Does arthritis make you tired


Fatigue and Inflammatory Arthritis


The feeling of fatigue is common in our busy lives. Fatigue that is the result of inflammatory arthritis, however, is very different than everyday tiredness. This kind of fatigue can often be intense and overwhelming, and can have a noticeable impact on quality of life. Steps to help make inflammatory arthritis-related fatigue more manageable include learning to better understand how it affects you as an individual and discussing it regularly with your rheumatologist.

What is Fatigue and What Are the Facts

Fatigue can be described as a severe lack of energy throughout the whole body, sometimes even after a full night of rest. It is very common among people with inflammatory arthritis, affecting 40% or more of those with RA.

Many people often describe fatigue as the most difficult part of their disease. In spite of this, the topic – unlike the subject of pain, for example – is rarely discussed between patients and their doctors.

Talking About Fatigue

Treating fatigue can be difficult for both patients and their doctors. Making a regular point of talking about it together can be a helpful step in treatment. Consider writing down a list of information to share with your doctor at your next appointment. This could include:

  • How you describe your fatigue
  • How often you feel fatigued during your daily activities
  • How fatigue impacts your day-to-day life
  • What you think causes your fatigue
  • What you do to manage your fatigue

Together, you and your doctor can assess, or measure, the way fatigue affects you personally. You may also better understand the causes of your fatigue.

Medications That Can Cause Fatigue

While fatigue is a common symptom of inflammatory arthritis, it may also be caused by other factors. Conditions such as anemia or an infection may contribute to it. It can also be a side-effect of certain medications. Drugs such as those taken for colds, blood pressure, pain, and depression can also cause fatigue. You should keep your doctor informed about any medications you are taking, as well as any changes in your medication regimen.

How Inflammatory Arthritis Can Cause Fatigue and How Anti-TNFs May Help

The immune system is very complicated, with many cells interacting with each other all the time. Some of these interactions produce what are called cytokines. One kind of cytokine is called Tumor Necrosis Factor, or TNF. TNF can sometimes cause cellular inflammation, which can in turn result in fatigue. Anti-TNF medications like Enbrel, Humira, and Remicade try to block TNF production, therefore decreasing inflammation. Less inflammation may mean less fatigue.

Measuring Fatigue

There are a number of ways you and your doctor can learn how fatigue affects you. Pain, for instance, is often rated on a scale. Fatigue can be measured in the same way.
Measuring your fatigue is a good way to determine how much it is a part of your day-to-day life, and whether it improves or gets worse over time. One way to measure fatigue for yourself is to keep a diary. Write down when during the day you feel the most tired, and also when you feel you have the most energy. It may help to use a scale to do this. For example, on a scale from 0-10, with 0 being no energy, and 10 being the most energized, how do you feel when you first wake-up? How do you feel at lunchtime? Over time, you may notice patterns in your fatigue. Identifying and understanding these patterns may help you and your doctor plan more effective ways to combat your fatigue.

What Your Doctor Can Do For You

One of the first things your doctor should do in assessing your fatigue is to look for other medical conditions you have that may be contributing. An undiagnosed iron deficiency, thyroid condition, or bleeding could all lead to fatigue. You and your doctor should also talk about your nighttime sleep. Do you generally sleep well or is your sleep interrupted? Are you sleeping on the right pillows? Is your mattress firm enough? Small changes in your nighttime sleep habits can make a big difference in daytime fatigue.

What You Can Do For Yourself

  • Go easy on yourself and respect your body’s limits. Accept that you are human, and that fatigue can be limiting. Consider making a to-do list and then cross off the least important items and save those for a time when you are feeling more energized. Make daily household chores and outside errands easier when you can. Limit trips to the grocery store by storing frozen foods or ready-to-eat meals that can be easily prepared on days when you may be feeling more tired.
  • On days when you are up for it, consider exercising. Exercise can improve muscle strength and release endorphins in the body, which can make people feel more energized. Before beginning any exercise routine, however, be sure to discuss it with your doctor.
  • There are also ways in which you can use your mind to help combat pain and fatigue. Cognitive behavioral therapy, or CBT, is a way of changing your thoughts to help change the way you feel. Certain therapists who are trained in CBT can provide this kind of help. Other activities, such as meditation and yoga (if joints allow), can also be effective.
  • Making healthy choices about your eating and sleeping habits can also go a long way to managing fatigue. Respect your body when it needs rest. Create a bedroom environment that is conducive to sleep. Leave the TV in the living room. TV watching at bedtime can be stimulating and make it hard to fall asleep.
  • In the workplace, take breaks, walk around, and ask for help when needed. You may be entitled to certain considerations, for example, a different chair, or a wrist pillow to use while typing. In certain cases, you may also be able to do part of your job from home. Consider speaking with your boss about accommodations that may help you to do your job more effectively.

Lastly, do not be afraid to ask family and friends for help. Most people will be happy to help with errands or other chores when you are not feeling up to them. Occasionally, someone may not understand why you are feeling so tired. You may have to help teach them about how and why fatigue affects you, and that it is a symptom of your arthritis.


Fatigue is very common with RA and it often has a big impact on quality of life. In spite of this, the topic is often overlooked in doctor/patient visits. When you see your doctor, remind him or her to discuss this with you. Doctors are still learning about the relationship between fatigue and inflammatory arthritis and the subject should be explored often as part of treatment.

Patients should learn about how fatigue impacts them personally and what they can do to adapt. Doctors and patients should make it a point to work together to become better educated about fatigue, and to find the best ways to manage it for each individual.


How to Beat Fatigue
Fatigue in Patients with Rheumatoid Arthritis: What is Known and What is Needed. Repping-Wuts. Rheumatology 2009; 207-09
Sick and Tired of Feeling Sick and Tired: Living with Invisible Chronic Illness. Paul J. Donoghue

Posted: 9/20/2010

Summary by Dayna Kurtz, LMSW


Jessica R. Berman, MD
Assistant Program Director, Rheumatology Fellowship, Hospital for Special Surgery
Associate Attending Physician, Hospital for Special Surgery &nbsp

RA Fatigue: How Do I Control Chronic Fatigue from RA?

Hugh Duckworth MD

Doctor of Medicine (M.D.) in 1984 from University of Tennessee School of Medicine

Oct 28, 2018 4 min read

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.

What is Chronic Fatigue?

Chronic Fatigue is the constant feeling of weariness or overwhelming tiredness that doesn’t seem to improve or change regardless of the amount of rest or sleep received. Patients may receive an adequate amount of sleep each night and still feel fatigued during the day.

Fatigue affects people physically, mentally and emotionally. When people experience fatigue they feel as though their energy has been depleted and they don’t have the strength to perform daily activities.

Fatigue may come and go or worsen during certain times. The onset of the fatigue may be unpredictable and occur without warning signs or symptoms. Fatigue may not be preceded by physical activity or exertion, and it may occur in between or during “flare-up” episodes of RA.

How Chronic Fatigue Affects You

Fatigue can be a serious and debilitating symptom of rheumatoid arthritis. Those who suffer from chronic fatigue report that it makes them feel so physically exhausted that everyday tasks of life become a burden. They report that their limbs feel heavy, weak and are difficult to move.

Fatigue also affects one’s ability to focus, making it difficult to perform daily tasks at home, work or school. It may also be challenging to pay attention during conversations. Chronic Fatigue can lead to decreased workplace productivity, social isolation, and depression.

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
  • Stress and depression
  • Side effects of medications
  • Inflammation and flare-ups
  • Anemia (low levels of red blood cells)
  • 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.

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
  • Choose the right diet
  • Take breaks
  • Get better rest
  • Rule out medication side effects
  • Seek counseling and support

Physical Exercise

Regular exercise helps boost energy levels and is one of the best methods of fighting fatigue for rheumatoid arthritis. Even spending as little as 30 minutes per day doing light exercise like walking can improve alertness and increase mood levels.

Try light stretching or slow yoga and tai chi movements to wake up your body and mind. Moving around increases blood flow and stimulates the mind leading to better focus and alertness.

Diet Shifts

Certain foods are linked to causing inflammation and thus worsening the effects of rheumatoid arthritis in patients. Be sure to eliminate these foods from your diet and choose carefully selected foods that are healthy and will give you plenty of nourishment. Fruits, vegetables, and natural foods can help boost energy levels and beat chronic fatigue.

Fatigue can also be made worse by the amount of food eaten. Avoid eating large portions of food that can make you feel more tired as your body works to digest it all.

Take Breaks

Often we find we push ourselves too hard. Because rheumatoid arthritis is an autoimmune disorder, it can naturally deplete energy levels. Frequent breaks and rest periods are important in fighting fatigue for rheumatoid arthritis patients.

If you sometimes forget to take breaks, try setting reminders and alarms to get your attention and alert you as to when a break is needed.

Get Better Rest

You may be getting enough rest, but you’re possibly not getting the right quality of rest. Tossing and turning can disrupt sleep patterns and leave you feeling fatigued.

Develop the right sleeping habits by keeping your bedroom dark and cool. Put away all electronic devices at least 30 minutes before sleeping so as to avoid stimulation and distractions. Invest in the right mattress for your posture. Mattresses should be supportive of your muscles and joints. Be prepared to do whatever it takes to get quality sleep and rest.


A common side effect of certain medications is chronic fatigue and even depression. If you are experiencing chronic fatigue or symptoms of depression, talk to your doctor about your concerns. The medication may or may not be responsible for your symptoms of fatigue. Each person reacts differently to various types of medication. It may take some trial and error before determining if medication is contributing to the fatigue, and which therapy is best for you.

Seek Counselling

When chronic fatigue starts to affect your daily life and your ability to perform social, family or work activities, it may be a sign of depression. A therapist or counselor can provide emotional support and guidance. Joining a support network and being around others who can relate to your struggle can also help boost your mood and potentially lessen chronic fatigue. If these measures are not helpful then a psychiatrist may be able to prescribe medications to help manage the depression and chronic fatigue.

Beating Chronic Fatigue by Improving Lifestyle

The effects of Chronic Fatigue can’t be managed overnight. It requires small daily habit changes and lifestyle shifts to incorporate more activity, better rest, and improved dietary habit. By assessing and adjusting your daily activities, you can help determine what is contributing to your chronic fatigue, and make the appropriate lifestyle changes. Successfully managing these factors that contribute to Chronic Fatigue associated with Rheumatoid Arthritis, a patient can drastically improve energy levels and overall wellbeing.

If you’re concerned about how chronic fatigue is affecting your life, talk to your rheumatologist about the options to beat fatigue and improve your wellbeing.

Invisible Disease: Rheumatoid Arthritis and Chronic Fatigue Survey

Ailsa Bosworth, Chief Executive of the National Rheumatoid Arthritis Society, said “The results from the survey are eye-opening. It is abundantly clear from the report that references to the management of chronic fatigue need to be strengthened within the relevant RA clinical guidelines and that further resources urgently need to be put in place to help healthcare professionals deliver improved care.”

Chronic fatigue also has a significant impact on capability for work, the survey finds. 50% of respondents of working age said that they were unemployed. 71% of working age unemployed respondents said fatigue had contributed to their inability to work.

Julia Manning, Chief Executive of 2020health, said “Hidden from our sight, this debilitating disease leads many people into worklessness, isolation and depression. These findings are shocking. A quarter of respondents experienced job loss within a year and 50% of sufferers stopped work within six years. The fact that so many people end up dependent on benefits through this disease is, itself, a call to action”.

Further results show that:

  • 90% of people said fatigue caused them to feel depressed during the last seven days
  • 54% reported that fatigue negatively affected their sex life
  • 8%, over 150 people, attributed the loss of a relationship to fatigue

Based on these findings, our report recommends the governments of England, Scotland, Wales and Northern Ireland to urgently initiate public awareness campaigns.

Click here to download the Invisible Disease: RA and Chronic Fatigue 2014 survey.

Download our survey infographic and share on Facebook and Twitter

Don’t 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 don’t need to complete a task. Set your own pace. You decide what you can and can’t do on days when fatigue is high.

Get regular exercise. The last thing you may want to do is work out. But activity lowers fatigue if you have RA. Simple things like a daily walk or a swim can build stronger muscles and soothe achy joints. Try to do something, even if you just stretch, even on days when you’re really tired.

Yoga and tai chi are two gentle activities that help ease fatigue and lower stress that can keep you awake.

Fuel up with the right foods. Your body gets energy from the foods you eat. Choose fresh, whole items like fruits and veggies, lean protein, dairy products, and healthy fats. Omega-3 fatty acids, found in foods like nuts and cold-water fish, help ease fatigue by reducing inflammation.

Start your day with a healthy breakfast, even if you wake up tired. Choose foods that are rich in fiber, complex carbohydrates, and lean protein. A bowl of high-fiber cereal, fresh fruit, and low-fat milk can give you more energy for the rest of your day.

Drink water. Your body needs fluids to keep going. Fatigue may be a sign that you’re dried out. Aim for about eight glasses a day. You may need more if you’re extra active or when it’s hot outside.

Stick to a sleep routine. Good habits help you get enough rest so you feel less fatigue the next day. Go to bed at the same time each night. Get up at the same time each morning. Cut back on caffeine, alcoholic drinks, and nicotine. All of these can disrupt your sleep.

Fight the urge to take an afternoon nap. Sleeping during the day can make it harder for you to nod off at night. When it’s time for lights out, turn off devices like your smartphone or tablet. You’ll rest better in a dark, quiet room.

Fatigue in Rheumatoid Arthritis Patients: Is it Methotrexate’s Fault?

Methotrexate (MTX) is one of the most common drugs used to treat Rheumatoid Arthritis (RA). It is also used to treat many other diseases, and in much higher doses it can also be used to treat cancers of certain types. Even though MTX is effective in reducing pain and joint damage and improving joint function, patients taking MTX commonly report experiencing fatigue. And it isn’t just a feeling of being tired. CreakyJoints’ Facebook community describes fatigue as “influenza without end” and “exhausted by exhaustion!”

It is no surprise that many RA patients who take MTX want to know if they can help their fatigue by stopping the medication.

To find out, we conducted a study involving 1,082 RA patients and compared levels of fatigue among those taking different combinations of MTX and biologic disease modifying antirheumatic drugs (DMARDs).

The Study: Methotrexate Use and Fatigue in Rheumatoid Arthritis Patient

RA patients from the ArthritisPower research registry participated in this study. Using the ArthritisPower web or mobile app, participants on MTX and/or biologic therapy submitted patient-reported outcomes about their fatigue, pain, and sleep via our ArthritisPower health assessment.

Questions to evaluate fatigue included:

  • In the past 7 days how much were you bothered by your fatigue on average?
  • In the past 7 days how often did you have to push yourself to get things done because of your fatigue?
  • In the past 7 days how run-down did you feel on average?

What We Learned

The symptoms of RA patients were compared across different treatments and patients taking MTX tended to have better scores of pain interference, sleep disturbance, and fatigue compared to those who were not. From these results, it appears that MTX use, especially when combined with biologic use, may be associated with better symptoms among RA patients.

Although patients taking MTX had slightly higher fatigue scores overall, the level of a patient’s RA disease activity as measured by the Routine Assessment of Patient Index Data 3 (RAPID3) seemed to make a difference. For patients in remission—with very low RAPID3 scores—those taking MTX monotherapy had the highest fatigue scores. Among patients in high disease activity, fatigue scores were similar across different treatment combinations.

In order to better understand the relationship between MTX and fatigue, we need to collect and analyze more data over time.

Why is this important for patients?

In general, patients don’t prefer MTX as their primary treatment because it is associated with other troublesome side effects (i.e., upset stomach). This study demonstrated that MTX can be an effective treatment for patients despite commonly heard patient reported experiences of bothersome side effects, such as fatigue, from the therapy.

Patients taking MTX may be tempted to discontinue treatment because of fatigue, but it’s important to recognize that the fatigue may be caused by something other than MTX. RA patients may have other conditions that could be causing the fatigue. Anemia, chronic fatigue syndrome, depression, sleep disorders and inflammation-induced fatigue are common comorbidities among RA patients and can cause chronic fatigue.

Despite the fatigue, discontinuing MTX without consulting a physician may worsen symptoms. It is important for patients to talk to their physician to help determine if the fatigue is due to MTX or some other factor.

What can patients do to manage fatigue?

Unfortunately, there is no quick remedy to eliminate chronic fatigue. Patients should work with their doctor to tailor options to their unique needs. More often than not, suggestions for dealing with fatigue fall into one of these categories:

  • Adjust medications by dose reduction or change in the class of medication
  • Find and treat underlying medical issues which may be the cause of the fatigue
  • Seek therapy and emotional help through support groups

Exercising, healthy eating, and good sleep habits can help patients overcome fatigue. It is important to eat balanced meals with a lot of fruits and vegetables. This can help patients feel energized throughout the day. Exercising increases muscle mass, strength and blood circulation, which boost energy. Exercising also leads to the production of endorphins in the brain that produce a sense of well-being and vitality. These brain chemicals also have an analgesic effect (i.e. reduce pain) and improve sleep.

Joining a support group may also be helpful. A support group can help patients cope more effectively and feel less isolated as they make connections with others facing similar challenges. Sharing feelings with others can ease the burden of fatigue and prevent depression. However, a support group shouldn’t replace your standard medical care.

Participating in Future Studies

If you are diagnosed with rheumatoid arthritis, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. As a patient-led, patient-centered initiative, our research team is committed to investigating research topics that matter most to patients.

Fatigue in patients with rheumatoid arthritis: what is known and what is needed

Treatment of fatigue

Disappointingly, given the fact that fatigue is by now recognized as a common symptom of RA, only few studies have focused on the treatment of RA fatigue. Studies on the effectiveness of biologic agents showed evidence of significant improvements in RA fatigue . Moreover, the results of a randomized controlled study of cognitive-behavioural therapy (CBT) showed significant improvement in fatigue . Also, a randomized controlled study on non-pharmacological interventions on home aerobic training demonstrated a trend towards improvement of fatigue .

Other interventions need to be tested. For example, we do not know the effects of nursing interventions on fatigue, such as advice regarding sleeping patterns, the balance between activity and rest, or social support, as components of self-management strategies. Otherwise, as CBT seems to be effective, is it possible for other members of the rheumatology team to deliver special interventions of that therapy?

Although, until now, causes of fatigue are unknown and RA patients with even a low to moderate disease activity have severe fatigue, healthcare professionals should pay attention to, assess and manage fatigue routinely and effectively, in the same way as they manage pain.


What is known?

  • Fatigue is a common, severe and chronic complaint of patients with RA.

  • RA fatigue is overwhelming and has a large impact on quality of life.

  • Patients and healthcare professionals do not know enough about how to manage fatigue.

  • Fatigue is, just like pain, not structurally discussed with patients.

What is needed?

  • A validated assessment instrument for RA fatigue is needed to facilitate comparison of results across studies. For research purposes, the multidimensional aspect of fatigue must be represented in the measurement instrument. For daily clinical assessment, a brief and simple assessment instrument would be most appropriate.

  • Information about causes and treatment of RA fatigue is needed to support and help patients in using self-management strategies. Also, more research is needed to accomplish evidence informed practice for RA patients.

  • As with pain, fatigue should be addressed and explored systematically in clinical practice, instead of waiting for the patients to mention the symptom spontaneously.

Disclosure statement: The authors have declared no conflicts of interest.

1 Voith AM , Frank AM , Smith Pigg J . Nursing diagnosis: fatigue. In: Carroll Johnson RM, ed. Classification of nursing diagnoses, Proceedings of 8th Conference NANDA. St Louis: Mosby,, 1989 2 Piper BF . Carrieri V , Lindsey A , West C . Fatigue, Pathophysiological phenomena in nursing, human response to illness, 1993 Philadelphia Saunders(pg. 279-302) 3 Fukuda K , Straus SE , Hickie I , Sharpe MC , Dobbins JG , Komaroff A . The chronic fatigue syndrome: a comprehensive approach to its definition and study. International chronic fatigue syndrome study group, Ann Intern Med, 1994, vol. 121 (pg. 953-9) 4 Hewlett S , Hehir M , Kirwan JR . Measuring fatigue in rheumatoid arthritis: a systematic review of scales in use, Arthritis Rheum, 2007, vol. 57 (pg. 429-39) 5 Repping-Wuts H , Fransen J , van Achterberg T , Bleijenberg G , van Riel P . Persistent severe fatigue in patients with rheumatoid arthritis, J Clin Nurs, 2007, vol. 16 (pg. 377-83) 6 Repping-Wuts H , Uitterhoeve R , van Riel P , van Achterberg T . Fatigue as experienced by patients with rheumatoid arthritis (RA): a qualitative study, Int J Nurs Stud, 2008, vol. 45 (pg. 995-1002) 7 Beurskens AJ , Bultmann U , Kant I , Vercoulen JH , Bleijenberg G , Swaen GM . Fatigue among working people: validity of a questionnaire measure, Occup Environ Med, 2000, vol. 57 (pg. 353-7) 8 Stulemeijer M , de Jong LW , Fiselier TJ , Hoogveld SW , Bleijenberg G . Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial, Br Med J, 2005, vol. 330 pg. 14 9 Prins JB , Bleijenberg G , Bazelmans E , et al. Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial, Lancet, 2001, vol. 357 (pg. 841-7) 10 Vercoulen JH , Alberts M , Bleijenberg G . De checklist individual strength, Gedragstherapie, 1999, vol. 32 (pg. 131-6) 11 Vercoulen JHMM , Hommes OR , Swanink MA , et al. The measurement of fatigue in patients with multiple sclerosis – a multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects, Arch Neurol, 1996, vol. 53 (pg. 642-9) 12 Felson DT , Anderson JJ , Boers M , et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials, Arthritis Rheum, 1993, vol. 36 (pg. 729-40) 13 Boers M , Tugwell P , Felson DT , et al. World Health Organization and International League of Associations for Rheumatology core endpoints for symptom modifying antirheumatic drugs in rheumatoid arthritis clinical trials, J Rheumatol Suppl, 1994, vol. 41 (pg. 86-9) 14 Tugwell P , Boers M . Developing consensus on preliminary core efficacy endpoints for rheumatoid arthritis clinical trials. OMERACT Committee, J Rheumatol, 1993, vol. 20 (pg. 555-6) 15 Kirwan JR , Hewlett S . Patient perspective: reasons and methods for measuring fatigue in rheumatoid arthritis, J Rheumatol, 2007, vol. 34 (pg. 1171-3) 16 Belza BL . Comparison of self-reported fatigue in rheumatoid arthritis and controls, J Rheumatol, 1995, vol. 22 (pg. 639-43) 17 Belza BL , Henke CJ , Yelin EH , Epstein WV , Gilliss CL . Correlates of fatigue in older adults with rheumatoid arthritis, Nurs Res, 1993, vol. 42 (pg. 93-9) 18 Wolfe F , Hawley DJ , Wilson K . The prevalence and meaning of fatigue in rheumatic disease, J Rheumatol, 1996, vol. 23 (pg. 1407-17) 19 Pinals RS , Masi AT , Larsen RA . Preliminary criteria for clinical remission in rheumatoid arthritis, Arthritis Rheum, 1981, vol. 24 (pg. 1308-15) 20 Huyser BA , Parker JC , Thoreson R , Smarr KL , Johnson JC , Hoffman R . Predictors of subjective fatigue among individuals with rheumatoid arthritis, Arthritis Rheum, 1998, vol. 41 (pg. 2230-7) 21 Rupp I , Boshuizen HC , Jacobi CE , Dinant HJ , van den Bos GA . Impact of fatigue on health-related quality of life in rheumatoid arthritis, Arthritis Rheum, 2004, vol. 51 (pg. 578-85) 22 Suurmeijer TP , Waltz M , Moum T , et al. Quality of life profiles in the first years of rheumatoid arthritis: results from the EURIDISS longitudinal study, Arthritis Rheum, 2001, vol. 45 (pg. 111-21) 23 Hewlett S , Cockshott Z , Byron M , et al. Patients’ perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored, Arthritis Rheum, 2005, vol. 53 (pg. 697-702) 24 Repping JWJ , de Hullu MCM , Barrera P , et al. Priorities nursing research in rheumatology, Dutch J Rheumatol, 2003, vol. 4 (pg. 19-23) 25 Moreland LW , Genovese MC , Sato R , Singh A . Effect of etanercept on fatigue in patients with recent or established rheumatoid arthritis, Arthritis Rheum, 2006, vol. 55 (pg. 287-93) 26 Weinblatt ME , Keystone EC , Furst DE , et al. Adalimumab, a fully human anti-tumor necrosis factor alpha monoclonal antibody, for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate: the ARMADA trial, Arthritis Rheum, 2003, vol. 48 (pg. 35-45) 27 Evers AW , Kraaimaat FW , van Riel PL , de Jong AJ . Tailored cognitive-behavioral therapy in early rheumatoid arthritis for patients at risk: a randomized controlled trial, Pain, 2002, vol. 100 (pg. 141-53) 28 Neill J , Belan I , Ried K . Effectiveness of non-pharmacological interventions for fatigue in adults with multiple sclerosis, rheumatoid arthritis, or systemic lupus erythematosus: a systematic review, J Adv Nurs, 2006, vol. 56 (pg. 617-35) © The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected]

How Do You Explain Fatigue to People Who Don’t Have a Chronic Disease Like Rheumatoid Arthritis?

By CreakyJoints, Special to Everyday Health

Most people know what it feels like to stay up too late and drag through the next day. In fact, the Centers for Disease Control and Prevention (CDC) reports that more than one-third of healthy adults are not getting enough sleep on a regular basis.

Fatigue vs. Feeling Tired: Two Different Experiences

People living with chronic diseases, like arthritis, often feel more than tired. Fatigue is the experience of long-lasting, seemingly relentless exhaustion that isn’t relieved by resting. Fatigue can impact a person’s energy and ability to concentrate. It can also lead to emotional and psychological distress, according to research published in the journal Arthritis Care & Research. Fatigue is a common aspect of arthritis and chronic diseases such as depression, multiple sclerosis, cancer, heart disease, COPD, and many, many others.

How Rheumatoid Arthritis and Other Chronic Diseases Cause Fatigue Symptoms

There are many reasons why chronic disease can cause fatigue. “Fatigue is extremely common and is associated with significant and oftentimes disabling consequences in patients with chronic diseases,” explains Vinicius Domingues, MD, a medical adviser to CreakyJoints and a rheumatologist based in Daytona Beach, Florida. “Fatigue can be related to the underlying disease, especially when it’s an inflammatory disease such as lupus and rheumatoid arthritis (RA), or it might be a consequence to certain medications. Often, patients are anemic (or have low iron), which can also increase their fatigue,” he says.

Dealing With Inflammation Saps the Body’s Energy Levels

In addition, a study showed that 95 percent of patients with RA report suboptimal levels of energy that impact their quality of life. There is a biological explanation for it, says Dr. Domingues: “When there is an inflammatory process, such as RA, lupus or ankylosing spondylitis, your immune system is constantly producing and carrying inflammation and, therefore, using energy.”

Importantly, chronic fatigue syndrome, also called myalgic encephalomyelitis, or ME/CFS, differs from fatigue. ME/CFS is a complex disease characterized by extreme fatigue that is not associated with an underlying medical condition and lasts for six months or longer. Researchers don’t know what causes it, but they do know that it will often worsen with physical or mental activity, according to a consensus report by the Institute of Medicine of the National Academies.

What Is It Like to Live With Arthritis Fatigue?

Recently, CreakyJoints, an online patient support group for people living with arthritis, asked its members to describe their fatigue. We heard:

  • “After I have a flare, I’m knocked out the next day.”
  • “Fatigue is not being tired; tired improves with rest, fatigue doesn’t.”
  • “ sure isn’t fun. It’s hard to make people understand, and then the guilt on top of it, for something we have zero control over.”

Accepting Fatigue as a Symptom of Disease

Domingues notes, “One thing I usually recommend to my patients is accepting fatigue as part of their disease in the same way that joint pain is a feature. By accepting it, patients will try to find a way to better deal with it. Afternoon naps (that should not last more than 30 minutes) are very useful in ‘recharging the battery’ and providing an extra boost in energy to carry out the day. Some of my patients with lupus will plan their day and place a slot for 25 minutes after lunch in their schedule dedicated for a quick nap.”

What People Living With Arthritis Want Others to Know About Fatigue

Here’s what some CreakyJoints members want their friends and family to know about their pain and fatigue:

  • “We’re not unreliable. But sometimes our pain and fatigue prevent us from attending events.”
  • “Symptoms like fatigue can make it seem like we aren’t fully present. But we are paying attention and want to engage with you.”
  • “Please cut us some slack as we want to spend time with loved ones and hope you want to spend time with us.”

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

Recognize and assess RA fatigue routinely, rheumatology experts urge

MADRID – Fatigue is one of the most frequent features of rheumatoid arthritis, and it needs to be assessed and addressed, several leading rheumatology experts urged at the European Congress of Rheumatology.

Sara Freeman/MDedge News

Dr. José António Pereira da Silva

“Fatigue is an outcome of outstanding importance for patients with rheumatoid arthritis, and therefore it should be an outcome of outstanding importance for clinicians who take care of these patients,” said José António Pereira da Silva, MD, PhD, a professor of rheumatology at the University of Coimbra (Portugal) during a clinical science session dedicated to the topic.

“Fatigue is described as being significant by as many as 40%-80% of all patients with rheumatoid arthritis, and described as being severe by 41%-49% of these patients according to different studies,” Dr. da Silva said.

“The impact upon the quality of life from the patients’ perspective is quite varied but always rather important, if not ‘dramatic,’ ” Dr. da Silva said. Fatigue needs to be part of treatment targets alongside disease activity and thus regularly measured, he added.

The problem of fatigue

The problem, however, is that fatigue is such a complex construct, observed James Galloway, MBChB, PhD, of the Centre for Rheumatic Diseases at King’s College London. “It’s definitely multifactorial in origin; it’s a combination of inflammatory disease, psychosocial situations, and comorbidity.”

Sara Freeman/MDedge News

Dr. James Galloway

Moreover, said Dr. Galloway, “what people describe as fatigue is multidimensional; it’s not just how well you sleep, but how much energy you have, and it’s also how motivated you are.” The fatigue that accompanies RA is different from the fatigue that is experienced in daily life, he noted, and it has a huge impact on patients’ lives.

Determining the cause of fatigue can be challenging, said Wan-Fai Ng, MBChB, PhD, professor of rheumatology at the Institute of Cellular Medicine at Newcastle (England) University.

“Fatigue is a syndrome that often coexists with other symptoms, and there may be different type of fatigue,” Dr. Ng said. He noted that there were many potential underlying biological mechanisms, but the most studied so far is inflammation. Fatigue is probably driven, at least in part, by “sickness behavior” and there are frequent associations between fatigue and chronic inflammatory conditions such as RA and Sjögren’s syndrome.

Sara Freeman/MDedge News

Dr. Wan-Fai Ng

“I think the role of conventional inflammatory mechanisms, at least in chronic fatigue in chronic conditions, remains unclear,” Dr. Ng added. “The biological systems, for example the vagus nerve, that regulate the immune system may play key roles in fatigue, especially in chronic inflammatory states.”

Whatever the underlying mechanism, it’s clear that there are multiple factors at play that need addressing if fatigue is to be properly addressed in the clinic. Dr. da Silva unveiled a new path analysis model that will be published in a future issue of Clinical and Experimental Rheumatology that showed how disease activity, pain, disability, sleep disturbance, and depression might all interlink to account for fatigue in patients with RA.

To get a firm diagnosis of Sjogren’s syndrome, doctors may run a number of tests. These may include urine and blood tests, lip biopsy, X-ray imaging, and a special test, called a Schirmer tear test, which measures dryness in the eyes.
People with primary Sjogrens syndrome sometimes develop blood, lung or kidney problems. They are also at a higher risk for a lymph node cancer called lymphoma. Regular follow up with their physicians to monitor for kidney and lung disease as well as lymph node check ups are important.
Treatment of Sjogren’s syndrome
Once your rheumatologist has diagnosed Sjogren’s syndrome, there are effective treatments available to help you manage the symptoms. While there is no known cure for Sjogren’s syndrome, treatments are available, and your rheumatologist is the best person to discuss these with and formulate a treatment plan to address all aspects of Sjogren’s syndrome.
There are several groups of medications which are used to treat Sjogren’s syndrome. These are:

  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (for example Advil® or Motrin IB®), naproxen (or Naprosyn®), diclofenac (or Voltaren® and Arthrotec®)
  • Corticosteroids, such as prednisone
  • Disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate, sulfasalazine, hydroxychloroquine and azathioprine

These medications can work alone or, most often, in combination to reduce the pain and other symptoms associated with Sjogren’s syndrome, as well as other disorders associated with secondary Sjogren’s syndrome.
There are a number of strategies to treat the dryness of the eyes and mouth often associated with Sjogren’s syndrome. To ease a dry mouth, try sipping water frequently throughout the day, chewing sugarless gum, and avoiding foods which can be drying to the mouth, such as chocolate and nuts. Mouthwashes and sprays are also available to help maintain moisture in the mouth. To care for dry eyes, artificial tears may help to reduce dryness and increase comfort. It is important to avoid medications that can cause a dry mouth, if possible.
Saliva is important to keep the teeth and gums healthy. People with Sjogrens syndrome have a much higher chance of developing tooth and gum disease. It is important to follow up regularly with a dentist to maintain oral health.
Keeping skin from getting too dry is important. Try using creams, or mineral oils to protect skin and keep it from becoming uncomfortable and dry. Using a humidifier in your home may help prevent dry skin and keep mucous membranes moist. Avoid air conditioners and electric heaters wherever possible.
As with any form of arthritis, maintaining a healthy lifestyle is also a critical part of any Sjogren’s syndrome treatment plan. Poor diet, lack of exercise, and high levels of stress may make disease activity worse, so healthy eating, appropriate levels of aerobic and strengthening exercise, and relaxation are highly recommended. As well, since smoking can cause dryness in the skin, mouth, nose, and eyes, it is highly recommended that people with Sjogren’s syndrome do not smoke.
Over the past 12 months, ACE received unrestricted grants-in-aid from: Abbott Laboratories Ltd., Amgen Canada / Wyeth Pharmaceuticals, Arthritis Research Centre of Canada, AstraZeneca Canada Inc., Bristol-Myers Squibb Canada, GlaxoSmithKline, Hoffman-La Roche Ltd., Merck Frosst Canada, Pfizer Canada, and Schering Canada.
ACE thanks these private and public organizations.

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