Managing Fatigue in Rheumatoid Arthritis: Strategies and Skills

A presentation from the HSS Early RA Support and Education Program

 

Fatigue is a common complaint for people with rheumatoid arthritis (RA), with 40% to 80% of patients facing fatigue at some point.

What is fatigue?

Fatigue is often hard to define, given how little we understand it. These basic definitions may help you begin to spot and describe what you’re feeling:

  • an overwhelming sense of exhaustion
  • decreased mental and exercise capacity
  • unpleasant, unusual, or abnormal whole-body tiredness

Although it is a common symptom of rheumatoid arthritis, sometimes fatigue can simply be a result of overdoing tasks and activities. To distinguish this type of fatigue from that which arises from RA, it’s good to ask yourself if the amount of fatigue you feel matches the amount of your activity.

One could expect to feel fatigued after a long hike. With RA, however, you may feel fatigued while doing nothing strenuous at all, such as while just watching TV. While severe, persistent fatigue is less common, what’s often described is a sense of feeling paralyzed or helpless, like you have to give into it.

Measuring fatigue

Doctors are good at measuring and talking about pain, but it’s more of a challenge to explore and understand a person’s experience of fatigue. Here are a few questions that can shed some light on your fatigue:

  • Are you exercising or not?
  • Describe your fatigue.
  • What are your thoughts about it?
  • How does it take shape in your life?
  • How do you cope with it?

There are many scales used to measure fatigue. The most common ones ask you to rate your fatigue, such as on a scale of 0 to 10, with 0 being no fatigue and 10 being the worst fatigue ever.

You are the expert about your body. You know yourself best, so trust in what your body tells you. This information will allow you to provide insights for you and your doctor. Win-win!

What causes fatigue?

It’s important to understand various causes of fatigue, since it’s not always related to RA disease activity. Could there be one or more reasons for your fatigue – beyond your rheumatoid arthritis?

Some causes of fatigue may be:

  • inflammation/swollen tender joints
  • pain
  • depression, anxiety or other mental health issues
  • anemia
  • thyroid problems (hypothyroid conditions)
  • infections
  • certain medications
  • sleep problems (lack of sleep due to insomnia, sleep apnea, work schedules or lifestyle )
  • low levels of Vitamin D

It’s helpful to talk to your doctor about these things in order to pinpoint what changes you make that can have a positive impact on your quality of life. Be sure to review any medications you take and the time of day you take them. Most people with RA frequently take steroids in the morning to combat stiffness, but when taken later in the day they can cause sleeplessness. There are a host of other medications, such as pain, blood pressure, and muscle relaxants that can cause some people to be tired. Antidepressants and anti-inflammatories are less likely to cause fatigue, but for some, do.

There’s a vicious cycle of food, fatigue, lack of sleep, not doing enough, low mood, and stress, which forms a circular pattern. Your mindset and view of each of these aspects can have an impact on your fatigue.

How can we reduce fatigue?

Like so many things in life, it’s 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:

  • Look for and treat other health issues that may add to your fatigue.
  • Review/adjust medications.
  • Prescribe activating meds like antidepressants – these may help for physical tasks during the day.
  • Prescribe sleep aids that may help you get a good night’s rest.
  • Ask about your fatigue.
  • Suggest lifestyle changes that may improve your energy.

You can:

  • 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 (cognitive behavioral therapy) 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 can’t always see or know when you need help.

Research studies

Some studies show that RA is right up there with depression, cancer and lung disease with regard to the level of fatigue. Other studies point out correlations between poor sleep and depression, higher disease activity shown by C-reactive protein (CRP) and ESR/sedimentation rates, which are blood tests that measure inflammation.

Other findings worth noting are that severe fatigue is seen more as a result of people’s viewpoint of their health and pain, rather than the disease itself. Also, some medications and supplements like vitamin D, vitamin B6, fish oil, and anti-TNF meds (a group of biologics) seem to improve fatigue.

There is also ongoing research about diets. For some reason, severe restriction of sugar and calories appears to have value. Doctors by no means recommend such a diet, but these findings beg for more research that can tell us why that is, and where we go from here. Always keep in mind, the best approach is, everything in moderation.

Summary

Being aware of your how fatigue presents in your life allows you to better plan and cope. Speak to and work with your doctor. If fatigue is a problem for you, be sure to bring it up at the beginning of the appointment so that it is adequately addressed during the visit. Doctors may not always ask the right questions or have all the answers, but they are there to help. Friends and family may want to be there for you too, but often don’t know what to ask. It’s okay to say, “This is a bad day, is there any way you could help with the dishes (garbage, laundry, etc.)?

Lastly, be kind to yourself. Fatigue is just a symptom, it doesn’t define you.

Authors

Image - Photo of Jessica R. Berman, MD
Jessica R. Berman, MD
Assistant Program Director, Rheumatology Fellowship, Hospital for Special Surgery
Associate Attending Physician, Hospital for Special Surgery

Laura Jasphy, Ed.D
Senior Clinical Social Worker

 

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