In this study, patients with RA had a total fatigue level score of (22.65 ± 14.54), which was lower than the findings by Shen et al. [6], most likely due to the good standard of medical care and healthcare facilities in the city where this study was carried out. The majority of RA patients were aware of their level of fatigue, and the population under examination in this study was 55.06 ± 0.48 years old, which was a clear indication of fatigue symptoms. The resilience score of RA patients was (27.41 ± 8.12), which was moderate and higher than the findings of Ye et al. [25]. The reason could be 36.9% of the study population had the disease for 1 to 5 years, and the disease was still at a controllable stage; thus, the psychological burden of the patients was low. For example, RA patients had a self-efficacy score of (45.92 ± 16.36), which was at an intermediate level, similar to the results of Zhao et al [26]. However, self-efficacy of RA patients is primarily influenced by their ability to manage illness. RA patients cannot engage in effective long-term self-management due to long disease duration, recurrent disease, and high financial burden. The scores for the PCS and MCS used in this study were (24.52 ± 6.00) and (56.72 ± 11.33), respectively, with somatic dimension scores significantly lower than the national norm for the general population, consistent with the findings of Bai et al. [27], indicating that the self-management capacity of RA patients is severely affected by the disease. In this study, RA patients had moderate ratings of fatigue, resilience, and self-efficacy, with some MCS problems and generally low ratings of QOL, indicating that there is much room for development in health promotion for RA patients and that the QOL level of RA patients and the factors affecting it deserve the critical attention of medical staff.

However, there was a significant correlation between fatigue and QOL among RA patients (P < 0.01), which is consistent with the findings of Yoshii et al. [28] and Tański et al. [29], further confirming that fatigue has a significant impact on the QOL of RA patients. The results of this study are consistent with those of other researchers. Fatigue is a more common symptom in RA patients, characterized by uncontrollable and unrelieved rest [30], which leads to reduced ability to live, negative emotions, impaired work capacity, and ultimately reduced QOL for patients. According to Papa et al. [31], fatigue in RA patients is linked to pain, disease activity, mood, and other factors, which can be treated and managed by themselves in several ways, including active psychological interventions, the development of regular exercise programs, and positive thought therapy. For this reason, the level of fatigue should be actively evaluated in the clinical management of RA patients [32], and treatment plans should be implemented to facilitate negative psychological emotions, reduce fatigue, and improve QOL.

It was found that fatigue in RA patients significantly mediated QOL somatic health and MCS dimensions over resilience (95% CI−0.068,−0.001 and−0.065,−0.017, respectively, with total effect mediated by 8.88% and 10.79%, respectively), i.e., fatigue acted on QOL somatic health and MCS dimensions by 8.88% and 10.79% acted through resilience, which is similar to the findings of Liu et al. [33]. As a positive psychological resource, resilience helps patients flexibly choose coping strategies tailored to their specific needs [34] and mitigates the impact of diverse stressors on their physical and MCS. Conversely, RA patients with higher levels of fatigue may cope negatively with the disease due to recurrent disease and lack of knowledge about the disease, which leads to anxiety and depression, as well as impulsive behavior, resulting in low levels of resilience and a consequent poorer ability to cope with stress, which in turn affects the QOL. Clinical work allows medical staff to assess resilience as part of treatment [35], as well as actively explore methods and strategies for increasing patients’ confidence and initiative, improving resilience, reducing fatigue, and promoting health through measures such as stepwise health education, encouragement to participate in social activities, and flexibility training [10].

The results of the pathway analysis showed that fatigue in RA patients significantly mediated self-efficacy on QOL somatic health and MCS dimensions (95% CI−0.070,−0.007 and−0.075,−0.024, respectively, with total effect mediation of 10.03% and 8.99%, respectively), i.e., fatigue acted on QOL somatic health and MCS dimensions by 10.03% and 8.99% acted through self-efficacy, which is similar to the results of Suh et al. [12] The purpose of this study was to assess the impact of the intervention. Patient self-efficacy is a determinant of patients’ intentions and behaviors, a key protection for controlling patients’ illness, and is associated with factors such as fatigue and psychological mood [36]. More fatigued RA patients were less compliant and motivated to get treated [37], leading to lower self-efficacy, negative mood, and poorer QOL. Improving self-efficacy in RA patients is primarily associated with increased physical activity and improved drug compliance [37]. Personalized intervention programs are developed through health education to improve patient self-management, self-efficacy, and healthy behavior, thereby improving patient disease outcomes.

In summary, the results of this study indicate that resilience and self-efficacy in people with RA play a chain mediating effect between fatigue and both the somatic and MCS dimensions of QOL (95% CI−0.014,−0.001 and−0.017,−0.003 respectively, accounting for 2.01% and 2.16% of the total effect values). Patients with RA who had higher levels of fatigue were less able to psychologically rebound while facing stress, affecting their ability to self-manage their illness and, in turn, their QOL. Conversely, RA patients with less fatigue may gain new resilience amid constant challenges [7] and have a correspondingly higher level of resilience, greater competence and confidence in disease management, and a higher QOL. Psychologically resilient RA patients are better able to manage the negative emotions associated with their condition [37], decide to accept and be open in the face of stress, and typically have higher levels of self-efficacy. As a contributor to patients’ QOL, self-efficacy may also help RA patients to manage disease progression, reduce fatigue, and achieve effective self-management. Thus, when managing illness and improving the QOL in RA patients, the assessment of the level of resilience and self-efficacy should be considered an important component of chronic disease management to increase patients’ confidence in coping with illness, enhance their ability to manage chronic illness and improve their QOL.