What Causes Chronic Fatigue
Fatigue is one of the common symptoms of rheumatoid arthritis. It can be one of the first warning signs of RA before the diagnosis is confirmed. For many patients, the onset of chronic fatigue symptoms associated with rheumatoid arthritis can be vague and difficult to categorize and may be attributed to other causes.
The cause of chronic fatigue can sometimes be difficult to identify because there are many factors to consider. Some of the different factors that cause chronic fatigue include:
- Poor sleeping patterns
- Poor diet and lack of physical activity
In addition to the regular rheumatoid arthritis symptoms, fatigue becomes even more chronic and debilitating when other medical complications are involved. Fibromyalgia, obesity, heart disease, respiratory disease such as COPD, and depression, are a few examples that can complicate and worsen the effects of fatigue.
Established Ra: Is There A Lag In Fatigue Improvement
Patients with RA in the Ontario Best Practices Research Initiative registry that were not in a low disease state at baseline were followed to determine if patient-reported outcomes improved differently comparing ERA with established RA. In nearly 1000 RA patients of whom one-third had early disease, time to remission was faster in ERA as was time to achieving a physician and patient global assessment of 0 or 1 out of 10. However, the time to improving fatigue was the same in both those with early and established RA.
Balance Rest With Activity
Everyone needs to allow time for rest, and when you have RA, getting adequate rest is particularly important. However, its still important to be active.
Doing too little can also lead to fatigue, according to the Arthritis Foundation. Do some light exercise every day to help keep your joints in shape and to avoid muscle deconditioning.
This showed that physical activity can help people with RA manage fatigue. Regular exercise also can make it easier to get a good nights sleep.
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Schedule Naps Into Your Day If You Can
Renee A., 40, says that her fatigue comes in spurts. Some days, I wake up feeling like I can conquer the world other days I wake up feeling like a Mack truck hit me, she says. Its very difficult and it requires a lot of mental fortitude. Renee home-schools her three children and says she sometimes holds lessons in her bedroom or on the couch, which allows her to rest. If Renee doesnt take time to nap or even sit for a while, then her fatigue and other rheumatoid arthritis symptoms flare up and she feels much worse, she says. I have learned that the hard way, Renee says.
If you dont work from home, or if your schedule is packed with Zoom meetings and tight deadlines, then you may not be able to nap whenever you feel exhausted. However, if you can, lying down even for a few minutes after work may be helpful. Creaky Joints volunteer Eileen D., 35, says taking a short nap can make a big difference in her energy levels. Sometimes I need to have a quick rest. Just 20 minutes can be a lifesaver, she tells SELF. Sleeping for too long can make you feel groggyand make fatigue worseso its a good idea to nap for 1020 minutes, according to the Mayo Clinic.
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Prepare Well For A Night Of Quality Sleep To Fight Fatigue
If you want to get refreshing sleep that helps you feel less tired when you wake up, plan your evenings carefully. Avoid big meals, caffeine, and alcohol before bedtime, suggests Dr. Araujo. You should also avoid caffeine late in the day. Consider what type of media you consume in the late evening, too stimulating television shows or upsetting movies may disrupt rest. And keep in mind that while a nightcap may help you fall asleep, its likely to cause you to wake up later and distract you from a restful night. Finally, consider going to bed earlier, so that you can wake up earlier and ease into your day at a more leisurely pace.
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Sleep Hygiene Can Help Improve Fatigue Symptoms
Many underestimate the importance of maintaining good sleep habits. Further, poor sleep has been associated with increased levels of pain in RA and fibromyalgia. Domingues offers the following tips to chronic disease patients looking to improve their sleep hygiene:
- Only go to your bed to sleep. Do not read, watch TV, play cards, or use computers in your bed. Instead, make your bed the place where your body knows, implicitly, that it is time to sleep.
- Try minimizing exposure to plain blue light from devices such as phones and tablets. Most of the newer versions have an option for warmer light that kicks in at nighttime.
- Coffee is a good friend to many, but avoid caffeine intake after 6 pm.
CreakyJoints is an online community of patients and families who are looking for arthritis resources and support. Founded in 1999, it now includes more than 100,000 arthritis patients and their family members. To learn more and to join for free, go to CreakyJoints.org.
Important: The views and opinions expressed in this article are those of the author and not Everyday Health.
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Pharmacologic Treatment Of Fatigue
Pharmacological treatment of fatigue in RA has been primarily studied by treating disease activity and/or pain. Treating to a target and achieving rapid remission or very low disease state in ERA predicts lower fatigue early and later . Effective treatment in RA will only partially reduce fatigue if it is related to the disease activity in RA.
Virtually all treatments in RA will reduce fatigue, including conventional synthetic disease-modifying anti-rheumatic drugs , targeted synthetic DMARDs, biologic DMARDs and corticosteroids. The average effect of treatment on fatigue in active RA with various advanced therapies is meaningful but not large. Treatment of disease activity in RA has a small impact on fatigue, whereas physical inactivity, poor sleep and depressed mood explain most of the fatigue. Often fatigue is an exploratory outcome in trials. Medications can cause or exacerbate fatigue. A strong predictor of nonadherence to methotrexate was fatigue .
Improvement in fatigue has been related to the line of therapy in a review of abatacept trials. Abatacept improved fatigue more than placebo, and improvements in fatigue were higher in ERA compared with biologic exposed patients. More than 1500 patients from the three trials were analysed, and the authors concluded that improvement in fatigue and other outcomes such as pain, sleep and remission had poor agreement and earlier lines of therapy had more responsiveness with respect to fatigue in patients treatd with abatacept.
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Physical Therapy And Exercise
Regular physical activity is an important piece of your overall treatment plan. It can help preserve range of motion in your joints and strengthen the muscles that support them.
Many people with RA benefit from working with an experienced physical therapist . A PT can create a strength and mobility program for you and show you how to move in ways that will help and wonât cause further damage. A physical therapist can also teach you pain relief techniques and prescribe splints and braces to support damaged joints.
In addition to exercises prescribed by a physical therapist, there are many activities you can do on your own to maintain or improve joint mobility, build muscles, strengthen your cardiovascular system and promote general health and well-being. The right form of activity for you depends not only on which joints are affected and the severity of your disease, but also on your interests. The best exercises are those you enjoy enough to do regularly. Popular and safe options for people with RA include walking, swimming, water exercise, low-impact aerobics and stationary cycling.
You should speak with your doctor before beginning any new exercise plan.
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The Causes Of Rheumatoid Arthritis Fatigue
You wake up exhausted, drag yourself through the day, and keel over into bed with nothing left. This is rheumatoid arthritis fatigue. Many of us have been known to say that the pain is bad, but the fatigue is almost worse.
We are not talking about just being tired. RA fatigue is pervasive. To make others understand what it feels like, you can liken it to the fatigue that people feel when they have the flu. An editorial in the journal Rheumatologydefined fatigue as physical and/or mental exhaustion that leads to a marked impairment in normal activities, whether mental, physical, domestic, social, or occupational. It is not improved substantially by bed rest and may be worsened by normal levels of physical or mental activity.
Living with a chronic illness is exhausting, and chronic pain certainly contributes to feeling like a wrung- out dishcloth. However, there is also a biological reason for RA fatigue.
Understanding RA fatigue
At the 2015 annual Congress of the European League Against Rheumatism it was reported that not only is there a biological basis for the fatigue experienced by people with rheumatic conditions, such as RA, but that this fatigue is also gene regulated. A Norwegian researcher presented the results of a study, stating his belief that interleukin 1 beta is the fatigue cytokine.
What you can do about RA fatigue
But this isnt the case for everyone. In fact, levels of fatigue are not always associated with the level of inflammation.
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Psoriatic Arthritis: Flares And Fatigue
Psoriatic arthritis might cause fatigue in several ways. In part, the disease process itself may be to blame.
When you have psoriatic arthritis, your immune system releases proteins called cytokines. Those proteins trigger inflammation throughout your body a hallmark of the disease. Researchers believe the cytokines also cause fatigue, perhaps through several different pathways in your body.
Psoriatic arthritis symptoms come and go. Sometimes, they are relatively mild. Other times, the pain and swelling become significant. Those bad periods are known as flares. And when a flare occurs, fatigue often comes along for the ride.
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Try To Keep A Reserve Of Meals And Supplies That You Can Use On Days When You Need Extra Rest
, 38, is a mom of three, and she says juggling the demands of motherhood and her rheumatoid arthritis fatigue can be tough. Shes found that meal prepping and reserving special toys that keep her kids entertained for longer give her more time to rest on particularly tiring things.
When Im feeling up to it, I cook big-batch meals and put some in the freezer for days when I have less energy, she tells SELF. Mariah also keeps a cupboard full of quiet activities and crafts that her kids can work on if she needs extra rest time. We also use a system of toy rotation, where about one-third of our toys are out in the playroom and two-thirds are off-limits in a closet, she says. So on days when I am in pain or have less energy, I can bring out new toys that will keep the kids attention longer because they havent been played with for a while.
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Treat Ra Fatigue By Reducing Ra Disease Activity
I believe the other part of rheumatologists not tackling fatigue head-on is that they believe if they can reduce disease activity, fatigue will also be reduced.
I personally have subscribed to that theory make RA less active and the fatigue will also be less so I was surprised to read a recent article that discussed several studies demonstrating that while biologics can be effective against disease activity , they arent always effective on addressing the debilitating effects of fatigue.
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Ask Your Doctor About Medications To Treat Fatigue
Certain medications may help chronic fatigue, such as modafinil. However, you need to use these with caution, because once you start taking them, it may be hard to stop, Ali says.
Using pain medications such as acetaminophen at night can help improve sleep thats disrupted by RA pain, Ali adds.
Another option, a low-dose antidepressant, also given at bedtime, has been shown to reduce pain, increase sleep, and reduce fatigue in some people with RA, he says.
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How Rheumatoid Arthritis Triggers Chronic Fatigue
More than just being tired, chronic fatigue is a feeling of exhaustion that cant be fixed with sleep. Its often associated with brain fog and a lack of motivation or inability to complete tasks. Chronic fatigue is common in people who have certain autoimmune conditions, including rheumatoid arthritis .
Chronic fatigue is a common struggle for those with RA. Read Rheumatoid Arthritis and Fatigue
Below are 6 possible reasons why a person with RA experiences chronic fatigue. These underlying factors may work alone or together to contribute to an individuals overall fatigue.
Measurement Of Fatigue In Ra
Numerous fatigue tools/scales have been used in RA. A systematic review described 23 different fatigue tools which were published before Patient-Reported Outcomes Measurement Information System was developed. In their review, they concluded that ordinal and VAS, the Short Form 36 vitality subscale, the Functional Assessment of Chronic Illness Therapy Fatigue Scale , the RA-specific Multidimensional Assessment of Fatigue scale and the Profile of Mood States were validated and seemed sensitive to change. Some scales are generic, and others are disease specific.
Commonly used measures of fatigue in RA include numeric rating scales such as VAS 0 to 100 mm or an 11-point scale . Other scales such as change in fatigue have been used . Other questionnaires within RA trials include the Functional Assessment of Chronic Illness-Fatigue Bristol Rheumatoid Arthritis Fatigue-Multidimensional Questionnaire SF-36 vitality domain and PROMIS-29 Fatigue T-score. The FACIT-F scale ranges from 0 to 52, where higher numbers imply less fatigue. Fatigue scales are correlated to each other, but there is no universally agreed-upon fatigue questionnaire/tool to use in RA. The PROMIS fatigue score has face validity measures fatigue across the spectrum of severity is correlated with pain, sleep disturbance, anxiety and depression and disease activity and is also strongly correlated with other fatigue scales.
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Stiffness In The Joints
In addition to pain, this disease causes stiffness in the affected joints. You may have difficulty getting out of bed or walking in the morning because of stiff and painful ankles, knees, or feet. This stiffness is usually worse in the mornings and can last for 45 minutes or more.
RA can also trigger swelling in the affected joints. Long-term inflammation can cause you to feel physically exhausted.
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Tips To Manage Psoriatic Arthritis Fatigue
If you have psoriatic arthritis and need a nap to get through the day, some simple changes can boost your energy and make you feel better.
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Reason : Youre Experiencing Side Effects
Speaking of antidepressants possibly causing fatigue, medications also come with a dose of this debilitating side effect. Certain drugs, for example, beta blockers that slow down the heart rate, can cause fatigue, Dr. Greer says. What makes things worse is that even the medications prescribed to help with RA pain can also make patients tired, Dr. Cohen says. For instance, methotrexatean anti-rheumatic, is prescribed to help control active RA, but this medication may also induce fatigue by negatively impacting the bodys metabolism.
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What Blocks Pain Signals
Many scientists think pain control methods help reduce pain by blocking pain signals. Pain signals are sent through a complex system of nerves in the brain and spinal cord.
There are many things that can block these signals and thus prevent the pain message from reaching your brain.
Pain signals are blocked by chemicals made by the brain called endorphins. There are several things that can cause the brain to produce endorphins. These include ânaturalâ controls, such as your own thoughts and emotions, or âoutsideâ controls such as medicines.
Natural controls
A father driving with his children is hurt in a car accident. The father is so worried about his children that he doesnât feel the pain from his own broken arm. The concern for his children somehow blocked the pain signal and kept the pain from affecting him.
Outside controls
Certain medicines such as morphine imitate the bodyâs endorphins and block the pain signal. Other pain control methods, such as heat and cold treatments, physical therapy, exercise, relaxation and massage can stimulate the body to release its own endorphins or to block the pain signal in other ways.
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