Coping with Chronic Fatigue in Rheumatoid Arthritis

For some people with rheumatoid arthritis (RA), chronic fatigue can be as debilitating as joint pain. A person might sleep for 8 hours and wake up feeling like he or she never slept. This exhaustion can affect mental concentration and lead a person to feel frustrated and helpless.

Unfortunately, there is no quick fix for eliminating chronic fatigue. Managing fatigue often requires a multi-pronged approach that incorporates both medical treatment and lifestyle changes.

See Rheumatoid Arthritis and Fatigue

Talking with a healthcare provider about fatigue

The first step to addressing fatigue is to talk to a health care provider or rheumatologist. Patients are advised to describe when and how long fatigue lasts, if it affects concentration, and if it is accompanied by feelings of anxiety or depression. Patients may also report symptoms like daytime drowsiness, night time insomnia, quality of sleep, and observations from a significant other (e.g., restless sleep, snoring).

A medical professional can offer specific suggestions tailored to the individual. Most suggestions for dealing with fatigue fall into one of these categories:

• Adjusting medications
• Testing for and treating underlying medical issues
• Seeking therapy and emotional support
• Altering diet and exercise
• Prioritizing and simplifying tasks

See Chronic Fatigue Syndrome and Myofascial Pain Syndrome vs. Fibromyalgia

Learn more about lifestyle factors and fatigue associated with RA.

Medication adjustments to reduce rheumatoid arthritis fatigue

Medications can have an effect on fatigue levels in two ways.

• Medications can reduce rheumatoid arthritis symptoms and pain thereby improving sleep quality and alleviating fatigue.
• Medication side effects or adverse reactions can cause fatigue and weakness.

Sometimes a medication can both relieve fatigue associated with disease activity and induce fatigue. For example, methotrexate (Rheumatrex, Trexall, Otrexup) is used to help bring active RA under control, leading to a reduction in disease-related fatigue. However, this medication can also trigger fatigue by interfering with the body’s normal metabolism.

See Coping with Chronic Pain and Insomnia

Other medications, such as etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade) have been reported to reduce fatigue, but some experts suspect this reduction may be limited and not permanent.¹Minnock P, McKee G, Bresnihan B, FitzGerald O, Veale D. How much is Fatigue Explained by Standard Clinical Characteristics of Disease Activity in Patients with Inflammatory Arthritis: A Longitudinal Study. Arthritis Care Res (Hoboken). 2014 Jun 25. doi: 10.1002/acr.22387. [Epub ahead of print] PubMed PMID: 24966144.

There is no one-size-fits-all prescription

Each person is unique and can react to medications differently. Side effects and adverse reactions can sometimes show up days or weeks after starting a new medication. Moreover, different patients may have different treatment goals. For example, some people may be willing to tolerate moderate fatigue as long as pain and inflammation are manageable. In some cases the body will develop a tolerance to a medicine’s side effects.

See Rheumatoid Arthritis (RA) Treatment

A person with rheumatoid arthritis must work with his or her health care provider to find the right combination of drugs and/or dosages that provide him or her with optimal results.

Reviewing RA medications and chronic fatigue

Patients who are experiencing fatigue can ask their healthcare provider to review their complete lists of medications and supplements. Patients are advised to report all medications and supplements, keeping these points in mind:

• Many over-the-counter cold and allergy medications (especially combination products) can cause drowsiness or dizziness.
• Certain over-the-counter, non-steroidal anti-inflammatory drugs (NSAIDs) can cause sleepiness or dizziness.²United Kingdom National Health Service. Non-steriodal anti-inflammatory drugs (NSAIDS) – side effects. NHS Choices: Your health, your choices http://www.nhs.uk/Conditions/Anti-inflammatories-non-steroidal/Pages Last reviewed April 6, 2014. Accessed December 1, 2014.^,3National Institutes of Health. Naproxen. MedlinePlus. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a681029.html Last Revised July 14, 2013. Accessed December 1, 2014.
• Many medications used to treat other conditions, such as depression, allergies, high blood pressure, and diabetes, can also cause fatigue.

Information about the patient’s chronic fatigue, RA, and medication prescriptions should be shared with all members of the health care team, such as physician specialists, nurse practitioners, physician assistants, psychologists, counselors, and pharmacists.