title: Fatigue in patients with juvenile idiopathic arthritis: A systematic review of the literature.
abstract: OBJECTIVE
  To perform a systematic review of the current literature on studies related to fatigue in children with JIA. We studied the measurements that were used to assess fatigue and we focused on three outcome measurements, namely, (1) the prevalence of fatigue in JIA patients, (2) the determinants of and associations with fatigue in JIA patients, and (3) the impact of fatigue in JIA patients on daily life.
  
  
  METHODS
  A search was conducted in the electronic databases Pubmed and Embase from January 1, 2000 until August 27, 2015. The quality in prognostic factors (QUIPS) tool was used to assess the risk of bias (ROB) in the selected studies, focused on the outcome fatigue. Of all, two authors independently judged the ROB.
  
  
  RESULTS
  A total of 15 studies were included in this review. To assess fatigue, two unidimensional and three multidimensional scales were used, which hampered comparison. Fatigue was reported to be present in 60-76% of the patients with JIA and was related to time of day, disease activity, pain, psychosocial factors, and sleep. Minor consequences for daily life were found, though this was not studied extensively.
  
  
  CONCLUSIONS
  Fatigue is common in patients with JIA. The cause reflects a complex interplay of different factors. Based on results from this review and its body of knowledge, a conceptual model for fatigue in patients with JIA is proposed. Consensus is needed for future studies on how to assess fatigue. We promote the use of a combination of unidimensional and validated multidimensional measurements.
authors.affiliation: Department of Pediatric Rheumatology, Beatrix Children's Hospital, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands. Electronic address: w.armbrust@umcg.nl.
authors.forename: Wineke
authors.initials: W
authors.lastname: Armbrust
authors.affiliation: Center for Human Movement Sciences, University Medical Center Groningen (UMCG), University of Groningen, A. Deusinglaan 1, Groningen, The Netherlands.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Siers
authors.affiliation: Center for Rehabilitation, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, Groningen, The Netherlands.
authors.forename: Otto T H M
authors.initials: OT
authors.lastname: Lelieveld
authors.affiliation: Center for Human Movement Sciences, University Medical Center Groningen (UMCG), University of Groningen, A. Deusinglaan 1, Groningen, The Netherlands.
authors.forename: Leonora J
authors.initials: LJ
authors.lastname: Mouton
authors.affiliation: Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Oostersingel, entrance 45, Groningen, The Netherlands.
authors.forename: Jolanda
authors.initials: J
authors.lastname: Tuinstra
authors.affiliation: Department of Pediatric Rheumatology, Beatrix Children׳s Hospital, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, Groningen, The Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Sauer
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D001171:Arthritis, Juvenile / Q000150:complications* / Q000453:epidemiology; D002648:Child; D005221:Fatigue / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D015995:Prevalence; D011788:Quality of Life
keywords: Conceptual model; Fatigue; Juvenile idiopathic arthritis (JIA); Pain; Patient reported outcome measures (PROM); Systematic review