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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New Drug Combination May Help Ease Fatigue Caused By Ra
A study presented at the 2020 conference of the European E-Congress of Rheumatology shows that methotrexate and prednisone, two prescription drugs commonly prescribed for rheumatoid arthritis, can help ease fatigue when started early in a patients treatment plan. Fatigue is a symptom of rheumatoid arthritis that keeps people from living productive, pain-free lives.
Texas Orthopedic board certified rheumatologist Dr. Joseph Martinez spoke to Healthline about what this study could mean for patients with RA.
This study provides further evidence that an early aggressive approach to rheumatoid arthritis treatment can improve outcomes of rheumatoid arthritis and its complications, Dr. Joseph R. Martinez told Healthline. Our patients with RA may be able to achieve a higher quality of life as suggested by this studys findings.
For more information on this study and how it could impact the treatment of rheumatoid arthritis, read the entire article here.
To schedule an appointment with one of our rheumatologists, schedule online or call 439-1001.
Keep up with Texas Orthopedics news by following us on and .
Limitations Of The Available Data
It is first worth highlighting that a range of measures exist to study fatigue within RA populations . These measures, which have been validated to a greater or lesser extent within the population, may measure various things such as the magnitude or qualities of fatigue, including severity, impact or coping , or Numerical Rating Scales ). Measures may also distinguish between mental and physical fatigue or include assessment of both the quality and type of fatigue, such as measuring physical fatigue, emotional fatigue and the social consequences of fatigue ). Finally, measures may position people on a continuum from energy to fatigue ). It is clear that the measures used may have substantial impacts on the associations observed if a predictor is differentially associated with distinct dimensions of fatigue . It is notable that few studies have used scales that capture the multidimensionality of fatigue, instead relying on single-item visual analogue scales, or numerical rating scales . Equally, there is no consistency in the definitions and measures used to capture exposures of interest and no single study has investigated all predictors of interest, making it likely that residual confounding exists and precluding the development of an evidence-based causal model/diagram of fatigue.
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How Does Fatigue Change Your Life
Fatigue is different than normal feelings of tiredness. People describe it as being overwhelming and uncontrollable. They feel worn out and drained of energy, and sometimes even lose all interest in anything.
It can increase the need for sleep and make it hard to concentrate or do anything. Constantly feeling exhausted and not being able to maintain an active lifestyle can affect your mood too: Many people who have rheumatoid arthritis also feel depressed, irritable or anxious. These feelings can be hard for others to fully understand.
The severity of rheumatoid arthritis symptoms may vary a lot over time. This can make it difficult to plan ahead. You don’t know how you will feel the next day or whether the symptoms will get better or worse. This means that people with rheumatoid arthritis feel like they have lost control of their lives. If they are too exhausted, they may not have enough energy even for simple everyday activities or for playing with their children or grandchildren. Appointments may need to be rescheduled, and some people give up their favorite activities if they prove to be too demanding.
And at work it may be difficult to accept that you can’t do as much as you used to. You might need more breaks, or certain tasks might need to be reassigned.
Can Rheumatoid Arthritis Fatigue Flare If You Do Certain Activities
Rheumatoid arthritis fatigue tends to flare when your inflammation is running its course. People living with rheumatoid arthritis get stiff during the night while they sleep, Dr. Rosian explains. In the morning, especially if they havent slept well, theyre very stiff and achy. As they get moving, they get less stiff and achy. They get more energy.
In other words, good news: Physical activity doesnt make rheumatoid arthritis fatigue worse. Things that have an impact on your immune system stress, not sleeping and having anesthesia could bring on flares, says Dr. Rosian. But exercise doesnt bring on flares. Physical therapy isnt going to bring on flares. Going to the gym and working out does not give you a flare-up.
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How To Manage Ra Fatigue
You may need a mix of treatments, lifestyle changes, and a new attitude to keep fatigue under control.
Recognize that fatigue is a part of life with RA. You canât always control it or predict when youâll be too tired to work or join a social event. Listen to your body. Youâll feel better if you take the time to rest when you need to. Take breaks if you have a task that takes a lot of energy.
Tune out the guilt. Your friends and family may not really get how bad you feel. You arenât lazy. Youâre exhausted by your arthritis. Donât feel guilty if you have to rest instead of going out or leave early because youâre too tired. Explain that fatigue is a symptom of your disease.
Donât push yourself to keep up with everyone else. If you need help with household chores that exhaust you, ask others to give you a hand. Cut out any steps you donât need to complete a task. Set your own pace. You decide what you can and canât do on days when fatigue is high.
Get regular exercise. The last thing you may want to do is work out. But studies show that aerobic activity — the kind that makes your heart beat faster — cuts fatigue in people who have an immune system disorder like RA.
Exercise also strengthens the muscles around your joints, keeps your bones strong, and boosts your mood.
Try to do something, even if itâs just stretching, on days when youâre really tired.
Two or three short periods of downtime may give you the boost you need.
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 won’t 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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Changes In Disease Activity Up To Month 12
Across active treatment groups , significant improvements from baseline in DAS28-4 and CDAI were observed vs placebo as early as month 1 and were maintained through month 6 . Improvements in DAS28-4 were MCID with tofacitinib and adalimumab by month 1 . There were significantly greater improvements with tofacitinib 10 mg BID vs adalimumab in DAS28-4 at months 3 and 6 and in CDAI at months 1, 3, and 6 .
Fig. 1
Changes from baseline in disease activity up to month 12. LS mean change from baseline in a DAS28-4 and b CDAI to month 12 across treatment groupsa pooled from Phase 3 ORAL Scan, ORAL Standard, and ORAL Sync study datasets . aAll treatments were administered in combination with background conventional synthetic disease-modifying antirheumatic drugs. ***p< 0.001 for tofacitinib and adalimumab vs placebo p< 0.05 and p< 0.01 for tofacitinib vs adalimumab. The horizontal dashed lines represent the MCIDs. The arrows on the y-axes indicate the direction of improvement. ADA, adalimumab BID, twice daily CDAI, Clinical Disease Activity Index DAS28-4, Disease Activity Score in 28 joints, erythrocyte sedimentation rate LS, least squares MCID, minimum clinically important difference Q2W, once every 2weeks SE, standard error
What Factors Contribute To Ra Fatigue
There are a lot of things that can contribute to fatigue. Among these are pain and inflammation and to the point that a biologic reduces those, fatigue can also diminish. However, other things can cause fatigue such as depression and sleeplessness which biologics do not address. Nor can biologics or other treatments reverse permanent joint damage which can cause pain which can cause fatigue directly or lead to sleeplessness or depression which, in turn, can contribute to fatigue.
Interestingly, some of the medications used to treat RA and associated conditions, also contribute to fatigue via having drowsiness as a side effect. These include certain antidepressants, pain medications, NSAIDs, some DMARDs and antihistamines. While drug-induced drowsiness is not truly fatigue, being drowsy or fuzzy-headed can aggravate the symptoms of fatigue.
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Find Support For Low Mood To Help Fatigue
You may find that your fatigue makes you feel low or even depressed. It often helps to talk about negative feelings and thoughts, so it could be useful to speak to your GP or rheumatology team, or your friends and family. Support groups are also available talk to your rheumatology team about organisations in your area.There are several kinds of support for low mood, such as talking therapies or a short course of drug treatment, some of which not only help with low mood but may also ease pain and improve sleep.
The first step is finding out what help or self-help might suit you best, so talk with your GP.
For more information on depression visit beyondblue.
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I Built Restorative Rest Time Into My Day
Just as I have made changes to my life to manage my pain, I also needed to make changes to cope with fatigue. I treat my daily nap as a sacred part of my efforts to manage pain and fatigue and quickly learned that I feel much better when I respect my bodys request for some downtime. Even if you dont have the flexibility to nap, you can give your body rest in different ways, including sitting on a bench, finding a quiet corner at work to meditate, or taking half an hour of lying on the couch when you come home. Simply getting off your feet and being still can make a difference.
My RA doesnt define me, but the reality is that it does affect everything I do and how I do it. I have finally realized that fighting back against this fact wastes precious energy on a futile endeavour. I know now that if I want to live as well as possible, I need to take care of my body and that includes accepting the fatigue. Making changes that address this ultimately creates a better life for me.
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Stay In Touch With Creakyjoints Canada
Part of the nonprofit Global Healthy Living Foundation, CreakyJoints is a digital community for millions of arthritis patients and caregivers worldwide who seek education, support, advocacy, and patient-centered research. All of our programming and services are always provided free of charge. As we grow CreakyJoints Canada we want to hear from you. Please join our email list to stay connected, learn about new content and initiatives, and send us suggestions and ideas.
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Proportions Of Patients Reporting Improvements From Baseline Mcid In Pros Up To Month 12
Through month 6, significantly higher proportions of patients receiving either tofacitinib dose reported improvements from baseline in FACIT-F total scores MCID vs placebo . This trend was also seen with adalimumab at months 1 and 3 . At month 6, the proportion of patients reporting improvements MCID was significantly higher with tofacitinib 10 mg BID compared with adalimumab .
Fig. 3
Proportions of patients reporting improvements from baseline MCID in PROs to month 12. Proportions of patients reporting LS mean change from baseline MCID ina FACIT-F total score and bi SF-36 domain scores, to month 12 across treatment groupsa pooled from Phase 3 ORAL Scan, ORAL Standard, and ORAL Sync study datasets . aAll treatments were administered in combination with background conventional synthetic disease-modifying antirheumatic drugs. *p< 0.05, **p< 0.01, and ***p< 0.001 for tofacitinib and adalimumab vs placebo p< 0.05 and p< 0.01 for tofacitinib vs adalimumab. ADA, adalimumab BID, twice daily FACIT-F, Functional Assessment of Chronic Illness Therapy-Fatigue MCID, minimum clinically important difference PRO, patient-reported outcome Q2W, once every 2weeks SE, standard error SF-36, Short Form-36 Health Survey
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Treat Arthritis Pain And Other Symptoms
Chronic pain alone can cause fatigue. Pain also can lead to depression and mood changes that can worsen fatigue. To control fatigue, it’s important to have pain well-managed. Talk to your healthcare provider about drug and non-drug techniques for effective pain management.
Higher-than-normal levels of cytokineschemical messengers involved in inflammationhave been found in the blood of those suffering from fatigue.It’s important to control inflammation and monitor active inflammation.
What Is Rheumatoid Arthritis Fatigue
Rheumatoid arthritis fatigue is impacted by your diet, your exercise and your sleep. As far as when this fatigue occurs, it tends to be cyclical throughout the day, says Dr. Rosian. Fatigue often hits mid-day, when we all get tired like two, three oclock in the afternoon. When people are doing well, their fatigue wont occur until later, maybe early evening.
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Talk About How Youre Feeling
Fatigue can make you feel low or depressed. Talking about how you feel can really help. Dont keep your feelings to yourself. Try to talk to a member of your healthcare team, members of a support group, your family or friends.
There are things that can help if youre feeling low. Your healthcare team may recommend a talking therapy, such as cognitive behaviour therapy also known as CBT. You can do it as one-to-one or group sessions.
Talking therapies aim to help people change the way they see their condition and any negative feelings towards it. Sessions, led by trained therapists, can help people change the way they react to and feel about their condition by making positive changes to the way they think and behave.
NHS England has a dedicated programme called Improving Access to Psychological Therapies, known as IAPT. It aims to connect people with anxiety and depression to local talking therapy services. You can refer yourself to this service by visiting the NHS England website and searching for IAPT or ask a health professional to refer you.
Health services in Scotland, Wales and Northern Ireland dont currently offer a self-referral service, but you can ask your doctor to refer you to a local NHS therapy service or group.
Joining a support group for people living with similar conditions can help you talk openly about your problems with people in similar situations. They may also be able to share tips on how to get around some of your problems.
Does Ra Medication Treat Fatigue
Your medications for treating RA can reduce both inflammation and fatigue. To address both, be sure to follow your treatment plan as prescribed by your healthcare provider.
If you find treatments aren’t working and you are experiencing fatigue that affects your ability to enjoy and participate in your life, reach out to your healthcare provider.
You might also consider asking your healthcare provider about medications that treat chronic fatigue, such as Provigil . Medications like Provigil need to be taken with caution because they can be difficult to stop once you start taking them
Your doctor might be able to prescribe pain medications, like Ultram , which can relieve pain and improve sleep. Low doses of anti-depressants, taken at bedtime, might also manage pain, improve sleep, and reduce fatigue.
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