How To Beat Fatiguelearn More About Fatigue Its Causes And How To Treat It So You Can Feel Your Energetic Self Again
Everyone gets tired from time to time. But when your need for rest seems excessive or becomes disruptive to your daily life, what once may have been run-of-the-mill tiredness has morphed into full-fledged fatigue. Many people with arthritis-related conditions experience fatigue. Up to 98 percent of people with rheumatoid arthritis report fatigue, as do 50 percent or more of those with lupus or Sjögrens syndrome. The percentage grows higher when obesity, depression, fibromyalgia, congestive heart failure, lung problems or chronic headaches are present, too.
Many people describe fatigue as severe weariness and overwhelming exhaustion that doesnt get better with sleep. If you find yourself with no energy even after a full nights rest, it may be fatigue. People with chronic diseases can have fatigue that comes and goes, but many experience long-lasting fatigue. The bouts may seem to come out of nowhere because they arent preceded by extra activity, and they may occur even when the joints are feeling good.
Common Causes of Fatigue
Sleep and pain. For many people with arthritis, fatigue often is triggered by insomnia and unrefreshing sleep due to pain. Getting into a comfortable sleeping position is a challenge when joints are swollen and sore. Quality of sleep tends to be more important than quantity. Getting six or seven hours of deep sleep makes you feel better than spending eight hours in bed tossing, turning and waking up repeatedly.
Lifestyle Changes to Beat Fatigue
Clinical Association Studies: Multiple Regression
Multiple linear regression in the initial clinical association study showed that five variables explained 53% of variation in VAS fatigue scores . Pain had the strongest association, then HAQ and depression. Methotrexate and erosive disease had negative associations, indicating that patients receiving methotrexate had less fatigue and that those without erosions had more fatigue.
Multiple linear regression in the second study showed that three variables explained 53% of the variation in VAS fatigue scores . Pain had the strongest positive association, followed by SF-36 mental health score and patient global assessment. Finally, an ordinal regression model of the relationships of SF-36 energy and vitality scores showed that three variables had significant associations: HAQ and pain had the strongest association followed by SF-mental health scores .
I Built Restorative Rest Time Into My Day
Just as I have made changes to my life to manage my pain, I also needed to make changes to cope with fatigue. I treat my daily nap as a sacred part of my efforts to manage pain and fatigue and quickly learned that I feel much better when I respect my bodys request for some downtime. Even if you dont have the flexibility to nap, you can give your body rest in different ways, including sitting on a bench, finding a quiet corner at work to meditate, or taking half an hour of lying on the couch when you come home. Simply getting off your feet and being still can make a difference.
My RA doesnt define me, but the reality is that it does affect everything I do and how I do it. I have finally realized that fighting back against this fact wastes precious energy on a futile endeavour. I know now that if I want to live as well as possible, I need to take care of my body and that includes accepting the fatigue. Making changes that address this ultimately creates a better life for me.
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Rearrange Your Kitchen Counter
A simple natural way to prevent fatigue: Put everything you use often within easy reach. Then do the same in your bathroom and bedroom. Set up your home to make life a little easier on you, particularly on the more difficult days, say experts.
And use specialized assistive tools throughout the day zipper pulls, gripping tools, electric can openers, and long shoe horns can all help conserve energy and ease pain.
Living With Rheumatoid Arthritis
Research shows that people who take part in their own care report less pain and make fewer doctor visits. They also enjoy a better quality of life.
Self-care can help you play a role in managing your RA and improving your health. You can:
- Learn about rheumatoid arthritis and its treatments.
- Use exercises and relaxation techniques to reduce your pain and help you stay active.
- Communicate well with your health care team so you can have more control over your disease.
- Reach out for support to help cope with the physical emotional, and mental effects of rheumatoid arthritis.
Participating in your care can help build confidence in your ability to perform day-to-day activities, allowing you to lead a full, active, and independent life.
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Talk With Others Who Understand
On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 197,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.
Do you have tips on how to manage fatigue? Share your experiences in the comments below, or start a conversation by posting on your Activities page.
Talk About How Youre Feeling
Fatigue can make you feel low or depressed. Talking about how you feel can really help. Dont keep your feelings to yourself. Try to talk to a member of your healthcare team, members of a support group, your family or friends.
There are things that can help if youre feeling low. Your healthcare team may recommend a talking therapy, such as cognitive behaviour therapy also known as CBT. You can do it as one-to-one or group sessions.
Talking therapies aim to help people change the way they see their condition and any negative feelings towards it. Sessions, led by trained therapists, can help people change the way they react to and feel about their condition by making positive changes to the way they think and behave.
NHS England has a dedicated programme called Improving Access to Psychological Therapies, known as IAPT. It aims to connect people with anxiety and depression to local talking therapy services. You can refer yourself to this service by visiting the NHS England website and searching for IAPT or ask a health professional to refer you.
Health services in Scotland, Wales and Northern Ireland dont currently offer a self-referral service, but you can ask your doctor to refer you to a local NHS therapy service or group.
Joining a support group for people living with similar conditions can help you talk openly about your problems with people in similar situations. They may also be able to share tips on how to get around some of your problems.
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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
- Feeling overwhelmed
We dont know the exact causes of fatigue in RA, but evidence from observational studies suggests RA fatigue may result from :
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.
Diagnosis Of Rheumatoid Arthritis
- Ordering laboratory tests.
- Ordering imaging studies, such as x-rays or ultrasound.
It can be difficult to diagnose rheumatoid arthritis when it is in the early stages because:
- The disease develops over time, and only a few symptoms may be present in the early stages.
- There is no single test for the disease.
- Symptoms differ from person to person.
- Symptoms can be similar to those of other types of arthritis and joint conditions.
As a result, doctors use a variety of tools to diagnose the disease and to rule out other conditions.
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Discordance With Disease Activity
Fatigue in RA is usually present even if disease activity is low. This can be due to chronic pain which is common in RA. Pain can lead to poor sleep, depressed mood and fatigue, all of which are connected. Also, more than 10% of patients with RA have fibromyalgia and 10% report depression in ERA. Behavioural and psychological factors are more likely explanations of fatigue in RA and not disease activity.
When patients with ERA were treated using a treat-to-target strategy, it was observed that there was only a small mean change in fatigue. In fact, three-quarters with baseline fatigue who had improved with respect to disease activity had residual fatigue at 1 year in another study one in four ERA patients had worsening fatigue over time, one in three was stable and 40% improved fatigue by 1 year.
Next Steps For Bionics Institute Researchers
A vagus nerve stimulation device developed to treat inflammatory bowel disease has passed safety tests for use in humans and will be moving into clinical trials.
As the rheumatoid arthritis device uses a similar therapeutic stimulation strategy, this approval for use in clinical trials will accelerate its development.
Our next steps are to consolidate preclinical data and start planning for a clinical trial with our clinical collaborator, Dr Evange Romas.
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Reviewing Ra Medications And Chronic Fatigue
Patients who are experiencing fatigue can ask their healthcare provider to review their complete lists of medications and supplements. Patients are advised to report all medications and supplements, keeping these points in mind:
- Many over-the-counter cold and allergy medications can cause drowsiness or dizziness.
- Certain over-the-counter, non-steroidal anti-inflammatory drugs can cause sleepiness or dizziness.2United Kingdom National Health Service. Non-steriodal anti-inflammatory drugs side effects. NHS Choices: Your health, your choices http://www.nhs.uk/Conditions/Anti-inflammatories-non-steroidal/Pages Last reviewed April 6, 2014. Accessed December 1, 2014.,3National Institutes of Health. Naproxen. MedlinePlus. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a681029.html Last Revised July 14, 2013. Accessed December 1, 2014.
- Many medications used to treat other conditions, such as depression, allergies, high blood pressure, and diabetes, can also cause fatigue.
Information about the patients chronic fatigue, RA, and medication prescriptions should be shared with all members of the health care team, such as physician specialists, nurse practitioners, physician assistants, psychologists, counselors, and pharmacists.
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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Does Rheumatoid Arthritis Make You Tired
Yes, rheumatoid arthritis can make you tired. Its a systemic inflammatory condition, says Dr. Rosian. The cytokines, or the cell signals, released by your immune system cause inflammation.
As anyone dealing with fatigue knows, your quality of life can be affected. If people are having a bad time with their rheumatoid arthritis, their window of opportunity to do things during the day is pretty small, notes Dr. Rosian. They might not feel very energetic or have much energy.
Timing Of Maximal Improvement In Fatigue When In Sustained Remission In Era
An ERA cohort which included 1864 patients studied how fatigue varied over time. A quarter had low fatigue, nearly 20% moderate and approximately 60% high fatigue at baseline. The baseline fatigue and pain scores were similar, around 5 out of 10. DAS28 seemed to be moderately related to fatigue at baseline where the DAS28 score was highest in the highest fatigue level, next highest in the middle level and smallest in the lowest fatigue group.
The baseline SF-36 mental component summary scores also were different differed significantly between the fatigue groups. The mean baseline fatigue score measured by a VAS was highest at baseline than follow-up visits. Fatigue decreased by the 3-months visit where the largest between visit change occurred .
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Reasons For Fatigue In Ra
There are several causes of fatigue in RA. For instance, active RA with inflammation and pain cause fatigue directly by altered cytokines but also disruption of sleep due to pain. Chronic pain alters sleep through changes in mood affecting sleep patterns. Decreases in physical activity and stress due to a chronic disease that is life altering will impact energy in a negative way. Medications such as methotrexate and even sulfasalazine can cause fatigue. Different routes of administration or dosing of methotrexate may be helpful to reduce fatigue as a side effect. Treatments should be multidimensional in order to improve fatigue in people living with RA.
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.
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Treat Arthritis Pain And Other Symptoms
Chronic pain alone can cause fatigue. Pain also can lead to depression and mood changes that can worsen fatigue. To control fatigue, itâs important to have pain well-managed. Talk to your healthcare provider about drug and non-drug techniques for effective pain management.
Higher-than-normal levels of cytokineschemical messengers involved in inflammationhave been found in the blood of those suffering from fatigue.Itâs important to control inflammation and monitor active inflammation.
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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Measurement Of Fatigue In Ra
Numerous fatigue tools/scales have been used in RA. A systematic review described 23 different fatigue tools which were published before Patient-Reported Outcomes Measurement Information System was developed. In their review, they concluded that ordinal and VAS, the Short Form 36 vitality subscale, the Functional Assessment of Chronic Illness Therapy Fatigue Scale , the RA-specific Multidimensional Assessment of Fatigue scale and the Profile of Mood States were validated and seemed sensitive to change. Some scales are generic, and others are disease specific.
Commonly used measures of fatigue in RA include numeric rating scales such as VAS 0 to 100 mm or an 11-point scale . Other scales such as change in fatigue have been used . Other questionnaires within RA trials include the Functional Assessment of Chronic Illness-Fatigue Bristol Rheumatoid Arthritis Fatigue-Multidimensional Questionnaire SF-36 vitality domain and PROMIS-29 Fatigue T-score. The FACIT-F scale ranges from 0 to 52, where higher numbers imply less fatigue. Fatigue scales are correlated to each other, but there is no universally agreed-upon fatigue questionnaire/tool to use in RA. The PROMIS fatigue score has face validity measures fatigue across the spectrum of severity is correlated with pain, sleep disturbance, anxiety and depression and disease activity and is also strongly correlated with other fatigue scales.
Rest Before And After Particularly Active Days Whenever Possible
Its been 12 years since Creaky Joints volunteer Elisa C., 55, was diagnosed with rheumatoid arthritis, and making sure she has plenty of downtime before and after busy days is one of the habits that have helped her most in that time.
If Im going to have a fun day with my husband at the park, I know to plan several days for that, she tells SELF. For her, that can mean doing food prep in advance and freezing meals so that she doesnt use up too much energy cooking the day before her planned activity. She also plans on having a rest day filled with naps and just taking it easy, after her activity day, Elisa says.
Although you cant always anticipate every single event that pops up, this can be helpful to try whenever you make plans in advance. Or you can try to modify this by scheduling a quick 20-minute nap or fitting in a few rest breaks whenever possible in the days after a super-hectic time.
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