The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding) and by inconsistency (unexplained variability in results).
A Cochrane review [Abstract] 1 included 24 studies with a total of 2 882 subjects with rheumatoid arthritis. Included studies investigated physical activity interventions (6 studies, n=388), psychosocial interventions (13 studies, n=1 579), herbal medicine (1 study, n=58), omega-3 fatty acid supplementation (1 study, n=81), Mediterranean diet (1 study, n=51), reflexology (1 study, n=11) and the provision of Health Tracker information (1 study, n=714).
The 6 studies investigating physical activity interventions included pool-based therapy, yoga, dynamic strength training, stationary cycling, low impact aerobics, and Tai Chi. Thirteen studies were broadly categorised as investigating psychosocial interventions; these included benefit finding, expressive writing, cognitive behavioural therapy, mindfulness, lifestyle management, energy conservation, self-management, and group education.
Physical activity was statistically significantly more effective than the control at the end of the intervention period (SMD -0.36, 95% CI -0.62 to -0.10; back translated to mean difference (MD) of 14.4 points lower, 95% CI -4.0 to -24.8 on a 100 point scale where a lower score means less fatigue; NNTB 7, 95% CI 4 to 26) demonstrating a small beneficial effect upon fatigue. Psychosocial intervention was statistically significantly more effective than the control at the end of the intervention period (SMD -0.24, 95% CI -0.40 to -0.07; back translated to mean difference of 9.6 points lower, 95% CI -2.8 to -16.0 on a 100 point scale; NNTB 10, 95% CI 6 to 33) demonstrating a small beneficial effect upon fatigue. For the remaining interventions meta-analysis was not possible and there was either no statistically significant difference between trial arms or findings were not reported. Only three studies reported any adverse events and none of these were serious, however, it is possible that the low incidence was in part due to poor reporting.
The optimal parameters and components of these interventions are not yet established.
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