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.
Remission Does Not Necessarily Equate To Low Fatigue
When in remission in ERA, many patients have low levels of fatigue but some still have significant fatigue. RA patients with a sustained state of low disease activity had a mean FACIT-F score in the 40s so residual fatigue persisted for many patients. The SF-36 vitality domain demonstrated all but approximately 15% were not in fatigue remission when in DAS remission .
Within the Outcome Measures in Rheumatology flare working group, a Delphi exercise was performed, and fatigue did not meet consensus for inclusion within the development of the flare questionnaire in RA. Fatigue in RA is multifactorial and only partially related to disease activity which may have accounted for poor agreement with respect to a fatigue domain within a flare questionnaire in RA.
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
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Lifestyle Changes That Combat Fatigue
According to studies, including several by Patti Katz, PhD, of the University of California San Francisco, the most effective interventions for fatigue are good lifestyle choices, such as these.
Get Up and Move. Exercise helps with fatigue in many ways. It increases muscle mass, strength, blood circulation and flexibility, all of which boost energy and reduce pain. Exercise also generates endorphins, brain chemicals that produce a sense of well-being and vitality and help improve nighttime sleep.
Hydrate. Dehydration can be a hidden source of fatigue. There’s no set amount of fluids you should consume, but a rule of thumb is to drink at least a half-gallon or more a day, depending on your activity level and how hot and dry the weather is.
Eat Well. Nourish your body with good, whole foods. Eat plenty of fruits and vegetables, and be sure to get adequate lean protein and healthy fats. If you need to lose weight, reduce your portions and limit processed, high-salt, sugary foods. Always start your day with breakfast that includes lean protein and complex carbohydrates to provide long-lasting energy.
Ease Your Mind. If depression or stress is adding to your fatigue or keeping you awake at night, you might want to see a therapist. Cognitive behavioral therapy, mindfulness-based stress reduction and mind-body exercise like yoga and tai chi can help calm your thoughts and boost your energy.
Managing Pain
Can Physical Activity Help To Lessen Fatigue
Some people who have try to get fitter by doing gentle physical exercise, with the aim of fighting the exhaustion that way. A number of different activities are well-suited for this, including stretching and strengthening exercises, yoga, tai chi, brisk walking, cycling, water aerobics and swimming. These activities may also be done in specialized exercise therapy.
An analysis summarizing the research on different types of exercise shows that physical activity can help reduce . About 15 out of 100 people felt less exhausted after exercising. It’s still not clear what form of exercise would be most suitable, though.
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Lifestyle Changes To Manage Ra Fatigue
Lifestyle changes can combat RA fatigue, especially mental and emotional fatigue. A gentle exercise regimen can improve energy levels and well-being. Stretching, short walks, aquatic therapy, and yoga are all recommended exercises for people with RA. Exercise can reduce the symptoms of conditions associated with rheumatoid arthritis, such as depression and fibromyalgia.
A healthy diet also helps smooth out energy highs and lows. Lowering sugar levels and pacing meals throughout the day can help avoid reactive hypoglycemia, otherwise known as a sugar crash. One myRAteam member said, A healthy snack can give a boost my favorites for that are unsalted nuts, dried apricots, or one or two dark chocolate candies.
Helping People Around You Understand Fatigue
Fatigue is a major symptom of many conditions, such as arthritis often its as much of a problem as pain and inflammation. But its an invisible symptom and a lot of people avoid talking about it because they think their family, friends and colleagues wont understand.
It can be stressful if you think people around you dont understand how youre feeling. Even when you explain, some people may struggle to realise how fatigue affects you and that it stops you doing certain activities. This can be frustrating and tiring and can put a big strain on your relationships. Getting help, support and understanding from the people around you can make a huge difference.
Good communication and explaining clearly and calmly how fatigue affects you is important to help others understand.
Its ok to say that you need help with tasks around the home.
Learning to say you cant do something or go somewhere because of the way it will affect you can help. It may also reassure people that sometimes you just dont feel up to socialising and its no reflection on their company.
If people ask for your help with something, remember its ok to say no. Its ok to put yourself first.
If you find it difficult to talk about your fatigue, you could ask people to read this information.
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How To Beat Arthritis Fatigue
Fatigue can be a persistent foe when you have arthritis. Learn how to fight back and get the rest and energy you need.
The first step in fighting arthritis-related fatigue is to identify possible causes. Keeping a journal to note your energy levels throughout the day and what you did before, during and after can help. Once you recognize possible causes of your fatigue, discuss them with your doctor. The two of you can come up with a comprehensive plan so you have the energy you need. The plan to regain your vigor may include changes to your arthritis medication and lifestyle, as well as medications to treat fatigue directly.
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.
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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.
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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.
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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.
Be Aware Of Medication Side Effects
While it is necessary for most arthritis patients to take medications to treat pain and other symptoms, drowsiness is a common side effect of many of these drugs. Pain medications, some NSAIDs, DMARDs, and tricyclic antidepressants are among the medications that list drowsiness as a known side effect. If the medications are part of a daily regimen, drowsiness may add to already-present fatigue.
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Take A Midday Stretch Or Walk Break If You Can
Jewell S., a 37-year-old yoga teacher, uses her lunch break to get in some type of movement. Midday walks in the park or around my neighborhood help to refresh me and fight off fatigue and lubricate my feet, knee, and hip joints, she tells SELF. On days when she is too busy to go for a walk, Jewell takes a short stretch break instead. Sometimes is as simple as taking a tech break and doing a wrist and finger stretch. Simple movements like bending and straightening my fingers, knees, ankles, and toe joints for a few repetitions help a lot, she says.
Whenever possible, Sandra B., CEO and founder of the Rheumatoid Arthritis Foundation, takes a walk as soon as she begins to feel tired. I stop what Im doing and go for a walk, the 57-year-old tells SELF. I feel so much better once I start being active. If the weather is crummy or walking outside feels too overwhelming, then Sandra will take a few laps around her house. Just 15 minutes of movement make a difference , she says.
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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What Causes Fatigue In Rheumatoid Arthritis
Several factors cause rheumatoid arthritis fatigue. One of these factors is the disease itself. Inflamed tissues release chemicals called cytokines. These cytokines normally help the body attack bacteria and viruses, but in people with rheumatoid arthritis, these cytokines cause the body to attack healthy tissue. However, the excess cytokines still create the same worn-down tiredness people experience during a bout of a cold or the flu.
See what Rheumatologist Dr. Ashira Blazer says about fatigue and RA.
Anemia is also common in people who have rheumatoid arthritis anywhere from 10 percent to two-thirds of people with RA have the condition. Anemia is a lack of red blood cells. The inflammation rheumatoid arthritis causes also limits red blood cell production. Without enough red blood cells, people with rheumatoid arthritis arent able to get enough oxygen into their blood, causing tiredness.
Joint pain also can make it difficult to participate in physical activity, which creates a vicious cycle. The less physical activity you participate in, the more likely you are to feel chronic fatigue, which makes it even harder to get up and get moving. A lack of physical activity may also cause sleep apnea, which can contribute to fatigue.
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.
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Coping With Chronic Fatigue In Rheumatoid Arthritis
For some people with rheumatoid arthritis , chronic fatigue can be as debilitating as joint pain. A person might sleep for 8 hours and wake up feeling like he or she never slept. This exhaustion can affect mental concentration and lead a person to feel frustrated and helpless.
Unfortunately, there is no quick fix for eliminating chronic fatigue. Managing fatigue often requires a multi-pronged approach that incorporates both medical treatment and lifestyle changes.
See Rheumatoid Arthritis and Fatigue
Schedule Naps Into Your Day If You Can
Renee A., 40, says that her fatigue comes in spurts. Some days, I wake up feeling like I can conquer the world other days I wake up feeling like a Mack truck hit me, she says. Its very difficult and it requires a lot of mental fortitude. Renee home-schools her three children and says she sometimes holds lessons in her bedroom or on the couch, which allows her to rest. If Renee doesnt take time to nap or even sit for a while, then her fatigue and other rheumatoid arthritis symptoms flare up and she feels much worse, she says. I have learned that the hard way, Renee says.
If you dont work from home, or if your schedule is packed with Zoom meetings and tight deadlines, then you may not be able to nap whenever you feel exhausted. However, if you can, lying down even for a few minutes after work may be helpful. Creaky Joints volunteer Eileen D., 35, says taking a short nap can make a big difference in her energy levels. Sometimes I need to have a quick rest. Just 20 minutes can be a lifesaver, she tells SELF. Sleeping for too long can make you feel groggyand make fatigue worseso its a good idea to nap for 1020 minutes, according to the Mayo Clinic.
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