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.
Ways To Fight Chronic Fatigue
Fighting fatigue for rheumatoid arthritis patients can be a challenge. However, there are some ways to improve your energy levels and lessen chronic fatigue. Here are some of the things you can do to help fight chronic fatigue in your daily life:
- Exercise regularly
- Rule out medication side effects
- Seek counseling and support
What Are The Features Of Fatigue
Common features of fatigue include:
- your body and limbs feeling heavy and difficult to move
- flu-like feelings of exhaustion
- the feeling that your energy has drained away.
Many people also report mental fatigue, when they cant think straight and lose their concentration or motivation. Some people refer to this as brain fog. Some people report an emotional fatigue which makes them irritable, down or tearful. This fatigue isnt the same as chronic fatigue syndrome, its a symptom related to RA , and you can learn to manage it successfully.
Feelings of fatigue may occur at any time of the day. You may experience it when you wake up, so you dont feel refreshed from sleep, or it may come on when youre physically busy or concentrating a lot. For many people, fatigue seems to have no clear cause and happens without warning. It may last anywhere from an hour to the whole day and could continue over several days or weeks at a time, although this is less common.
Fatigue can have a major impact on your life. It can force you to stop what youre doing and rest, or make you change your plans. This can have a big effect on your ability to run your life or do the things that we all take for granted.
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Talking To Your Doctor About Fatigue
There are several things that can reduce the impact of fatigue. Firstly, it helps if you can work out what could be causing it.
There arent any specific tests for fatigue. However, you can help your doctors diagnosis by writing down how you feel, what could be causing it and how its affecting your life. They may also be able to provide you with a self-assessment questionnaire to fill out.
Depending on your symptoms your doctor may recommend you have blood tests to check your fatigue hasnt been caused by another condition. If it has been, treating this condition may improve your fatigue.
There arent any specific drug treatments for fatigue. However, your doctor, physiotherapist, occupational therapist or rheumatology team, should be able to help you recognise the signs and learn to manage them.
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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How Can I Help Myself
There are a number of things you can do to help manage your fatigue.
Planning your time wisely to spread your energy over the course of a day or week can help. Its also important to factor some gentle exercise into your day and to have a healthy diet.
Theres a strong link between getting enough good quality sleep and fatigue. And there are several positive steps you can take to improve your chances of sleeping well.
Stress and worry can make your fatigue feel worse, so its a good idea to spot anything that is causing you stress and try to deal with them in good time.
- The four Ps
- Get a good nights sleep
- Talk about how youre feeling
- Stress and anxiety
- Helping people around you understand fatigue
- At work
- Eat a healthy diet
How Can We Accurately Measure Ra Fatigue
Anecdotal evidence and personal experience tells me that many rheumatologists fail to address fatigue directly. Instead, rheumatologists tend to focus on the more measurable aspects of the disease: number of swollen joints, lab results, joint deterioration, restricted movement, and similar metrics. I think part of this is because fatigue, like pain, cannot be objectively measured. Fatigue is subjective a personal opinion of the patient so there are no clear guidelines between patients or even with the same patient at different times.
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Joint pain you expect. Stiffness and swelling, too. But with rheumatoid, psoriatic, and other kinds of inflammatory arthritis, theres another symptom thats just as common, but much less tangible: chronic fatigue.
Fatigue in inflammatory arthritis is different than just being tired or a little worn out. Fatigue is a more overwhelming feeling, a deeper sense of slowing down that can be tough to define.
Some patients describe it as not feeling like doing much, says Elena Schiopu, MD, a rheumatologist at the Michigan Medicine Rheumatology Clinic in Ann Arbor, Michigan. Others say its falling asleep all day long, at the drop of a hat.
Research shows as many as 80 percent of people with RA report chronic fatigue. Experts believe inflammatory arthritis activates inflammatory proteins in the body, which not only cause pain but also fatigue.
Much like influenza, when the body is fighting the viral burden with increased inflammation, deep muscle aches and fatigue are present, explains Dr. Schiopu, who also serves as associate professor of rheumatology and internal medicine at the University of Michigan.
Fatigue can come and go in bouts one day you feel fantastic and ready to do it all the next day you cant get yourself out of bed. That unpredictability can make arthritis fatigue a tough symptom to manage. And its not a symptom that others who havent experienced it can easily understand or empathize with.
Get A Good Night’s Sleep
Because poor sleep can cause fatigue, its important that you get a good night’s rest. Try the following tips to improve your sleep:
- Aim to wind down in the hour before you go to bed a warm bath might help you relax and reduce discomfort from tired muscles.
- Make a note early in the evening of things youve achieved during the day and what you need to do the following day. This can help prevent you worrying about things in the night. It may also be useful to keep a pen and notepad next to the bed so you can jot things down if you think you may not remember them in the morning.
- Reduce the amount of caffeine you drink and avoid alcohol after early evening.
- If you have pain, take a simple painkiller like paracetamol before you go to bed. Try to organise it so that you could take another dose if the pain wakes you in the night. Ask your doctor about treatment options if pain is affecting your sleep, or speak to a hand therapist about wearing splints to support your joints in the night.
- Look at your sleep environment is the room too hot, light or noisy? Are your mattress, pillow and blankets comfortable?
- Try to remove as many disturbances as possible to help you to settle down to sleep more easily. Removing clocks and phones from the bedroom can also reduce the temptation of checking the time or your messages if you wake up during the night.
For more tips, read our information on sleep.
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Ask For A Sleep Divorce
You know the basics: Avoid screens, caffeine, and alcohol before bed sleep in a dark room try relaxation exercises before hitting the hay. But more significant changes to your household sleeping arrangements might be in order to reduce sleep disturbances. If you share a bed with pets or children, work toward having them stay in their own space. If your partner snores or sheet-hogs, you may want to consider a sleep divorce, a.k.a. sleeping in separate beds, Brady-Bunch style, or in separate rooms. A good nights sleep can help you fight daytime RA fatigueand spend more quality time with your partner.
Find Support For Low Mood To Help Fatigue
You may find that your fatigue makes you feel low or even depressed. It often helps to talk about negative feelings and thoughts, so it could be useful to speak to your GP or rheumatology team, or your friends and family. Support groups are also available talk to your rheumatology team about organisations in your area.There are several kinds of support for low mood, such as talking therapies or a short course of drug treatment, some of which not only help with low mood but may also ease pain and improve sleep.
The first step is finding out what help or self-help might suit you best, so talk with your GP.
For more information on depression visit beyondblue.
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Into The Sunlight To Reset Your Body Clock And Help Fight Fatigue
One way to fight fatigue is to pay attention to your internal clock. Sunlight delivers vitamin D and tells your brain and body when to get active. For some people, the dark winter months can be the hardest time to fight fatigue due to the short days and lack of sunshine. Besides bundling up and getting outside, fight winter fatigue by arranging your home and office environment to allow for maximum sun exposure. Aim for at least 30 minutes of sunlight every day.
What Factors Contribute To Ra Fatigue
There are a lot of things that can contribute to fatigue. Among these are pain and inflammation and to the point that a biologic reduces those, fatigue can also diminish. However, other things can cause fatigue such as depression and sleeplessness which biologics do not address. Nor can biologics or other treatments reverse permanent joint damage which can cause pain which can cause fatigue directly or lead to sleeplessness or depression which, in turn, can contribute to fatigue.
Interestingly, some of the medications used to treat RA and associated conditions, also contribute to fatigue via having drowsiness as a side effect. These include certain antidepressants, pain medications, NSAIDs, some DMARDs and antihistamines. While drug-induced drowsiness is not truly fatigue, being drowsy or fuzzy-headed can aggravate the symptoms of fatigue.
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Medications To Treat Causes Of Fatigue
A 2017 study published in Current Rheumatology Reports, along with earlier ones, show that medications used to treat your inflammatory arthritis dont do much to help fatigue, and some medications can make you drowsy to boot. But unchecked inflammation and pain caused by arthritis certainly contribute to fatigue. So, your first step in getting your energy back is to get disease activity under control. You will also need to treat any other underlying medical conditions you have that may cause or worsen your fatigue.
Here are a few types of medicine your doctor may prescribe that are focused on treating fatigue.
If you have anemia, you may need iron supplements or the hormone epoietin .
Sleeping pills may help promote restorative sleep. Newer medications, including eszopiclone , lorazepam , zaleplon and zolpidem , are less likely to trigger dependence than older sleep medications.
If your nutrition is poor, your doctor may suggest you take vitamins or other supplements to fill your nutritional gaps and strengthen your overall health.
You may benefit from activating medications that increase energy. These include some antidepressants, like bupropion , and psychostimulants, like modafinil .
What Causes Rheumatoid Arthritis Fatigue
Rheumatoid Arthritis fatigue is a weariness that rest cannot cure. It is tiredness without the benefit of the pleasure of activity. Over 90% of RA patients report fatigue as a symptom. It is counted second only to pain as the greatest difficulty of living with RA.
Unlike normal fatigue, pathological fatigue does not improve with rest. This kind of fatigue is seen in most acute and chronic inflammatory diseases, including arthritis
Where does this weariness come from? What causes us to feel precisely like Superman with Kryptonite pushed in his face? Does anybody know?
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Talking With A Healthcare Provider About Fatigue
The first step to addressing fatigue is to talk to a health care provider or rheumatologist. Patients are advised to describe when and how long fatigue lasts, if it affects concentration, and if it is accompanied by feelings of anxiety or depression. Patients may also report symptoms like daytime drowsiness, night time insomnia, quality of sleep, and observations from a significant other .
A medical professional can offer specific suggestions tailored to the individual. Most suggestions for dealing with fatigue fall into one of these categories:
- Adjusting medications
- Testing for and treating underlying medical issues
- Seeking therapy and emotional support
- Altering diet and exercise
How Good Was The Evidence
The quality of the evidence ranged from low to moderate, with the evidence for physical activity graded as moderate quality and for psychosocial interventions low quality. Data were combined where possible. Poor reporting in most of the studies hampered the reviewers in determining whether quality criteria had been met and made it unclear whether the absence of adverse events in 21 RCTs was due to poor reporting or if there were genuinely none. Only one RCT was specifically powered to detect changes in fatigue though the reviewers say its likely that others were big enough to enable this too. A range of fatigue measures were used and the reviewers urge that future RA research uses standardised fatigue measures.
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Treat Ra Fatigue By Reducing Ra Disease Activity
I believe the other part of rheumatologists not tackling fatigue head-on is that they believe if they can reduce disease activity, fatigue will also be reduced.
I personally have subscribed to that theory make RA less active and the fatigue will also be less so I was surprised to read a recent article that discussed several studies demonstrating that while biologics can be effective against disease activity , they arent always effective on addressing the debilitating effects of fatigue.
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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How Can We Reduce Fatigue
Like so many things in life, its better not to go it alone. There are things that can be done by your doctor, friends, family, and even your workplace, that can help you in your day to day life.
Your doctor can:
- Suggest lifestyle changes that may improve your energy.
- Make a to-do list and cross off the least important things.
- Do some exercise exercise supports the joints.
- Eat healthy. Get your protein for strong muscles and carbs for energy.
- Check out CBT and learn how to reframe your mindset.
- Talk to your boss at work perhaps you could work from home or change your hours.
- Try to ask for help when you need it people cant always see or know when you need help.
Monitor Your Energy Output And Fatigue
It can be difficult to assess how much energy you use on different tasks during the day, so it may be useful to monitor it and create a visual picture to help you see links with your fatigue. Create a chart to record your activities, when you do them, how long they take, and the energy levels you use.
Colour the activity yellow if its low energy. This is when youre doing something which isnt using a lot of energy.
Use green for rest time, for example when youre reading or watching TV. During this time, youll have a chance for recovery and wont be using much energy.
Use blue for sleep.
When your fatigue is very noticeable , put a cross through the activity.
At the end of a week, look back at your diary and ask yourself these questions:
- Were there episodes when you were exhausted?
- Were these related to high-energy activities ?
- Were there long blocks of high-energy activity with no breaks?
- Was your sleep disturbed?
- Were you sleeping during the day?
- Was there enough time for enjoyment and recovery?
Use the information to give you a better idea of when you need to pace yourself and to help you to prioritise your time. Try planning the next few weeks and review your progress as you go. Your rheumatology nurse specialist or occupational therapist may be able to give you charts and work through the process with you.
Download our activity chart to help get you started.
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