Review
Immune mechanisms underlying energy and fatigue in immune-inflammatory rheumatic diseases: a narrative review
F. D'acquisto1, A. Boolani2, E. Dainese3
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Italy; Department of Human Performance and Health Sciences, Oklahoma State University, Stillwater, OK, USA; and William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, UK. fdacquisto@unite.it
- Department of Human Performance and Health Sciences, Oklahoma State University, Stillwater, OK, USA.
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Italy.
CER33
Review
Received: 05/08/2026
Accepted : 25/09/2026
In Press: 19/10/2026
Abstract
Emerging research suggests that subjective experiences of energy and fatigue reflect dynamic immune system states, integrating emotional and physiological processes. Here we review evidence that energy and fatigue are distinct mood states with unique neurochemical, metabolic, and immunologic profiles, shaped by immunometabolism and immune resilience. We propose that immune system activation reallocates energy resources, influencing these states and contributing to fatigue in disease. Understanding this immune-energy interplay offers novel clinical insights, suggesting that interventions targeting immune resilience, such as tailored nutrition, exercise, emotional well-being cultivation, and novel pharmacological strategies, may alleviate fatigue and enhance vitality in rheumatologic conditions. This framework shifts the focus from symptom suppression to restoring immunesupported energy, with potential to improve patient quality of life.
