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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6 thoughts on “Fighting the Fatigue of RA

  1. Having trouble breathing,I was refered to a respitory doctor who looked at my chest scan and told me my lungs were scared,he said he was more than certain it was RA,and sent me for a blood test,two days later I was phoned to undertake a “lung function test”
    This was four weeks ago and he has not contacted my GP,this is despite me ringing the hospital and speaking to his secretary who promisted to leave a note to ask him to.
    My joints are stiff,my fingers are bent over with limited movement,the last word from the hospital doctor was “see you in 10 weeks”I have an appoint ment with my GP infive days time and hopefully he can start to treat me.
    I read that early treatment is vital,but I do not hold out any hope and this coupled with heart failure makes my life very uncomfortable to say the least.I think depression is beginning to set in as the future looks bleak indeed.

  2. I’m dealing with a lot of fatigue at work and at home. I find myself almost falling asleep at my desk at work, in meetings, or just sitting on the couch at home. I was diagnosed with RA back in 2003 and currently taking Orencia 125mg one shot per week along with Percocet for pain. I’m 59 and in pretty good health otherwise, but now find it hard to make it through a round of golf.

    Thanks for this article and any further advice would be appreciated.

  3. I am so grateful to see an article which actually acknowledges chronic fatigue in RA sufferers as a real thing. I am 20 years diagnosed and verbal upset all the time with my family and friends joking about me being lazy and always lying down. Was also interested in the advice to get up and get active totally different from what I was advised many years ago. Thank You

  4. I’ve had RA for 10 years and I feel if I didn’t have pain medication I wouldn’t be here . It makes me angry that a rheumatoid arthritis patient has to be told pain medication don’t help by doctors who don’t have rheumatoid arthritis.. Are joints are ate up and without pain meds I know alot of ppl wouldn’t be here … I’ve took methotrexate and tons of other medications for RA not 1 of them helps with joints that are ate up .. so why is this believed.. If a dr sees a mri or xray and damage to joints don’t you think it is painful?? I will tell you as a RA sufferer and having a disc removed from my next and replaced and my hips bone on bone, shoulders, knees, dam and damage to every joint in my body including 4 disc in my neck , 3 in the lower back and having surgery.. NOTHING COMES CLOSE TO RA PAIN …
    having a pain clinic dr tell me we need to take my pain meds away is unethical I’ve took pain meds ever sense I got RA I don’t abuse it or drink or do anything wrong and ppl living like this and proving for years that they don’t abuse the rules shouldn’t be punished by ppl who sales and abuses the pain medication… its unfair. Walk a day in our shoes .. All this unethical stuff will only push ppl in chronic pain who will suffer until they die to suicide.. It’s sad you will give someone with back pain pain medication and believe ppl with RA are cured by immune suppressant medications.. NUTS ..

  5. I’m so glad to see the recognition that debilitating fatigue can hit people whose RA seems otherwise to be in remission. However, the other causes the article states–obesity, poor sleep, inactivity, and depression–are not applicable to me. My sleep is never restorative, but I’ve had a sleep study and had no signs of apnea or other sleep impairments. I’m at the low end of normal weight for my height. I’ve had depression in the past and know for certain I’m not depressed. And I’ve always been an avid exerciser, but have had to stop because every time I exercise, my body crashes and I end up pretty much bedridden for days or weeks. I wish this article would address folks like me who don’t fit into the neat categories of other fatigue causes.

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