What Are Options For Pain Management
Minor pain and stiffness of mild PsA can be alleviated with non-steroidal anti-inflammatory drugs . In addition, injections of corticosteroids may be used.5
For moderate to severe disease, treatments that target joint disease in PsA frequently can reduce symptoms and prevent disease progression. Recommended treatments include disease-modifying anti-rheumatic drugs .
The first step for treatments is usually DMARDs such as methotrexate, leflunomide, or sulfasalazine. Other treatments include medicines that target tumor necrosis factor , a chemical that produces a wide range of inflammation in PsA.
Examples of TNF blockers include etanercept , adalimumab , infliximab , golimumab , and certolizumab pegol . Other DMARDs that have proven effective in clinical trials include ustekinumab , and secukinumab .1
The FDA has also recently approved Inflectra , a biosimilar to infliximab, for the treatment of psoriatic arthritis.7Physical and occupational therapy can be critical treatment approaches to both protect the involved joints and maintain function.5
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Helping People Around You Understand Fatigue
Fatigue is a major symptom of many conditions, such as arthritis often its as much of a problem as pain and inflammation. But its an invisible symptom and a lot of people avoid talking about it because they think their family, friends and colleagues wont understand.
It can be stressful if you think people around you dont understand how youre feeling. Even when you explain, some people may struggle to realise how fatigue affects you and that it stops you doing certain activities. This can be frustrating and tiring and can put a big strain on your relationships. Getting help, support and understanding from the people around you can make a huge difference.
Good communication and explaining clearly and calmly how fatigue affects you is important to help others understand.
Its ok to say that you need help with tasks around the home.
Learning to say you cant do something or go somewhere because of the way it will affect you can help. It may also reassure people that sometimes you just dont feel up to socialising and its no reflection on their company.
If people ask for your help with something, remember its ok to say no. Its ok to put yourself first.
If you find it difficult to talk about your fatigue, you could ask people to read this information.
Talking To Your Doctor About Fatigue
There are several things that can reduce the impact of fatigue. Firstly, it helps if you can work out what could be causing it.
There arent any specific tests for fatigue. However, you can help your doctors diagnosis by writing down how you feel, what could be causing it and how its affecting your life. They may also be able to provide you with a self-assessment questionnaire to fill out.
Depending on your symptoms your doctor may recommend you have blood tests to check your fatigue hasnt been caused by another condition. If it has been, treating this condition may improve your fatigue.
There arent any specific drug treatments for fatigue. However, your doctor, physiotherapist, occupational therapist or rheumatology team, should be able to help you recognise the signs and learn to manage them.
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Multidimensional And Multicausal Aspects Of Fatigue
Fatigue is a multidimensional concept and has various causes. In rheumatic diseases, the association between fatigue and pain has been well established . High fatigue is most often associated with high pain, and fatigue and pain seem to be synchronous . The link between fatigue and disease activity is less clear. First, fatigue is clearly a symptom included in rheumatic diseases: in rheumatoid arthritis , it is an important outcome to evaluate according to OMERACT , and it has been associated with the Disease Activity Score in 28 joints and the Clinical Disease Activity Index . In spondyloarthritis , fatigue is part of the Bath Ankylosing Spondylitis Disease Activity Index and appears more strongly related to the disease process than patient-related variables . Furthermore, in anti-neutrophil cytoplasmic antibody-associated vasculitis, fatigue was associated with increased levels of C-reactive protein . However, a systematic review of fatigue in RA found no link between it and some characteristics of inflammatory activity, such as erythrocyte sedimentation rate or DAS28 . Of note, Lee et al. described a subgroup of RA patients with well-controlled disease but high persistent levels of fatigue .
Fig. 1
The Causes Of Rheumatoid Arthritis Fatigue
by Patient Advocate
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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Role Of Inflammation In Fatigue
The mechanisms of fatigue are complex and have been studied in animal models and humans. Because fatigue could be explained by loss of muscle mass or altered mood, Norden et al. proposed a model to discriminate between these phenomena: some colon tumor-bearing mice demonstrated signs of fatigue and depressed mood , with no association with decreased normalized contractile properties of skeletal muscle of the limb. So fatigue seemed linked more to behavior than muscle activity.
Inflammation could play an important role . The injection of IL-1 in murine models decreased social exploration and increased hypersomnia and body weight loss, which were all improved by the administration of anti-inflammatory IL-1RA or IL-10 . Moreover, in the model of tumor-induced fatigue in mice seen earlier, fatigue was associated with increased levels of IL-1 and IL-6 in the brain, and treatment with minocycline, an anti-inflammatory agent, improved grip strength without reducing tumor growth or muscle mass .
Table 1 Possible mechanisms involved in fatigue
Eat A Nutritious Diet
Vitamin deficiencies and anemia can cause fatigue. In many cases, you should be able to get the correct amount of vitamins from the foods you eat in a balanced diet. A good trick is to try to eat the rainbow. Choose whole, unprocessed foods in various colors to eat a wide range of nutrients.
If youre worried that you arent getting enough vitamins from your diet, talk to your doctor. They can do a blood test to see if youre anemic. They can also help you make adjustments to your diet. They may recommend a vitamin supplement, as well. Do not start taking supplements unless recommended by your doctor.
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Rheumatoid Arthritis: Living And Dealing With Fatigue
People with rheumatoid arthritis typically have several permanently inflamed joints. The inflammation inside the body can lead to general physical weakness, drowsiness and exhaustion. This feeling of extreme tiredness is also called “.” Some people find this to be the worst symptom of the disease.
Other typical symptoms are joint pain and swelling, and also joint stiffness and physical weakness later on. Non-specific symptoms like exhaustion often start earlier on in the disease. But the symptoms and course of rheumatoid arthritis can vary greatly. People also deal with the disease in different ways. Although people experience their symptoms differently and cope with the disease in different ways, there are some things that many people with rheumatoid arthritis have in common.
Ra Fatigue: How Do I Control Chronic Fatigue From Ra
Rheumatoid arthritis is a debilitating condition that causes a wide range of symptoms. One of the most prevalent symptoms experienced in suffering from rheumatoid arthritis is chronic fatigue. Fighting fatigue for rheumatoid arthritis patients seems like an ongoing uphill battle.
For those who suffer from rheumatoid arthritis, feelings of fatigue and constant tiredness can make it difficult to get through each day. But there are some ways to help beat fatigue, stay alert, and feel more rested and happy.
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Ways To Fight Chronic Fatigue
Fighting fatigue for rheumatoid arthritis patients can be a challenge. However, there are some ways to improve your energy levels and lessen chronic fatigue. Here are some of the things you can do to help fight chronic fatigue in your daily life:
- Exercise regularly
- Rule out medication side effects
- Seek counseling and support
Causes Of Fatigue In Inflammatory Arthritis
Theres no one single cause of inflammatory arthritis fatigue its multifactorial, or due to a number of causes, explains Saakshi Khattri, MD, a board-certified dermatologist, rheumatologist, and internist at Mount Sinai in New York City. And the causes are often interrelated, which can make you and your rheumatologist do some detective work to figure out whats going on.
Dr. Cohen shows her patient a fatigue wheel with fatigue in the middle and the potential causes around it. There is so much overlap, so its my job to be the detective and tease away all of the different things on the fatigue wheel that contribute to fatigue, she says.
The following factors and comorbidities are all potential causes of inflammatory arthritis fatigue:
- Anemia
- Chronic pain that disrupts sleep
- Diabetes
- High disease activity or inflammation
- Certain inflammatory arthritis medications
- Lack of exercise or de-conditioning
- Low thyroid
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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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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.
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How Do People Cope With Exhaustion
Many people gradually come to learn how to regulate their energy better and to accept the changes associated with the condition. They pay more attention to their body’s signals and then adjust what kinds of activities they do based on their symptoms.
As well as the phases where the arthritis gets much worse, there are also periods where it’s possible to live a quite normal life. It often helps to start seeing the condition as a part of your life and to set new goals that you can still achieve anyway. Some people say that the disease has helped them to live their lives more consciously.
Many mention in interviews that they’ve discovered practical ways of dealing with :
- Learn to say “no” sometimes
- Don’t plan to do too much at once
- Reconsider and adapt your goals
- Plan activities carefully, take your time, spread out demanding tasks across the week.
- Take breaks before you become too exhausted
- Get to bed early, take naps and learn relaxation techniques
- Avoid going out at busy times of the day, for instance when you go shopping or on a trip
- Talk with others about your disease so that they can better understand how it affects you
- Talk to others who have rheumatoid arthritis so that you can learn from their experiences
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.
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Tips For Getting A Hold Of Ra Fatigue
Talk with your healthcare provider about RA fatigue. They may be able to address other health issues that contribute to fatigue like:1
- Review or adjust medications
- Discuss medications like antidepressants that may help with physical tasks during the day
- Discuss sleep aids that may help you get a good nights rest
- Suggest lifestyle changes that may improve your energy such as manageable ways to maintain physical activity
You can:1
- Make a to-do list and cross off the least important things
- Find small ways to stay physically active
- Maintain a balanced nutrition. Protein helps build strong muscles and complex carbs are great for energy
- Check out CBT to cope with the impact of fatigue on mental health
- If youre comfortable, talk to your employer about adjusting your hours
- Ask for help from a friend or family member that you trust
* Top 2 box on a 7-pt. scaleThe 8th Annual RA In America survey was conducted online from April 6 to June 25, 2020. A total of 3,511 people completed the survey.
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What Is Fatigue
Fatigue is an extreme, sometimes overwhelming, physical and mental tiredness, that doesnt significantly improve with rest or sleep.
Its a common problem associated with arthritis and can make other symptoms, such as pain and joint stiffness feel more severe and limiting.
It can affect your motivation and your ability to concentrate, this is sometimes described as having brain fog. Some people find it affects their emotional wellbeing making them feel irritable or depressed.
People with fatigue often say its similar to having the flu, with symptoms such as:
- their body and limbs feeling heavy and difficult to move
- exhaustion
- feeling their energy has drained away.
Fatigue is unpredictable. It can start suddenly at any time of the day. Some days you may feel exhausted from the moment you wake up, even if you think you slept well.
It can last an hour, a day, or several days. Some people may find it lasts longer.
It can make you feel as though you havent the strength or energy to achieve even simple everyday tasks.
People with fatigue often feel they have to miss out on things they enjoy doing, to save energy for jobs or tasks. However, missing out on the things that lift your mood can make fatigue worse.
Fatigue is more extreme than simple tiredness. However, there are ways you can manage it and reduce its impact on your life.
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