fighting fatigue rheumatoid arthritis

Fighting the Fatigue of RA

Symptoms of rheumatoid arthritis (RA) don’t stop at joint pain and swelling. Most people with RA also experience mental and physical exhaustion, a symptom known as fatigue. Studies show that up to 80% of people with RA have at least some sense of feeling run down, and more than 50% have high levels of fatigue.

Terence Starz, MD, a rheumatologist at the University of Pittsburgh Medical Center, says the feeling can be described as overwhelming or different from just being tired because it is extreme and seems to come from nowhere. In fact, fatigue may have a greater impact on daily life than pain.

Causes of Fatigue

You may expect disease activity and high levels of inflammation to cause your fatigue. It’s true they account for much of it, but recent studies have shown that these factors don’t tell the whole story. A 2016 study published in Rheumatology found that even when people are in clinical remission, they can still have significant fatigue.

If it’s not disease activity, what else could be causing your fatigue? In a study published in Arthritis Care & Research in 2016, Patricia Katz, PhD, professor of medicine at University of California San Francisco, and her colleagues found that “fatigue may result from a constellation of factors that includes disease activity and pain, but also includes inactivity, depression, obesity and poor sleep.”

Pinpointing which factors cause fatigue and which are a result of fatigue is difficult. Katz says the relationships may be cyclic: “Fatigue may lead to inactivity and depression; then the inactivity worsens fatigue, depression and poor sleep.”

Fatigue can be overwhelming, but you don’t have to accept your crushing exhaustion. Medications and lifestyle habits can alleviate your fatigue and boost your energy.

How Your Doctor Can Help

Eric Ruderman, MD, professor of medicine at Northwestern University Feinberg School of Medicine in Chicago, says “a comprehensive disease management program will help control inflammation, disease activity, pain and fatigue.”

Disease Control

“As disease activity decreases, usually, so will fatigue. Controlling inflammation through early and aggressive treatment is essential for your long-term well-being,” Dr. Ruderman explains. If you have successfully treated your disease activity, but you still have significant fatigue, you may need to target other factors that influence your fatigue levels.

Pain Control

Your doctor can prescribe a variety of medications to help control the pain of RA and the secondary osteoarthritis that may develop. These medications include acetaminophen, nonsteroidal anti-inflammatory drugs, topical pain relievers, corticosteroids (injected into individual joints or taken orally) and hyaluronic acid injections.

If you have fibromyalgia and RA, your doctor may prescribe antidepressants or anti-seizure medications to help control your centralized pain.

Dr. Ruderman says opioids are not the best option for most people with RA because opioids should generally be avoided for long-term use.

Depression Control

Fatigue, depression and RA often go hand-in-hand with one making the others worse. Dr. Ruderman explains depression can be a brain chemical issue that may require consultation with a psychiatrist and possibly antidepressant medications. For milder cases, some rheumatologists are comfortable prescribing these drugs. When taken in low doses, they can also help ease pain.

Insomnia Control

Sleep aids can help you get more restorative sleep, helping both pain and fatigue. But Dr. Ruderman says not to rely on them. It’s important to engage in daytime physical activity and practice good sleep hygiene. “The newer medications can be used as a last resort, but I try to avoid the older sedatives,” he says.

What You Can Do

Because fatigue in RA is multifactorial, you shouldn’t rely on medications alone to alleviate your drained feeling. These lifestyle habits can help increase your energy.

Activity and Exercise

Besides controlling your underlying inflammation and disease, probably the most important thing you can do to lessen your fatigue is to get moving! If you’re exhausted, the last thing you want to do is exercise. But studies show that increasing your activity level will improve your fatigue.

Katz presented a study at the 2015 American College of Rheumatology annual meeting that showed giving a person with RA a pedometer and some modest step goals improved physical activity and decreased fatigue. “Results suggest that increasing physical activity by prescribing a pedometer can be effective for reducing fatigue,” Katz says, “particularly among individuals with very low activity levels initially.”

Sleep Hygiene

Poor sleep can significantly affect your pain and fatigue. Dr. Starz recommends several non-drug steps to improve your sleep, including developing a ritual with a stable bedtime; sleeping in a cool, dark room; limiting caffeine; and turning off electronics at least an hour before bed.

Life Balance

You may need to adapt your activities and lifestyle when your fatigue is at its worst. Find balance by giving yourself periods of rest and plenty of sleep. Dr. Starz says, “Thoughtful planning, prioritization and pacing of your daily activities should be your guiding principles.”

Hot and Cold Therapies

Cold packs slow blood circulation, which can help reduce inflammation and pain. Warm baths or compresses improve blood flow and relax sore muscles, which can ease your pain and stiffness.

Mind-Body Techniques

Cognitive behavior therapy, meditation, yoga, tai chi and other therapies work on the connection between your mind and body. Harnessing this connection can help reduce fatigue, improve mood and energy, and reduce pain.

Weight Management

Katz’s studies show that people with RA who are obese are more fatigued than patients of a healthy weight. So achieving and maintaining a healthy weight may help reduce your fatigue levels.

Drs. Ruderman, Katz and Starz agree about the best overall tactic to take to fight fatigue: Control your underlying disease and “move more, sit less.”

Related Resources:

Fibromyalgia and RA

RA With a Side of Fibromyalgia

For years, fibromyalgia was a mystery illness. No one knew what caused it, how to diagnose it or how best to treat it. Some people, including doctors, even questioned its existence. In the last few years, however, researchers have cleared up some of the mystery. Although much about fibromyalgia still isn’t understood completely, two things are clear: It’s very real, and it affects a disproportionate number of people with rheumatoid arthritis (RA).
Continue reading RA With a Side of Fibromyalgia

Arthritis Increases Risk of Heart Attack

Risk of Heart Attack Rises After RA Diagnosis

Generally, patients with rheumatoid arthritis (RA) have higher levels of inflammation in their bodies, which can affect other organs and tissues besides the joints. In fact, people with RA have up to twice the risk of heart disease and development of heart failure (especially if they test positive for rheumatoid factor, or RF) than the general population, according to a 2013 Mayo Clinic study published in the American Heart Journal.
Continue reading Risk of Heart Attack Rises After RA Diagnosis

Biologics Rheumatoid Arthritis Cancer

Biologics Appear Safe for Some Rheumatoid Arthritis Patients Who’ve Had Cancer

Researchers set out to answer a pressing question: Is it safe for rheumatoid arthritis (RA) patients who have had cancer in the past to use a biologic drug rather than a traditional disease-modifying antirheumatic drug (DMARD), like methotrexate, to control their disease? Their answer, detailed in a study recently published online in the journal Rheumatology, is reassuring. They found that patients with a previous malignancy who later took certain biologics did not appear to have an increased risk of cancer after an average of five years, compared to those who took a traditional DMARD.
Continue reading Biologics Appear Safe for Some Rheumatoid Arthritis Patients Who’ve Had Cancer

Anti TNF RA Flare

Study: Risk of Rheumatoid Arthritis Flare Triples in People Who Stop Anti-TNFs

Biologic drugs make it possible for many people with inflammatory types of arthritis, such as rheumatoid arthritis (RA), to achieve low disease activity or remission. But because of the drugs’ cost and the potential for serious side effects, many patients don’t want to stay on them indefinitely, so researchers have been looking at whether it’s possible to taper or stop them. A new study, published recently in Arthritis & Rheumatology, is adding to the growing body of research on the topic.
Continue reading Study: Risk of Rheumatoid Arthritis Flare Triples in People Who Stop Anti-TNFs

Track React Rheumatoid Arthritis Tracking Tool

Announcing the New and Improved Rheumatoid Arthritis Track + React App!

Track what you do and how you feel on a daily basis – even when you’re on the go! The newly relaunched Track + React app can be used as a web tool on arthritis.org as well as on your smartphone via the app. Track + React features a completely revamped free mobile app available for download for iPhone and Android devices that allows you to track key daily activities related to your rheumatoid arthritis (RA) wherever you are.
Continue reading Announcing the New and Improved Rheumatoid Arthritis Track + React App!

Fatigue Rheumatoid Arthritis

Study Shows Fatigue Persists in Some Cases Even When Rheumatoid Arthritis Is Controlled

The fatigue that often accompanies rheumatoid arthritis (RA) can be as distressing and disabling as the pain – and often harder to treat. RA-related fatigue has been associated with molecules called cytokines that promote inflammation, such as tumor necrosis factor (TNF), and the use of biologics that block TNF have been shown to somewhat reduce fatigue. But a new study published online in the journal Rheumatology quantifies just how stubborn RA-related fatigue is – even when the disease itself is well controlled with an anti-TNF medication – and characterizes which patients are most likely to beat it.
Continue reading Study Shows Fatigue Persists in Some Cases Even When Rheumatoid Arthritis Is Controlled

Rheumatoid Arthritis Flares Management Control

Get and Keep Control of Your Rheumatoid Arthritis

When arthritis is active and painful, you have a constant reminder and strong incentive to take your medications. But when your disease is under control, it may be easy to forget a dose or two or you may even be tempted to stop taking your medication altogether. But doing so is not a good idea. The way you are feeling – particularly when you are on medication – is not always an indication of whether there is underlying disease activity. Stopping your medication could cause your disease to flare, resulting in the irreparable joint damage your doctor was aiming to prevent when prescribing medications in the first place.
Continue reading Get and Keep Control of Your Rheumatoid Arthritis

Rheumatoid Arthritis Remission Obesity

New Research: Obesity May Reduce the Chance of RA Remission by as Much as Half

People with rheumatoid arthritis (RA) who are obese are less likely to achieve disease remission than their non-obese counterparts, according to a meta-analysis published in May in Arthritis Care and Research. The review also found that obesity was associated with higher levels of disease activity and pain, suggesting excess weight may negatively affect overall outcomes in RA. This meta-analysis supports earlier research, including a study presented at the 2015 annual meeting of the American College of Rheumatology.
Continue reading New Research: Obesity May Reduce the Chance of RA Remission by as Much as Half