Fatigue is one of the most common, unexpected, and misunderstood symptoms of rheumatoid arthritis (RA), an autoimmune disease in which the body attacks its own joints. One study noted that up to 80 percent of rheumatoid arthritis patients had clinically relevant fatigue.
This is not your normal, I-tossed-and-turned-all-last-night tiredness—it doesn’t go away just by resting. With RA fatigue, it feels like your energy has been totally drained, and it encompasses your whole body. Although researchers aren’t sure exactly how rheumatoid arthritis causes fatigue, it’s theorized that overactivity of the immune system releases too many inflammatory cytokines (a type of protein), which may stress the body and contribute to fatigue.
And RA fatigue can be extremely difficult to handle because it doesn’t manifest itself physically (compared with other rheumatoid arthritis symptoms, such as joint inflammation) so it can be hard for patients to explain how they feel—and for others to understand. RA fatigue can come on suddenly, so you can never know when it’s going to strike, which contributes to the frustration patients feel with it.
With RA fatigue, it feels like your energy has been totally drained, and it encompasses your whole body.
“Some say fatigue is the hardest symptom to manage—they can ‘tough it out’ with a painful joint, but fatigue can overwhelm them,” says Susan M. Goodman, MD, a rheumatologist at the Hospital for Special Surgery in New York City. “Fatigue is complicated and multifactorial, and needs to be carefully evaluated in each patient.
You’d think that if your RA disease is controlled with medications, your fatigue would subside as well, but unfortunately, that isn’t necessarily the case. “RA disease activity does influence patient’s fatigue, but does not completely account for it,” says Namrata Singh, MD, a rheumatologist at University of Iowa Hospitals and Clinics and Iowa VA Medical Center. “It has also been shown that even after achieving a low disease state or remission, patients still continue to report fatigue.” However, keeping your disease in check may impact other factors that may improve your fatigue, such as your ability to exercise, your mood and your sleep patterns.
Here are more tips for managing and living better with your RA fatigue.
To learn more about your particular case of RA fatigue, try keeping a “fatigue diary” that may help you and your doctor figure out the reasons for when and why fatigue strikes, and what makes the fatigue better. You can write down at what points in the day you experience fatigue, rating your level of tiredness from one to 10. The resulting pattern may indicate problems sleeping at night, for example, if you’re still tired in the morning, or after certain activities. You can also record other symptoms to see if your fatigue accompanies periods of feeling more depressed, or if it gets better after physical activity.
File this one under Alanis Morissette’s version of irony: While RA fatigue might make it difficult to get moving, exercise actually has benefits for improving your exhaustion. “Physical inactivity has been correlated with fatigue in RA patients,” Dr. Singh says. One study found that RA patients who were given pedometers exercised more, and this led to decreased fatigue in those people. “Once the inflammation is under control, a careful exercise program does help,” Dr. Goodman says. Boosting muscle mass helps support your joints better, and exercise also helps with relieving pain and depressive symptoms by releasing feel-good hormones.
A healthy lifestyle also includes eating well and drinking enough in order to get proper nutrients and avoid dehydration, which can contribute to fatigue. Dr. Singh notes that obesity can also be a cause of increased RA fatigue. So, consuming a good diet of vegetables, fruits, healthy fats and lean meats in addition to exercising can keep your weight at a proper level, which puts less stress on joints and helps your body better handle the effects of the disease.
In many cases the reason that simply addressing RA disease activity doesn’t work in reducing fatigue is because the tiredness is due to another “co-morbid” factor, such as depression. “Multiple studies have shown depression to be a strong predictor of fatigue in RA,” Dr. Singh says. Living with a chronic illness is understandably not easy, which can over time lead to mental health symptoms. Because depression, stress, and other mental issues can actually take a physical toll on RA patients, it can be important to receive psychological treatment in dealing with RA.
“RA can feel overwhelming, so getting help and support from friends and family can help,” Dr. Goodman says. In addition, one study showed that cognitive behavior therapy was effective in reducing RA fatigue; other studies have shown that mindfulness meditation and other stress management techniques can help, too.
In a vicious cycle, RA fatigue can contribute to depression and physical inactivity, which can lead to poor sleep, which then leads to more daytime tiredness. “Poor quality sleep and nighttime awakenings have been linked to fatigue in RA patients,” Dr. Singh says. “Improving sleep may help prevent the development of fatigue in RA.” Talk to your doctor about addressing pain or other issues that may be keeping you up at night. “For one patient, a solution might be a splint to wear at night so the pain of carpal tunnel doesn’t keep waking them,” Dr. Goodman says. Also, make sure you sleep in a cool, dark room, turning off electronics at least an hour before bedtime, and avoid caffeine.
Your RA medications may also contribute to sleeping problems. “Patients may be awakened by heartburn if they are taking their anti-inflammatory on an empty stomach before they go to sleep,” Dr. Goodman says. In addition, other medications that you might be taking for RA, such as steroids, can make you extra sleepy. Talk to your doctor about how your meds may be contributing to your fatigue in order to develop strategies to manage these medication side effects.
RA is notorious for making simple household tasks more challenging, which might be causing you to expend extra energy. So take help where you can get it by using specialized devices such as zipper pulls, shoe horns, and electric can openers and reachers to reduce RA fatigue. “Assistive devices make everyday life a bit easier and help to maintain independence, which is key for a patient with rheumatoid arthritis,” Dr. Singh says. “They do help conserve energy and lessen the pain.” An occupational therapist can help you find tools and tricks to avoid difficult twisting and turning hand motions.
The emotional and physical energy you use when dealing with RA fatigue can take its toll. “Early on, rest is usually more appropriate,” Dr. Goodman says, especially if the disease is not yet under control. Even after your RA is better managed, make sure to listen to your body, take breaks when needed, and don’t overdo it. Acceptance of your condition, and its limitations, is key when coping with a long-term illness. But if your fatigue is interfering with your job, your ability to stay awake throughout the day, or your overall quality of life, let your doctor know. You may need to tweak your medication regimen or try different physical and occupational therapies to find techniques that will work for you to better handle RA fatigue.