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.”
“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.
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.
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.
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.”
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.
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.
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.
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.”