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Disruption of sleep is one factor of RA fatigue, but experts say the tiredness can happen even when people get proper rest. Getty Images
  • Fatigue is a common and debilitating symptom for people with rheumatoid arthritis.
  • Experts say they aren’t certain yet why fatigue is so prominent in the lives of people with the autoimmune disease.
  • This fatigue can affect people’s moods and ability to work.
  • The Arthritis Foundation recommends cognitive behavioral therapy, management of anemia, vitamins, hydration, proper sleep, and exercise as ways to try to combat fatigue.

Proper rest is an important part of managing any disease, but with painful conditions such as rheumatoid arthritis, sometimes rest doesn’t quite happen — or it simply isn’t enough.

One of the most pressing symptoms of rheumatoid arthritis (RA) is fatigue.

Beyond sleepiness, tiredness, or exhaustion, people with RA oftentimes describe their unique type of fatigue as “debilitating” or “unrelenting,” or even “bone-tired.”

Doctors remain puzzled by how to manage RA fatigue, as no one really knows the cause yet.

Is it the pain and inflammation of the disease itself? The medications? Lack of exercise or movement? Poor quality of sleep? Does depression play a role?

The truth is that there may be many varying factors contributing to the special brand of fatigue found in people with rheumatoid arthritis.

Recent studies have shed some light on this issue.

An article in Rheumatology Advisor states that “Fatigue is considered a disabling symptom and has a significant effect on a patient’s physical functioning.”

It adds that managing fatigue symptoms can help a person function better.

This assessment was based on the findings of various studies that state a correlation between RA and fatigue, and the impact that fatigue has on a person’s functioning and quality of life.

“RA and all autoimmune diseases can lead to fatigue,” said Kristine Blanche, PhD, PA-C, the chief executive officer of the Integrative Healing Center in New York.

“The autoimmune process itself is a systemic inflammatory reaction. I describe it as a 3-alarm fire and the body is constantly working to put out that fire. This requires energy,” she said. “When we calm the inflammation, the body requires less energy to heal and thus energy levels improve for patients.”

However, most studies haven’t been able to nail down a direct or definitive cause of fatigue.

Experts say it could be many factors combined.

“The fatigue in rheumatoid arthritis is caused by a combination of many factors and the contribution of each factor may not be the same for all patients,” Diane Lewis Horowitz, MD, the director of the Rheumatoid Arthritis Center at Northwell Health in New York, told Healthline.

“Elements of rheumatoid arthritis that cause fatigue include pain, anemia, and inflammation. Pain can cause mood alterations and sleep disturbances and these can also increase fatigue,” she continued.

Horowitz noted that some medications can cause fatigue, but these medications can also help manage the arthritis, which can lessen fatigue.

“A patient with high disease activity will have more fatigue than a patient in remission or with low disease activity,” Horowitz explained. “Therefore, while medications may cause some fatigue, the overall effect of the medications is to improve fatigue.”

Some studies report an apparent association between the number of sleep problems one has and the level of fatigue. However, other studies indicate that a relationship between sleep problems and fatigue isn’t significant.

This means that a person with RA can get enough sleep, or even quality sleep, and still experience fatigue.

What’s known is that fatigue can impact prognosis — and it also seems that lifestyle changes can help people better cope with and manage fatigue.

A study published in August stated that “Fatigue is a key contributor to increased clinical care costs, primary care consultations, and employment loss. Despite this, our understanding of the prognostic of factors of poor fatigue outcomes is lacking and fatigue is poorly managed.”

“The available data appears to implicate generic factors such as pain, mental health, disability, and sleep as consistent predictors of fatigue outcome while the role of disease activity and inflammation seems less clear,” the study authors wrote. “However, the existing data are not without methodological limitations and there have been no specific studies primarily designed to investigate the inflammatory biomarkers of fatigue.”

The researchers also found that broad factors such as disability, mood, and pain appear to amplify or drive fatigue in people with rheumatoid arthritis.

Fatigue also plays a role in a person’s ability to keep working.

A 2018 study discussed factors that contributed to work disability among people with RA and ankylosing spondylitis. Researchers concluded that fatigue was a main symptom that impacted people’s ability to keep working.

The mental health component that comes along with chronic diseases such as RA can also contribute to fatigue.

A 2015 review mentioned psychological correlations between RA and fatigue. It’s known that RA can be associated with mood disorders and mental illnesses including depression, PTSD, and anxiety.

These conditions can cause fatigue. In addition, fatigue can worsen these conditions themselves. It’s a vicious cycle that a person with RA wrestles with.

Another vicious cycle is that of exercise.

Many healthcare professionals and physical therapists will recommend mild to moderate exercise as a way to help manage symptoms of RA. However, when someone’s too sore and tired to work out, they’re faced with a conundrum.

While most people living with RA say they experience fatigue, not everyone reports having it.

Carolyn Walker Smith of Pennsylvania is 54 and has had RA for 35 years.

“I do not get fatigued from RA. I may tire sooner than others, but I wouldn’t call it fatigue,” Smith told Healthline. “My opinion is that all the meds they shove down our throats cause this. I do not take RA meds… I am perfectly healthy other than RA.”

But some people like Elaine Trujillo of California do get fatigued. She attributes hers to “painsomnia” and mental health components more so than her RA.

“I believe that lack of sleep due to pain will cause fatigue, and when you’re not able to sleep, anxiety kicks in as you tend to lay there and worry,” Trujillo told Healthline.

“I’ve had many sleepless nights worrying about what I need to get done and know that I won’t be able to. Therefore, my anxiety and fatigue level will go up,” she added.

“Fatigue is usually how I know I’m going into a flare,” Kate Leonard, an Oklahoma resident with RA, told Healthline. “I will find myself getting a good night’s sleep then needing a nap and I’m still tired. It isn’t from pain causing me to not sleep. It’s [the] exhaustion of my body fighting itself. It happened before I was on meds and after.”

The Arthritis Foundation mentions a few ways to combat fatigue, including cognitive behavioral therapy, management of anemia, vitamins, hydration, proper sleep, and exercise.

Experts say if fatigue is a debilitating symptom or is having a negative impact on your everyday life, you should talk to your rheumatologist or primary care provider about what can be done.

At this time, most RA medications don’t help with the issue of fatigue, but some doctors believe that controlling disease activity can help.

In the end, people should do what works best for them to manage fatigue.

As Melanie Ann Barnes, an Ohio resident with RA and osteoarthritis, told Healthline, “Fatigue is a puzzle.”