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.
Me/cfs And Rheumatoid Arthritis
Both conditions are associated with a hyperactive sympathetic nervous system, which in turn, is associated with increased levels of pain, fatigue, and blood circulation issues.
Wirth and Scheibenbogen, for instance, place heightened sympathetic nervous system activity at the core of ME/CFS. Increased sympathetic overdrive was also linked to an inability to complete an exercise program in ME/CFS. Likewise, sympathetic nervous system dominance has been documented in overtraining syndrome. High levels of systemic inflammation arent found in either of these conditions.
They are in RA. In the Brazilian study, the most impaired RA patients exhibited both increased sympathetic overdrive and depleted parasympathetic functioning and the highest levels of inflammation.
Note that Alan Lights MECFS gene expression and exercise study found the same metaboreflex receptor upregulation. Light proposed that high levels of muscle metabolites might be tweaking these receptors. Since then, numerous studies suggest that problems with energy production may exist.
The situation, at least at this point, appears to be markedly different in RA. Citing a 17-year-old study that did not find high levels of lactate in RA, the authors of the RA paper refused to go down the energy production rabbit hole. Instead, they proposed that inflammation was probably sensitizing the muscle metabolite receptors in RA.
The Brazilian group has also found odd responses to exercise in people with long COVID.
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.
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Contributing Role Of Inflammation
High levels of inflammation might be a cause of RA fatigue. According to a 2018 review, chronic low-grade inflammation might create imbalances in cellular energy availability and expenditure. That imbalance ultimately causes you to become drained and worn when RA symptoms are active.
RA inflammation also increases pain, leaving a person feeling further worn out. When joints hurt, pain makes it harder to sleep and get good quality sleep. When your rest is unrefreshing, you experience more fatigue. It is a vicious cycle.
Does Ra Medication Treat Fatigue
Your medications for treating RA can reduce both inflammation and fatigue. To address both, be sure to follow your treatment plan as prescribed by your healthcare provider.
If you find treatments aren’t working and you are experiencing fatigue that affects your ability to enjoy and participate in your life, reach out to your healthcare provider.
You might also consider asking your healthcare provider about medications that treat chronic fatigue, such as Provigil . Medications like Provigil need to be taken with caution because they can be difficult to stop once you start taking them
Your doctor might be able to prescribe pain medications, like Ultram , which can relieve pain and improve sleep. Low doses of anti-depressants, taken at bedtime, might also manage pain, improve sleep, and reduce fatigue.
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The Impact Of Fatigue On Work & Career
Employment is an important part of providing for our family and loved ones. For some, their jobs and careers are a part of their identities. But when fatigue is a constant, its increasingly challenging to show up physically or even mentally. 55 percent agreed* that fatigue interferes with their responsibilities.
Because symptoms like fatigue are sometimes invisible, many in the community often feel misunderstood by their employer. As one person shares, I gave up my job because my employer did not understand or care about this disease with few physical signs to the normal person.
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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What Causes Fatigue In Rheumatoid Arthritis
The causes of fatigue in RA are linked to the disease itself, along with related conditions that are commonly associated with RA. Chronic inflammation from disorders in the immune system may be a factor that leads to fatigue in people with RA. With inflammatory arthritis, such as RA, inflammation can cause feelings of sickness and lethargy.
Other symptoms and factors related to RA can also contribute to fatigue, including:
- Disability from RA
- Sleep disturbance, such as sleep apnea
A number of related health conditions or comorbidities that can occur with RA may increase fatigue as well, such as:
- Chronic obstructive pulmonary disease
- Anemia Can be a side effect of methotrexate, which lowers levels of folic acid
S For Improving Your Sleep
There are many reasons why a person with RA may not be getting enough sleep, from stress to depression to joint pain. You can work with your doctor to determine the cause of sleep problems. There are a variety of solutions for sleep problems, depending on the specific problem.
Sleep hygiene is an important part of getting a good nights rest. Some ways to improve your sleep may include:5
- Avoid alcohol, nicotine, and caffeine because they can disrupt sleep
- Go to bed and get up at about the same time every day
- Get some exercise during the day, when possible
- Make your bedroom cool, dark, and comfortable
- Turn off your computer, cell phone, and television
- Follow a bedtime ritual to signal your body that it is time to sleep
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Comparison Of Fatigue As A Predictor Of Work Disability Between Ra And As
The most consistent predictive factor for both populations was the baseline level of the predicted work outcome. Otherwise, although overall fatigue was a commonly identified independently significant predictor of work disability in both RA and AS patients, its effect appears more prominent among RA patients in relation to other putative predictors while, in AS patients, the effect of anxiety/depression was relatively stronger. In contrast, other variables such as disease activity and pain did not appear to be important in these study samples.
When considering the associations between fatigue and the different work disability components, both similarities and differences existed across RA and AS patients. For both diseases, fatigue was associated with presenteeism and activity impairment . However, fatigue was identified as a significant predictor of all four work disability components under investigation in our RA population, while fatigue was not identified as an independent predictor of absenteeism or work productivity loss among AS patients. In both studies, no interactions between fatigue and visit were significant, suggesting a consistent effect of fatigue over the following 12-month period.
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.
You can:
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How Is Ra Diagnosed
RA is diagnosed by reviewing symptoms, conducting a physical examination, and doing X-rays and lab tests. Its best to diagnose RA earlywithin 6 months of the onset of symptomsso that people with the disease can begin treatment to slow or stop disease progression . Diagnosis and effective treatments, particularly treatment to suppress or control inflammation, can help reduce the damaging effects of RA.
Ask For The Help You Need
Often, the psychological anxiety of having an invisible illness a condition other people do not immediately recognize can add to a persons fatigue. Letting loved ones and friends know about your fatigue can help you better manage daily activities and social interactions. Family members and friends may need guidance when it comes to offering help.
If your workday is difficult to manage, reach out to your supervisor or human resources manager to discuss work schedules, working from home, or other accommodations that can help you get your job done without it being too fatigue-inducing.
You may also want to ask your health care provider for a referral for psychological counseling. Counseling and therapy can help relieve anxiety and give you tools and techniques to manage stress, mood swings, and communication with others.
Research has shown that psychological therapy can relieve fatigue. In one rheumatology study, people with RA who participated in cognitive behavioral therapy reported feeling less tired. They also reported better sleep.
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Increase Your Physical Activity
Adding some gentle exercises to your day can increase the amount of energy you have.
Staying active increases your fitness levels and strengthens your muscles. Weak muscles use more energy, so doing too little can be as damaging as doing too much.
Exercise also increases your circulation and improves the health of vital organs, such as your heart and lungs, which can also give you more energy.
Its important to give yourself time to recover after exercise by taking a break before you move onto your next activity.
When you start exercising
Introducing more physical activity to your day may be tiring at first. Dont overdo it, start your activity slowly, perhaps just add a 510 minute walk or some gentle stretching exercises to begin with.
If youre in pain you can take painkillers before you exercise.
Gradually build up the amount of activity you do. For example, when youre ready, walk for 5 more minutes or add some strengthening exercises to your routine.
Generally, the best way to build up your fitness levels is to do a little exercise as often as you can. Stick with it because as you get fitter youll start to feel better, stronger and more energetic.
You could try using a step counter such as a fitness tracker, a pedometer, or a mobile phone app. When youre ready and depending on how youre feeling, you could try to beat your previous records.
You should aim to exercise every day. But be aware some days will be easier than others.
Other Sources Of Fatigue
Your fatigue is not always directly related to your arthritis disease activity, inflammation or pain. In fact, according to a 2017 study published inCurrent Rheumatology Reports, your fatigue level probably has more to do with other contributing factors, including obesity, physical inactivity, sleep disturbance and depression. Several of them may work together to cause your extreme tiredness, but identifying and treating even one of these factors can provide relief.
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Managing Pain
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The Causes Of Rheumatoid Arthritis Fatigue
You wake up exhausted, drag yourself through the day, and keel over into bed with nothing left. This is rheumatoid arthritis fatigue. Many of us have been known to say that the pain is bad, but the fatigue is almost worse.
We are not talking about just being tired. RA fatigue is pervasive. To make others understand what it feels like, you can liken it to the fatigue that people feel when they have the flu. An editorial in the journal Rheumatologydefined fatigue as physical and/or mental exhaustion that leads to a marked impairment in normal activities, whether mental, physical, domestic, social, or occupational. It is not improved substantially by bed rest and may be worsened by normal levels of physical or mental activity.
Living with a chronic illness is exhausting, and chronic pain certainly contributes to feeling like a wrung- out dishcloth. However, there is also a biological reason for RA fatigue.
Understanding RA fatigue
At the 2015 annual Congress of the European League Against Rheumatism it was reported that not only is there a biological basis for the fatigue experienced by people with rheumatic conditions, such as RA, but that this fatigue is also gene regulated. A Norwegian researcher presented the results of a study, stating his belief that interleukin 1 beta is the fatigue cytokine.
What you can do about RA fatigue
But this isnt the case for everyone. In fact, levels of fatigue are not always associated with the level of inflammation.
Maintaining Ability To Work
Patients with RA who maintained their ability to work had less fatigue compared to those who were work disabled, and these differences seemed related to better mental health, not physical health. However, other factors are likely related to an ability to work, which may not have been measured, where both fatigue and work disability are a consequence of joint damage, age, type of job, less flexibility at work and so on. A prospective study is needed to determine if a programme that keeps people in the workplace will improve fatigue.
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Treating The Symptoms Of Rheumatoid Arthritis
People living with rheumatoid arthritis commonly develop anemia either from the condition itself or from medications taken as treatment. If their anemia seems more profound, if they have tachycardia or fast heart rate, or theyre feeling short of breath, it might mean they have anemia on top of their arthritis, says Dr. Rosian.
This isnt necessarily out of the ordinary. You can live with rheumatoid arthritis and other conditions, such as heart disease and high blood pressure, or experience stress from kids and work. Thats why its sometimes difficult to tell whats causing your fatigue.
If the fatigue is worse with rheumatoid arthritis, you treat that, explains Dr. Rosian. Thats where you focus on a steady diet, the exercise and sleep. When the rheumatoid arthritis is quiet and people still have a lot of fatigue, thats trickier.
Dr. Rosian also says some people like to take a hot shower or soak in a warm bath to help manage their stiffness and fatigue. Others might practice mindfulness or meditation, get a massage or practice Tai Chi. Finding what works for you to help your rheumatoid arthritis is key.
Some people with fatigue get better if they do an activity or a hobby something that makes them happy and something positive for them, encourages Dr. Rosian. If something makes you feel better and reduces your pain, its going to help you with your fatigue.
Get A Good Nights Sleep
Its important to try to get a good nights rest because poor sleep patterns can cause fatigue or make it worse.
If youre having trouble sleeping, or you regularly wake up feeling unrefreshed, it would probably help to look at ways you might be able to sleep better. Healthcare professionals talk about a principle called sleep hygiene, which covers things you can do to improve your chances of getting a good nights sleep.
Too much sleep can also cause fatigue. Thinking about what a good nights sleep means to you, can help. Your activity charts can tell you a lot about how youre sleeping.
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Social Life Hobbies And Family
The impact of RA fatigue doesnt stop at work, career, or daily responsibilities. Fatigue also finds its way into a persons social and family life. When combined with pain, many people may set aside their favorite hobbies or activities in order to rest. 59 percent* said that fatigue interfered with their family and social life.
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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