Rheumatoid Arthritis and Fatigue

For some people with rheumatoid arthritis, chronic fatigue can be more debilitating than the painful, swollen joints associated with the disease.¹Klippel JH et al, eds. Primer on Rheumatic Diseases, 13th edition. (pg 115) Spinger. 2008. Experts estimate than anywhere from 40% to nearly 90% of RA patients experience chronic fatigue.²Invisible Disease: Rheumatoid Arthritis and Chronic Fatigue Survey. National Rheumatoid Arthritis Society [United Kingdom]. http://www.nras.org.uk/invisible-disease-rheumatoid-arthritis-and-chronic-fatigue-report Accessed October 16, 2014.^,3Wolfe F, Hawley DJ, Wilson K. The prevalence and meaning of fatigue in rheumatic disease. J Rheumatol 1996;23-1407-1417.^,4Pollard LC, Choy EH, Gonzalez J, Khoshaba B, Scott DL. Fatigue in rheumatoid arthritis reflects pain, not disease activity. Rheumatology 2006;45:885-889.

See Recognizing Rheumatoid Arthritis (RA) Fatigue

Rheumatoid Arthritis Fatigue Is Different Than Just Being Tired

The fatigue associated with rheumatoid arthritis has been compared to the fatigue typically experienced by patients with cancer. RA fatigue may be characterized as:⁵Fatigue in patients with rheumatoid arthritis: British and Dutch nurses’ knowledge, attitudes and management." Journal of Advanced Nursing, 65: 901–911. doi: 10.1111/j.1365-2648.2008.04904.x

• Abnormal, excessive whole-body exhaustion
• Physical tiredness or weakness not related to exercise or exertion
• Lasting for more than a month
• Not easily relieved by sleep or rest

See Getting the Sleep You Need With Fibromyalgia

In addition to feeling tired, people with chronic fatigue may experience:

• More pain. Patients who are fatigued have a more difficult time coping with pain, and pain may seem worse.
• An inability to concentrate. Chronic fatigue can affect people both physically and mentally, and critical thinking and decision-making may take longer and seem more difficult.
• Helplessness. People can feel like they are losing control of their lives because they are physically and mentally exhausted.
• Irritability. Patients who are fatigued face constant mental and physical challenges throughout the day leading to moodiness and irritability.

Chronic fatigue can lead to feelings of helplessness and irritability as well as depression.

Fatigue Is Associated With Depression

People with rheumatoid arthritis and other people who experience everyday fatigue are more likely to suffer from depression.⁶Alex J. Zautra, Robert Fasman, Brendt P. Parish, Mary C. Davis, Daily fatigue in women with osteoarthritis, rheumatoid arthritis, and fibromyalgia, Pain, Volume 128, Issues 1–2, March 2007, Pages 128-135, ISSN 0304-3959, http://dx.doi.org/10.1016/j.pain.2006.09.004. (http://www.sciencedirect.com/science/article/pii/S0304395906004611)^,7Irwin MR; Olmstead R; Carrillo C; Sadeghi N; FitzGerald JD; Ranganath VK; Nicassio PM. Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis. Sleep. Apr 1, 2012;35(4):537-543.

The association between depression and fatigue is not surprising, given that people living with chronic fatigue may feel unable to keep up with their work, household responsibilities, and relationships. Also, because bouts of fatigue are unpredictable, people with rheumatoid arthritis may have difficulty planning ahead for events, such as home projects or vacations. Cancelling or missing out on normal activities is frustrating and can make a person feel unproductive and isolated.

Depression is not the only mood disorder associated with rheumatoid arthritis. One study found that anxiety is at least as common as depression among people diagnosed with rheumatoid arthritis.⁸Yasser M El-Miedany, Amany Haroun El Rasheed, Is anxiety a more common disorder than depression in rheumatoid arthritis?, Joint Bone Spine, Volume 69, Issue 3, May 2002, Pages 300-306, ISSN 1297-319X, http://dx.doi.org/10.1016/S1297-319X(02)00368-8.

When fatigue is significantly reduced, a person with RA has more energy to do chores around the house,⁹M Hazes, O Purcaru, G Coteur, P Mease, QL11 Fatigue reduction and physical function improvements associated with increased productivity at work and at home in rheumatoid arthritis paitents. Value in Health, Volume 11, Issue 6, November 2008, Page A355, ISSN 1098-3015, http://dx.doi.org/10.1016/S1098-3015(10)66222-5. exercise, and socialize, which in turn can help alleviate feelings of depression.