Abstract
Objectives Severe fatigue in rheumatic diseases is prevalent, at approximately 50%, and intractable to conventional management in the majority of patients.[1,2] This review explores the impact of dietary interventions on reducing fatigue in patients with rheumatic diseases.
Methods The search strategy for this umbrella review was developed and executed in collaboration with a medical librarian, using MEDLINE, Embase, CINAHL, and Cochrane Library from inception to August 2025. Quality of included reviews was assessed using AMSTAR 2, and evidence for each intervention was assessed using GRADE methodology.
Results 2,715 results were retrieved and after removing duplicates, 2,218 unique results remained for title and abstract screening. 270 full-text records were assessed for eligibility, and 49 systematic reviews and meta-analyses were included. Among these, 6 reviews were rated high quality, 22 moderate, 9 low, and 12 critically low. Conditions included are fibromyalgia, systemic lupus erythematosus, rheumatoid arthritis, psoriatic arthritis, spondyloarthritis, Sjögren’s disease, and dermatomyositis. The certainty of evidence ranges from very low to moderate (Table).
Assessment of evidence quality for each intervention.
Conclusion There is moderate quality evidence to support Vitamin D supplementation, at 1,200 IU/day to 50,000 IU/week, and Fib-19-01 phytotherapy for fatigue management in rheumatic diseases. These interventions offer a new therapeutic opportunity for patients with intractable fatigue or desire to pursue natural therapies. Remaining evidence shows potential, but the low quality highlights a need for further research with rigorous study design. Furthermore, only patients with fibromyalgia and systemic lupus erythematosus are represented within the moderate quality evidence. Although shared pathways underlie fatigue in various rheumatic diseases, supporting generalizability of our findings, it remains important to create a representative evidence base to inform treatment.[3]
References [1.] Overman C. Clin Rheumatol 2016;35:409-15. [2.] van Eeden C. Expert Rev Clin Immunol 2022;18:1049-70. [3.] Davies K. Nature Rev Rheumatol 2021;17:651-64.
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