“RA fatigue is a symptom that we rheumatologists really struggle with understanding well,” says Yousaf Ali, MBBS, a professor of medicine at the Icahn School of Medicine and chief of the division of rheumatology at Mount Sinai West Hospital in New York City. “It is a systemic type of exhaustion, meaning it affects your whole system instead of just a certain body part.” People who have RA often describe their fatigue as a deep tiredness or slowing down, akin to the feeling someone might have while recovering from the flu. It’s also worth noting that other potential causes of fatigue exist, outside of RA. “You should be evaluated for reversible causes of chronic fatigue, such as depression, anemia, sleep apnea, and hypothyroidism,” Dr. Ali says. Depression in particular can also take a toll on energy levels and create a snowball effect, as having RA can cause depression, and having depression can also make RA symptoms worse, according to the Arthritis Foundation. Other underlying causes of exhaustion may include side effects from your medications or poor sleep. Once you’ve determined what’s causing your fatigue, you can work with your doctor to eliminate it or get proper treatment. You’ll likely need a strategy that addresses multiple fronts and goes beyond the basics, like taking rest breaks, to start feeling energized again.
1. Talk to your doctor about controlling RA inflammation.
You don’t need to battle fatigue on your own; working with your doctor to get any underlying RA-related inflammation under control can help significantly. “Cytokines — proteins produced by cells — can amplify inflammation, which may have a direct influence on brain receptors to cause fatigue. So the first step is to work with your rheumatologist to get inflammation under control,” Ali says. “Medications that decrease inflammation often decrease fatigue.”
2. Kick-start your exercise routine.
The best exercises for people with RA are often low-impact activities like stationary cycling, swimming, and walking.
3. Nix the naps.
A good night’s sleep requires healthy sleep habits. If possible, avoid napping during the day. You need to be awake for about 16 hours in order to sleep well at night — for example, getting up at 7 a.m. and going to bed at 11 p.m. When you do turn in, keep your bedroom quiet, dark, and comfortable and avoid making it an entertainment center (that means no electronics). Also, skip the alcohol and heavy meals before bedtime and limit caffeine after noon. Going to bed and waking up at the same time every day can also help you establish a quality sleep routine that leaves you feeling refreshed.
4. Try assistive devices.
Using certain devices can help cut down on the energy you use every day at home and at work. Home devices include zipper pulls, buttonhooks, electric can openers, gripping and reaching tools, and bathroom bars and handrails. Workplace devices may include a height-adjustable chair and work surface and a hands-free telephone headset. An occupational therapist can help you identify the right tools to try and adjustments to make to help you save energy and feel more comfortable throughout the day.
5. Consider cognitive behavioral therapy (CBT).
Having a chronic and unpredictable physical condition is exhausting, and it can take a toll on your emotional health. CBT, which is a form of talk therapy, teaches you to change the way you think about fatigue — and changing your thinking can alter the way you feel and act. Findings from a review published in May 2020 in the journal RMD Open suggest that RA-related fatigue may often be from causes outside the condition itself — and that the best ways to reduce fatigue might be cognitive, such as cognitive behavioral therapy, as well as behavioral, such as getting exercise.
6. Ask your doctor about medications to treat fatigue.
Certain medications may help chronic fatigue, such as modafinil. However, “you need to use these with caution, because once you start taking them, it may be hard to stop,” Ali says. “Using pain medications such as acetaminophen at night can help improve sleep that’s disrupted by RA pain,” Ali adds. Another option, a low-dose antidepressant, also given at bedtime, has been shown to reduce pain, increase sleep, and reduce fatigue in some people with RA, he says.
Rally the Troops
The chronic fatigue of RA may not be as clear-cut as pain and swelling, but it can take a toll on your physical and mental well-being. To fight fatigue, a team approach is best, meaning you should enlist the help of your rheumatologist, a physical therapist, an occupational therapist, and a mental health specialist. But the most important member of your care team is you. Be sure to learn as much as you can about RA and work with your care team to get fatigue under control so you can get your energy back. Additional reporting by Erica Patino and Brian Dunleavy.
