EULAR: Early and intensive treatment of rheumatoid arthritis reduces fatigue

EULAR: Early and intensive treatment of rheumatoid arthritis reduces fatigue

Early intensive treatment of rheumatoid arthritis can reduce disease-related tiredness, known as fatigue. This is the finding from a Belgian study presented at the EULAR, European League Against Rheumatism conference.

Many people with a rheumatic disease can suffer from a special type of tiredness, called fatigue. This disease-related fatigue can affect anyone and is, along with pain, one of the most common symptoms.

Fatigue is a tiredness that occurs when you sleep at night, wake up and do your morning routines, but still feel exhausted. Signs of fatigue may be that the body feels unnaturally heavy and difficult to move, fever-like symptoms, and/or a general feeling of tiredness. Many people with fatigue describe that they have difficulty thinking clearly, and lose their concentration and motivation. Some also describe it as a brain fog, and that it is difficult to escape from.

"As well as pain, fatigue reduces quality of life for many people, even more so than swelling in the joints," explains the President of EULAR, the European League Against Rheumatism, Professor Iain B McInnes from Glasgow, UK.

Early intensive treatment has a positive effect on fatigue

A recent Belgian two-year study examined the question of whether early intensive treatment of RA immediately after diagnosis has a positive effect on the course of the disease and offers an opportunity to manage fatigue. Using the same approach, the study also examined whether these mechanisms also apply to patients who have a lower risk of serious disease progression.

In the study, up to 90 percent of patients reported that they experienced fatigue. "Fatigue has a major impact on patients' lives and is perceived by many as difficult to manage. Early in the process, there is an opportunity to manage fatigue," said Dr Diederik De Cock, Katholieke Universiteit Leuven, Belgium, who conducted the study with his team.

80 patients with a low-risk profile were selected for the study. This risk profile was based, among other things, on low disease activity status. The participants in the study were randomly divided into two groups of 38 and 42 people, immediately after being diagnosed with RA. One group received the drug methotrexate while the other group received both methotrexate and cortisone as treatment *.

The results showed that patients who received both drugs for two years were less tired than patients who received methotrexate alone - although the disease activity in both groups was comparable over time. The levels of fatigue seemed to differ more and more over time between the groups.

"This underscores the importance of initiating optimal, intensive treatment early, even in so-called low-risk patients," said EULAR's Scientific President of the Congress, Professor John Isaacs of Newcastle University, UK. “Unfortunately, this is not yet standard practice. The study clearly shows how fatigue levels in early RA can be significantly improved.”

* The European League against Rheumatism (EULAR) 

* Adjustments to medication should always be made in consultation with your rheumatologist


  1. EULAR: Early and intensive treatment of rheumatoid arthritis reduces fatigue. Better quality of life for people with rheumatic and musculoskeletal diseases (2020)

  2. De Cock D, Nooyens A, Pazmino S et al. Treating early and intensively is associated with lower fatigue levels on the long term, even in patients with early Rheumatoid Arthritis considered to have a favourable risk profile.