The feeling of fatigue is common in our busy lives. Fatigue that is the result of inflammatory arthritis, however, is very different than everyday tiredness. This kind of fatigue can often be intense and overwhelming, and can have a noticeable impact on quality of life. Steps to help make inflammatory arthritis-related fatigue more manageable include learning to better understand how it affects you as an individual and discussing it regularly with your rheumatologist.
Fatigue can be described as a severe lack of energy throughout the whole body, sometimes even after a full night of rest. It is very common among people with inflammatory arthritis, affecting 40% or more of those with RA.
Many people often describe fatigue as the most difficult part of their disease. In spite of this, the topic - unlike the subject of pain, for example - is rarely discussed between patients and their doctors.
Treating fatigue can be difficult for both patients and their doctors. Making a regular point of talking about it together can be a helpful step in treatment. Consider writing down a list of information to share with your doctor at your next appointment. This could include:
Together, you and your doctor can assess, or measure, the way fatigue affects you personally. You may also better understand the causes of your fatigue.
While fatigue is a common symptom of inflammatory arthritis, it may also be caused by other factors. Conditions such as anemia or an infection may contribute to it. It can also be a side-effect of certain medications. Drugs such as those taken for colds, blood pressure, pain, and depression can also cause fatigue. You should keep your doctor informed about any medications you are taking, as well as any changes in your medication regimen.
The immune system is very complicated, with many cells interacting with each other all the time. Some of these interactions produce what are called cytokines. One kind of cytokine is called Tumor Necrosis Factor, or TNF. TNF can sometimes cause cellular inflammation, which can in turn result in fatigue. Anti-TNF medications like Enbrel, Humira, and Remicade try to block TNF production, therefore decreasing inflammation. Less inflammation may mean less fatigue.
There are a number of ways you and your doctor can learn how fatigue affects you. Pain, for instance, is often rated on a scale. Fatigue can be measured in the same way.
Measuring your fatigue is a good way to determine how much it is a part of your day-to-day life, and whether it improves or gets worse over time. One way to measure fatigue for yourself is to keep a diary. Write down when during the day you feel the most tired, and also when you feel you have the most energy. It may help to use a scale to do this. For example, on a scale from 0-10, with 0 being no energy, and 10 being the most energized, how do you feel when you first wake-up? How do you feel at lunchtime? Over time, you may notice patterns in your fatigue. Identifying and understanding these patterns may help you and your doctor plan more effective ways to combat your fatigue.
One of the first things your doctor should do in assessing your fatigue is to look for other medical conditions you have that may be contributing. An undiagnosed iron deficiency, thyroid condition, or bleeding could all lead to fatigue. You and your doctor should also talk about your nighttime sleep. Do you generally sleep well or is your sleep interrupted? Are you sleeping on the right pillows? Is your mattress firm enough? Small changes in your nighttime sleep habits can make a big difference in daytime fatigue.
Lastly, do not be afraid to ask family and friends for help. Most people will be happy to help with errands or other chores when you are not feeling up to them. Occasionally, someone may not understand why you are feeling so tired. You may have to help teach them about how and why fatigue affects you, and that it is a symptom of your arthritis.
Fatigue is very common with RA and it often has a big impact on quality of life. In spite of this, the topic is often overlooked in doctor/patient visits. When you see your doctor, remind him or her to discuss this with you. Doctors are still learning about the relationship between fatigue and inflammatory arthritis and the subject should be explored often as part of treatment.
Patients should learn about how fatigue impacts them personally and what they can do to adapt. Doctors and patients should make it a point to work together to become better educated about fatigue, and to find the best ways to manage it for each individual.
How to Beat Fatigue http://www.arthritistoday.org/
Fatigue in Patients with Rheumatoid Arthritis: What is Known and What is Needed. Repping-Wuts. Rheumatology 2009; 207-09
Sick and Tired of Feeling Sick and Tired: Living with Invisible Chronic Illness. Paul J. Donoghue
Summary by Dayna Kurtz, LMSW