A Systematic Review of Approaches to Manage Fatigue Among Children and Youth with Juvenile Idiopathic Arthritis

Objectives Children and youth with juvenile idiopathic arthritis (JIA) frequently experience fatigue, which adversely affects daily functioning. Fatigue is a common yet under-researched symptom in JIA. There is a need for evidence-based information on how to manage fatigue and to present this information in the JIA Option Map, a web-based patient decision aid for JIA symptoms. This systematic review (SR) aimed to determine the benefits and harms of approaches to manage fatigue for children and youth with JIA. Methods We conducted a comprehensive search of 5 major databases (MEDLINE, Embase, PsycINFO, CINAHL, and CENTRAL) from inception to September 2024. We included randomized controlled trials (RCTs), SRs and clinical practice guidelines (CPGs) evaluating approaches to manage fatigue compared to any control group in children and youth 0-21 years with JIA. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Cochrane RoB 2.0 (for RCTs), AMSTAR 2 (for SRs with a meta-analysis) and AGREE II (for CPGs). Certainty of evidence was appraised using GRADE. Evidence was summarized descriptively, and standardized mean differences and risk ratios were calculated where applicable. Reporting follows PRISMA guidelines. Results We included 4 RCTs and 2 SRs. The RCTs assessed laser therapy, exercises and self-management strategies. The SRs summarized existing evidence on physical activity and self-management approaches but did not conduct meta-analyses. No CPGs were included in this SR as they did not report recommendations specific to fatigue. Overall, RCTs were rated as having moderate to high risk of bias, resulting in low to moderate certainty of evidence. RCTs did not demonstrate statistically significant effects, except for 1 RCT, which showed with moderate certainty that adding low-level laser therapy to an exercise program reduced fatigue compared with exercise alone. No adverse events were reported. Conclusion We included 4 RCTs and 2 SRs. The RCTs assessed laser therapy, exercises and self-management strategies. The SRs summarized existing evidence on physical activity and self-management approaches but did not conduct meta-analyses. No CPGs were included in this SR as they did not report recommendations specific to fatigue. Overall, RCTs were rated as having moderate to high risk of bias, resulting in low to moderate certainty of evidence. RCTs did not demonstrate statistically significant effects, except for 1 RCT, which showed with moderate certainty that adding low-level laser therapy to an exercise program reduced fatigue compared with exercise alone. No adverse events were reported. This SR highlights the limited number of studies assessing interventions to manage fatigue in JIA. A low-level laser added to an exercise program RCT may improve fatigue; however, the certainty of the evidence was suboptimal, and adverse events were not reported. These findings will inform updates to the JIA Option Map to help support families’ and clinicians’ decision-making and will orient future research priorities. Supported by a CIORA grant .