Category Archives: Symptom Management

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.”

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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

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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

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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.
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Being Overweight Can Hurt Rheumatoid Arthritis Remission

If you have a few – or a lot – of pounds to lose, you know that carrying excess weight around can stress your painful or fragile joints. But research shows that the mechanical effects of weight are just part of the problem.

Fat itself releases chemicals including tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1) that promote inflammation. These chemicals may not only increase the risk of developing some forms of arthritis, but they may also increase arthritis severity or make it harder to control.

In fact a study presented at the 2015 annual meeting of the American College of Rheumatology found that for people with early rheumatoid arthritis (RA), being overweight or obese can reduce the chance of achieving sustained remission.
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Outlook Brighter For People With Rheumatoid Arthritis

People with rheumatoid arthritis (RA) are likely to have a much better quality of life today than they did two decades ago. Researchers in the Netherlands observed more than 1,100 patients diagnosed with RA between 1990 and 2011. They attribute the gains to earlier diagnosis, more aggressive medications and a greater emphasis on overall well-being. Their findings were published in Arthritis Care & Research in 2014.

Lead author Cecile Overman, a postdoctoral researcher at Utrecht University in the Netherlands, says she and her colleagues wanted to determine if improved treatments over the last 20 years led to better physical and psychological health for RA patients. Continue reading Outlook Brighter For People With Rheumatoid Arthritis

rheumatoid arthritis inflammation control

Early Control of RA Inflammation Prevents Joint Surgery

With the advent of early, aggressive treatment and more effective drugs, rheumatoid arthritis (RA) patients are facing joint surgery much less than they were 20 years ago.

When rheumatologist Erdal Diri started working at Trinity Health Center in Minot, N.D., more than a decade ago, he saw many RA patients referred to him by surgeons frustrated by the levels of joint inflammation they saw. Better inflammation-fighting drugs and a new approach to treating RA more aggressively have changed that, he says. From an average of 30 to 40 RA patients per year being sent for surgery at this rural hospital, Dr. Diri now sends only 4 or 5.

Research Backs a Decline in RA Joint Surgeries

A study conducted by rheumatologists at the Mayo Clinic in Rochester, Minn., and published in Journal of Rheumatology in March 2012, tracked surgeries among 813 RA patients from 1980 to 2007. The researchers, led by Eric L. Matteson, MD, found that the incidence of any joint surgery within 10 years of diagnosis went from 27.3% in the 1980 to 1994 period, to 19.5% in the 1995 to 2007 period.
Continue reading Early Control of RA Inflammation Prevents Joint Surgery

RA Exercise Fatigue

Can a Pedometer Help Fight Rheumatoid Arthritis-Related Fatigue?

The key to helping people with rheumatoid arthritis (RA) fight fatigue may be – literally and figuratively – a walk in the park, according to research presented at the 2015 American College of Rheumatology Annual Meeting. Researchers from University of California, San Francisco (UCSF) found that modest exercise decreased fatigue and that a pedometer – plus a bit of guidance – helped increase the amount people exercised.

“Fatigue is one of the top-rated concerns; it has multiple sources and causes. We know from earlier studies that physical inactivity is associated with fatigue,” says lead study author Patricia Katz, PhD, a professor of medicine and health policy at UCSF. “We wanted an intervention that is simple, exportable and has few barriers to implementation.”

Katz and her team measured the activity level of 96 people with RA for one week, and had them fill out questionnaires. Then the participants were randomly divided into three groups. One group was educated on the need to be active. The second group was given a pedometer and a diary to record their daily steps. The third group got a pedometer, a step diary plus personalized daily step targets. The step targets were based on each person’s starting activity level and increased 10%every two weeks. Groups two and three also got phone calls every two weeks to collect the information from their step diaries.
Continue reading Can a Pedometer Help Fight Rheumatoid Arthritis-Related Fatigue?