Rheumatoid Arthritis and Fatigue

Fatigue is not just being tired or sleepy. It is a medical symptom that impacts your physical and mental state and your ability to think clearly, stay motivated, and do the things you need or want to do.

Roughly 40 percent to 80 percent of patients with RA experience fatigue at some point — and many people say it’s one of the most difficult symptoms to live with. 

What causes fatigue in patients with RA and other types of inflammatory arthritis? There’s usually no one single cause. Fatigue is “multifactorial,” or due to several causes. And the causes are often interrelated. Fatigue may require some detective work from you and your rheumatologist to figure out what’s going on.

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Potential Causes

If you have RA and fatigue, your rheumatologist may screen you for the following factors and conditions that may contribute to your fatigue:

  • Anemia (low red blood cell count)
  • Anxiety and/or depression
  • Cardiovascular (heart) disease
  • Pulmonary (lung) disease
  • Certain RA medications (including disease-modifying antirheumatic medications, or DMARDs)
  • Chronic stress
  • Chronic pain that disrupts sleep
  • Diabetes
  • Fibromyalgia
  • Poorly controlled RA disease activity or inflammation
  • Lack of exercise (or de-conditioning)
  • Low thyroid
  • Nutritional deficiencies
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How Can You Manage Fatigue?

Depending on the underlying cause of your fatigue, different types of treatments may be needed. These may include lifestyle changes such as changing your diet and exercise patterns, practicing self-care, knowing your limits, medication adjustments (changing the dose, timing, or class of medication), and/or therapy and mental/emotional help through support groups. The good news is there are a lot of steps you can take — both with your doctor and on your own — to help manage and reduce fatigue related to RA.

Talk to Your Health Care Provider

Working with your health care provider is the best way to determine what’s causing your fatigue — and to come up with a plan for restoring your energy. Even if your doctor doesn’t understand how fatigue feels for you, they can understand how it impacts your daily living, so make sure to share when it occurs, how long it lasts, and what fatigue prevents you from doing that you care about. 

Importantly: For most patients with chronic pain, therapy isn’t meant to take the place of medication but complement it as part of an overall treatment plan that aims to help people feel better physically and mentally.

There are a lot of different types of talk therapy, including:

  • Cognitive behavioral therapy
  • Dialectical behavioral therapy
  • Acceptance and commitment therapy

These types of therapy involve working with a mental health professional, which may include a psychiatrist, psychologist, or licensed professional with training and certification in mental health like counselors from your religious group, social workers, and marriage and family therapists. 

Many mental health professionals incorporate multiple techniques and types of therapy in order to personalize care for a given patient. 

Cognitive behavioral therapy has been studied for arthritis pain for many years and is considered the “gold standard” for psychological treatment of chronic pain. CBT is rooted in the idea that the way you perceive situations influences the way you feel, and that you have the ability to change your thought patterns to feel better. 

Dialectical behavioral therapy (DBT) is a type of CBT that is designed to help people to live in the moment and cope with stress and emotions in a healthier way by developing skills like mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation. 

Acceptance and commitment therapy (ACT) is a form of behavioral therapy that combines mindfulness with self-acceptance. 

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Pace Yourself

Carefully monitoring how you spend your energy and activity, known as pacing, is one way of addressing fatigue from RA. Although “energy pacing” or “activity pacing” doesn’t work for everyone, it may help you to better manage and cope with extreme tiredness. Energy pacing generally works like this: Think of the energy you have for the day as a fixed amount like money in a bank account. Then for any activity you need to do, you figure out how much energy it will take so you can make sure you don’t withdraw more than the total amount of energy you have available in any given day. It may mean divvying up chores or errands into different days of the week, for example.

Usually, relaxation is considered safe and healthy, but if you’ve had anxiety or depression, check with your provider to make sure it’s okay for you. There are therapists trained to help you learn to do any of these relaxation techniques properly, but you can also teach yourself to do them by using online videos or apps.

Although these practices can help improve mental well-being, they are not a sole solution to serious mental health issues. If you are struggling with mental health issues, talk to your doctor or health care provider to find effective solutions. They may suggest talking to a therapist or taking medications to manage your anxiety, depression, and stress.

Get Regular Exercise

In addition to fatigue, joint pain and stiffness can make exercise particularly difficult for people with rheumatoid arthritis. Surprisingly, research has found that fighting through initial fatigue in order to do gentle exercise could actually improve fatigue in the long run. Start slowly with 10- or 15-minute walks and slowly build up. Other exercise activities to try include tai chi, cycling, stretching, and water aerobics. Just be sure to listen to your body and don’t do anything that could cause an injury.


Manage Mental Health

As anyone with RA understands, it’s not just a “joint” condition — the pain affects your whole life, including your mental health. About 30 percent of people with RA develop depression within five years of their diagnosis. If depression or anxiety is playing a role in your fatigue, getting mental health support is key. Depending on the severity of your anxiety and stress, you can also try relaxation strategies such as meditation, reading a book, and listening to your favorite music.


Prioritize Sleep

Fatigue might be a sign that you aren’t sleeping long enough or well enough but it also could be a sign that you have a sleeping disorder. In fact, the chances of having sleep problems, including insomnia and sleep apnea, are significantly greater in people with RA than in those without the disease.

Poor sleep quality has been linked to chronic pain, changes in mood, and worsened RA disease activity.

Inflammation may also worsen without enough quality sleep. RA activity involves increases in certain inflammatory chemical messages in your blood cytokines, such as tumor necrosis factor (TNF). These inflammation signaling proteins may interfere with normal sleep patterns.

RA AND sleep

What can you do to improve your sleep?

Maintain a consistent sleep-wake schedule.

By going to sleep and waking up within two hours of the same time each night and morning, you can train your body to match natural day-night cycles and your body’s response to them call Circadian rhythms.

Eliminate electronics or screen time close to bedtime.

Viewing the bright light from a television or other electronic screen late at night can throw off your Circadian rhythms and worsen fatigue.

Create a relaxing bedtime routine.

Allowing your body to gradually transition from awake to asleep allows you to avoid suddenly going from 60 to zero. A routine of nighttime wind-down activities can help smooth this process.

Consider a sleep study with your doctor.

Your doctor may suggest undergoing a sleep study to determine if you have any underlying sleep disorder that is contributing to your fatigue. There are also many available apps to help you track your sleep quality, including SleepWatch, Sleep ++, Pillow, and Sleep Cycle. 

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More Fatigue Resources

Here are some additional articles and videos to help you understand and cope with RA fatigue.

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