared decision between the person with an I-RMD and healthcare and well-being professionals. 4. Management of fatigue should be based on the needs and preferences of people with I-RMDs, as well as their clinical disease activity, comorbidities and other individual psychosocial and/or contextual factors. Recommendations LoE GoR 1. Healthcare professionals should incorporate regular assessment of fatigue severity, impact and coping strategies into clinical consultations. 5 D 2. As part of their clinical care, people with I-RMDs and fatigue should be offered access to tailored physical activity interventions and encouraged to engage in long-term physical activity. 1a A 3. As part of their clinical care, people with I-RMDs and fatigue should be offered access to structured and tailored psychoeducational interventions. 1a A 4. The presence or worsening of fatigue should trigger evaluation of inflammatory disease activity status and consideration of immunomodulatory treatment initiation or change, if clinically indicated. 1a A I-RMDs, inflammatory rheumatic and musculoskeletal diseases; GoR, Grade of recommendation; LoE, Level of Evidence. GoR and LoE as per 2011 Oxford Centre for Evidence Based Medicine Levels of Evidence. Acknowledgements B Farisogullari and E Santos contributed equally to the manuscript. Disclosure of Interests Emma Dures: None declared, Bayram Farisogullari: None declared, Eduardo Santos: None declared, Anna Moltó: None declared, Caroline Feldthusen: None declared, Claire Harris: None declared, Corinna Elling-Audersch: None declared, Deirdre Connolly: None declared, Elena Elefante: None declared, Fernando Estevez-Lopez: None declared, Ilaria Bini: None declared, Jette Primdahl: None declared, Kirsten Hoeper Speakers bureau: AbbVie, Novartis, Galapagos, Consultant of: AbbVie, Novartis, Galapagos, Marie Urban: None declared, Mart van de Laar: None declared, Marta Redondo: None declared, Peter Böhm: None declared, Raj Amarnani: None declared, Rhys Hayward Speakers bureau: Abbvie, Rinie Geenen: None declared, Simona Rednic: None declared, Susanne Pettersson: None declared, Tanja Thomsen: None declared, Till Uhlig: None declared, Valentin Ritschl: None declared, Pedro Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB. Keywords: Patient reported outcomes, Health Services Research DOI: 10.1136/annrheumdis-2023-eular.2793Citation: , volume 82, supplement 1, year 2023, page 437Session: Health, public health and health services (Poster Tours)