What treatments relieve arthritis and fatigue associated with systemic lupus erythematosus?

Nondrug treatments for fatigue
 produce mixed results


Studies of nondrug treatment of SLE-associated fatigue show inconsistent results. A systematic review of nonpharmacologic interventions for fatigue in several chronic diseases found 2 RCTs and 4 quasi-experimental studies that included 324 patients with SLE.⁶ Of 4 studies that evaluated the effect of exercise, 2 showed improvement and 2 didn’t. Neither group self-management nor relaxation therapy and telephone counseling significantly relieved fatigue.^6-8 A small RCT (24 patients) found no benefit for acupuncture over sham needling in treating pain and fatigue in SLE.⁹

RECOMMENDATIONS

Methotrexate reduced arthralgias by as much as 79%, but produced adverse effects in up to 70% of patients. The American College of Rheumatology guideline for referral and management of SLE states that “NSAIDs are sometimes helpful for control of fever, arthritis, and mild serositis. Antimalarial agents (eg, hydroxychloroquine) are useful for skin and joint manifestations of SLE, for preventing flares, and for other constitutional symptoms of the disease. They may also reduce fatigue.”¹⁰

The European League Against Rheumatism recommends antimalarials or glucocorticoids to treat patients with SLE without major organ manifestations. They also say clinicians may try NSAIDs for limited periods of time in patients at low risk for the drugs’ complications.¹¹