Concordance With Active Disease
RA disease activity and fatigue are correlated in many studies, but often the associations are weak. When patients with RA flare, usually pain and fatigue increase. For instance, fatigue was associated with flare in RA patients with the TNF inhibitor dose decreased, but other variables had more impact in the analyses such as baseline DAS28 and mental health.
The mean fatigue in RA patients studied cross-sectionally was 4/10, with 40% having severe fatigue. Associations with fatigue are not necessarily consistent between studies. High fatigue in one study was associated with females, disease activity, function, treatment and multimorbidity . However, significant fatigue in RA in another study was associated with self-rated poor health, pain and anxiety/depression but not physical capacity/function.
How Do You Fight Fatigue From Rheumatoid Arthritis
– Learn to say “no” sometimes.- Don’t plan to do too much at once.- Reconsider and adapt your goals.- Plan activities carefully, take your time, spread out demanding tasks across the week.- Take breaks before you become too exhausted.- Get to bed early, take naps and learn relaxation techniques.
Rheumatoid Arthritis – Disease Overview | Johns Hopkins
Limitations Of The Available Data
It is first worth highlighting that a range of measures exist to study fatigue within RA populations . These measures, which have been validated to a greater or lesser extent within the population, may measure various things such as the magnitude or qualities of fatigue, including severity, impact or coping , or Numerical Rating Scales ). Measures may also distinguish between mental and physical fatigue or include assessment of both the quality and type of fatigue, such as measuring physical fatigue, emotional fatigue and the social consequences of fatigue ). Finally, measures may position people on a continuum from energy to fatigue ). It is clear that the measures used may have substantial impacts on the associations observed if a predictor is differentially associated with distinct dimensions of fatigue . It is notable that few studies have used scales that capture the multidimensionality of fatigue, instead relying on single-item visual analogue scales, or numerical rating scales . Equally, there is no consistency in the definitions and measures used to capture exposures of interest and no single study has investigated all predictors of interest, making it likely that residual confounding exists and precluding the development of an evidence-based causal model/diagram of fatigue.
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Check For Thyroid Issues
RA is, as you know, an autoimmune disease. People with an autoimmune condition are more likely to develop another autoimmune condition. One of those conditions that often pairs up with RA is thyroid disease, says Dr. Cappelli. Low thyroid activity, hypothyroidism, causesyou guessed itfatigue. Its reasonable to ask your doctor for a blood test to check for hypothyroidism, she says, even if you dont have some of the other symptoms of the condition, including weight gain, constipation, dizziness, muscle cramps, a hoarse voice, and dry, scaly skin.
Funny Thing About Rheumatoid Arthritis Fatigue
I have read as many times that depression causes Rheumatoid Arthritis fatigue as I have read that fatigue causes depression. This is not a fair fight. We have to fight the fatigue while we are in a state of chemically-induced tiredness.
And we must fight back depression from an exhausted state. And how could we be anything BUT fatigued when managing such extreme pain levels over an extended time?
Other legitimate theories for explaining the fatigue of RA include anemia and nutritional deficiencies. Red blood cells can be reduced by both the disease and some of its treatments. Similarly, both Rheumatoid Arthritis and many of the medicines prescribed for it tend to curb normal appetite so nutrition may suffer. The impact of diet and nutrition in RA is being studied, including Vitamin D and potassium.
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What Causes Chronic Fatigue
Fatigue is one of the common symptoms of rheumatoid arthritis. It can be one of the first warning signs of RA before the diagnosis is confirmed. For many patients, the onset of chronic fatigue symptoms associated with rheumatoid arthritis can be vague and difficult to categorize and may be attributed to other causes.
The cause of chronic fatigue can sometimes be difficult to identify because there are many factors to consider. Some of the different factors that cause chronic fatigue include:
- Poor sleeping patterns
- Poor diet and lack of physical activity
In addition to the regular rheumatoid arthritis symptoms, fatigue becomes even more chronic and debilitating when other medical complications are involved. Fibromyalgia, obesity, heart disease, respiratory disease such as COPD, and depression, are a few examples that can complicate and worsen the effects of fatigue.
Reason : You Have A Lot Going On
Finally, those with RA often spend more time at doctors appointments and often face painful treatments, which can be disruptive to their schedule and well-being. All of which can lead to increased fatigue. One tip Dr. Hylland recommends to his patients is to invite your spouse to your doctor appointments at least once. This gives them a glimpse into what youre facing in these appointments. Asking for help is key to alleviating RA fatigue, and its easier to do that when your partner is an active participant in your care.
The Impact of Fatigue:Rheumatology . The Impact of Fatigue in Rheumatoid Arthritis and the Challenges of its Assessment.
Inflammatory Proteins:Rheumatology. Patients Receiving Anti-TNF Therapies Experience Clinically Important Improvements In RA-Related Fatigue: Results From The British Society For Rheumatology Biologics Register For Rheumatoid Arthritis.
Other Medical Conditions:Advances in Therapy. Prevalence of Co-existing Autoimmune Disease in Rheumatoid Arthritis: A Cross-Sectional Study.
Depression and RA:International Journal of Clinical Rheumatology. Depression in Patients with Rheumatoid Arthritis: Description, Causes and Mechanisms.
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What Is Ra Fatigue And What Causes It
Chronic fatigue in RA is described as having the following characteristics:
- Extremely low physical and mental energy that may be difficult to explain to other people, more than just tiredness
- Lack of motivation
A 2015 systematic review of 29 observational studies involving 21,076 patients found that the symptom most consistently associated with fatigue was a low mood . Researchers concluded that interventions focusing on mental health and perceptions of RA may be helpful for those who experience fatigue .
One literature review explained that disease activity is associated with RA fatigue. However, RA medications that reduce disease activity such as methotrexate and biologic DMARDs have small impacts on fatigue . This suggests that other factors including obesity, physical inactivity, disrupted sleep , and depression may also contribute to fatigue in RA.
One other interesting review of chronic pain and fatigue suggests that fatigue may be an adaptive evolutionary strategy that weve learned to help us rest and prevent further pain and nervous system stress . While this knowledge doesnt negate the powerful impact fatigue has on a persons quality of life, it may be comforting to know that fatigue is, from the physical bodys perspective, a healing strategy meant to keep you alive and safe.
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Consequences Permeate Every Sphere Of Life
The consequences of fatigue permeate every part of life such that activities are reduced to a minimum or âdumbed downâ: âIt affects everything. It sort of dumbs down everything that I want to do reallyâ . Participants struggled to carry on with work, leisure, and household activities: âWell, Ive always liked to go out to dancing, and liked night clubs, and now I find I just dont have the energy to do that any moreâ âWhen I get home I feel as though Ive done a weeks, what I should have done in a week, and weve just gone and got some groceries. I mean my husband brings it in and unpacks it and puts it all away, which I would normally do and I just collapse on a chair. It just, I dont know, it just dont seem rightâ .
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How Does Fatigue Change Your Life
Fatigue is different than normal feelings of tiredness. People describe it as being overwhelming and uncontrollable. They feel worn out and drained of energy, and sometimes even lose all interest in anything.
It can increase the need for sleep and make it hard to concentrate or do anything. Constantly feeling exhausted and not being able to maintain an active lifestyle can affect your mood too: Many people who have rheumatoid arthritis also feel depressed, irritable or anxious. These feelings can be hard for others to fully understand.
The severity of rheumatoid arthritis symptoms may vary a lot over time. This can make it difficult to plan ahead. You don’t know how you will feel the next day or whether the symptoms will get better or worse. This means that people with rheumatoid arthritis feel like they have lost control of their lives. If they are too exhausted, they may not have enough energy even for simple everyday activities or for playing with their children or grandchildren. Appointments may need to be rescheduled, and some people give up their favorite activities if they prove to be too demanding.
And at work it may be difficult to accept that you can’t do as much as you used to. You might need more breaks, or certain tasks might need to be reassigned.
Study Design And Procedure
All participants were invited to attend four separate clinical examinations, three months apart, during the course of the study, in order to capture the four seasons. At these examinations, demographic and disease-related data were collected and questionnaires aimed at assessing the level of fatigue were administered. To obtain a nuanced picture of the variations in fatigue levels and to ensure that information was recorded during all four seasons, fatigue assessment questionnaires were also sent to the participants between clinical examinations. The participants thus filled in fatigue assessment questionnaires at seven time points during the course of the study .
Fig. 1
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Disease Activity And Inflammation
Historically, fatigue has been perceived to be caused by disease-specific processes, such as inflammation and joint damage . Pro-inflammatory cytokines, which are pivotal to RA progression, have been linked to fatigue via sickness behaviour and it is possible that these inflammatory processes initially trigger fatigue in RA . Certainly, while the apparent response of fatigue to inflammation-focused interventions would indicate that an association between inflammatory disease activity and fatigue exists, it is now widely recognized that fatigue persists despite receiving the best available care for their disease , although anti-inflammatory pharmacological interventions do confer reductions in fatigue in subgroups of patients .
Where an association has been observed between inflammation and fatigue prognosis, it has tended to show both that higher and lower inflammation is associated with greater fatigue, depending on the study in question. Further, within a path analysis model , we found that when DAS-28 was substituted for ESR or CRP the direct relationship between disease activity and fatigue disappeared, indicating that it may be that the patient reported/influenced , which drive the associations between DAS-28 and fatigue. Overall, the balance of evidence would seem to indicate that while fatigue prognosis may be associated with composite measures of disease activity , it is not consistently predicted by traditional measures of inflammation, such as CRP or ESR .
What Kind Of Treatment Could Help Against Fatigue
Sometimes is still a major problem despite adjusting your daily schedule, doing physical exercise and getting support from other people. Then professional help may be an option, for instance in the form of psychological treatment or occupational therapy. Some specialized programs have been developed specifically for people who have fatigue as a result of autoimmune diseases like rheumatoid arthritis. They’re designed to do things like help you plan activities and make sure you don’t use up all of your energy at once.
Cognitive behavioral therapy strategies can also be learned to help cope with . Some involve recognizing and then changing certain thoughts, beliefs and behaviors that make it more difficult to live with the disease.
Studies on non-drug treatments show that approaches used in occupational therapy and psychotherapy can relieve exhaustion.
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Symptoms Of Rheumatoid Arthritis
The symptoms of Rheumatoid Arthritis vary from one person to another and there is no known cure for this disease. It often starts with joint pain in the small and medium joints in the hands and feet, which then spreads to other joints over time. Sometimes it affects the large joints, such as hips or knees, but not always.
The severity of RA can range from mild to severe, which means that it may only affect a few joints or every joint in the body. When all joints are affected by RA, its called polyarticular disease, whereas when only a few joints are affected, its called oligoarticular disease.
RA commonly affects your hands and feet but may also occur in other parts of your body such as your elbows, knees, ankles, neck or shoulders. Rheumatoid arthritis symptoms may also occur at different times. For example, you may experience morning stiffness followed by periods of less pain and a greater range of motion as the day goes on. Also, symptoms can come and go for a short period of time before becoming more constant over time. Rheumatoid arthritis symptoms include:
Some common symptoms of RA include:
- Morning stiffness in your joints lasting longer than 30 minutes
- Joint pain or stiffness that worsens with activity
- Swelling from inflammation in your bodys tissues
- Weakness or fatigue because RA interferes with sleep patterns and restful slumber
- Tenderness, swelling or warmth in joints
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Look Out For Signs Of Depression
People with chronic pain are four times more likely to experience depression than the general population. Symptoms of depression include:
People with depression may also have marked changes in their appetite and sleep habits.
If you have symptoms of depression along with fatigue, talk to your doctor. They can prescribe antidepressants or talk therapy, or both. Since fatigue is a symptom of depression, treating your depression may help relieve your fatigue too.
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Get The Facts About Jak Inhibitors The Newest Class Of Fda
2. Kick-start your exercise routine. Inactivity can be a vicious circle RA fatigue makes it hard to get moving, and inactivity makes fatigue worse,â Ali explains. âMost people with RA do feel energized after exercise. It may help to work with a physical therapist to get started.â The best exercises for people with RA are often low-impact activities like stationary cycling, swimming, and walking.
3. Nix the naps. A good nights sleep requires healthy sleep habits. If possible, avoid napping during the day. You need to be awake for about 16 hours in order to sleep well at night for example, getting up at 7 a.m. and going to bed at 11 p.m. When you do turn in, keep your bedroom quiet, dark, and comfortable and avoid making it an entertainment center . Also, skip the alcohol and heavy meals before bedtime and limit caffeine after noon. Going to bed and waking up at the same time every day can also help you establish a quality sleep routine that leaves you feeling refreshed.
6. Ask your doctor about medications for fatigue. Certain medications may help chronic fatigue, such as modafinil. However, âyou need to use these with caution, because once you start taking them, it may be hard to stop,â Ali says. âTramadol is a pain medication that can help improve sleep thats disrupted by RA pain. As another option, a low-dose antidepressant, also given at bedtime, has been shown to reduce pain, increase sleep, and reduce fatigue in some people with RA,â he says.
Strategies To Boost Your Energy
Any plan to fight fatigue begins with taking good care of yourself. Start with these tips to help you manage chronic RA fatigue and regain energy.
1. Talk to your doctor about controlling RA inflammation. You dont need to battle fatigue on your own working with your doctor to get any underlying RA-related inflammation under control can help significantly. Cytokines proteins produced by cells can amplify inflammation, which may have a direct influence on brain receptors to cause fatigue. So the first step is to work with your rheumatologist to get inflammation under control, Ali says. Medications that decrease inflammation often decrease fatigue.
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Are The Causes Of Ra
On balance, and based on the available evidence, it appears likely that the predictors of fatigue are not unique to RA populations. Rather, some of the most consistent candidates have been identified as predictors in other rheumatic diseases, such as osteoarthritis and fibromyalgia, as well as in a broader range of long-term medical conditions such as multiple sclerosis and cancer . Together, this points towards an as yet untested hypothesis that fatigue, its prognostic factors, and therefore its optimal treatment strategy, may be common across many long-term illnesses, irrespective of whether they have an inflammatory aetiology. Future studies may benefit from investigating this hypothesis with a view to developing generic fatigue interventions across a range of chronic conditions.
How Do People Cope With Exhaustion
Many people gradually come to learn how to regulate their energy better and to accept the changes associated with the condition. They pay more attention to their body’s signals and then adjust what kinds of activities they do based on their symptoms.
As well as the phases where the arthritis gets much worse, there are also periods where it’s possible to live a quite normal life. It often helps to start seeing the condition as a part of your life and to set new goals that you can still achieve anyway. Some people say that the disease has helped them to live their lives more consciously.
Many mention in interviews that they’ve discovered practical ways of dealing with :
- Learn to say “no” sometimes
- Don’t plan to do too much at once
- Reconsider and adapt your goals
- Plan activities carefully, take your time, spread out demanding tasks across the week.
- Take breaks before you become too exhausted
- Get to bed early, take naps and learn relaxation techniques
- Avoid going out at busy times of the day, for instance when you go shopping or on a trip
- Talk with others about your disease so that they can better understand how it affects you
- Talk to others who have rheumatoid arthritis so that you can learn from their experiences
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