If you have rheumatoid arthritis (RA), symptoms like joint pain and swelling are a given. But you may also be in the grip of a less tangible symptom: fatigue. In fact, fatigue is one of the most common and frustrating RA symptoms.
“RA fatigue is a symptom that we rheumatologists really struggle with understanding well,” says Yousaf Ali, MBBS, a professor in the department of medicine and the chief of the division of rheumatology at Mount Sinai West 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 recovering from the flu.
But there are steps you can take on multiple fronts to lessen fatigue and regain your energy.
1. Talk to Your Doctor About Controlling Your RA
You don’t need to face fatigue on your own; working with your doctor to get any underlying RA-related inflammation under control can help significantly. Getting RA pain under control with an effective treatment plan can also help you sleep better.
“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,” Dr. Ali says. “Medications that decrease inflammation often decrease fatigue.”
Note that the side effects of some RA medications, such as methotrexate, include fatigue. It’s worth discussing the risks and benefits with your doctor.
2. Get Checked Out for Other Causes of Fatigue
3. Commit to an Exercise Routine
“Inactivity can be a vicious circle — RA fatigue makes it hard to get moving, and inactivity makes fatigue worse,” Ali says. “Most people with RA do feel energized after exercise. It may help to work with a physical therapist to get started.”
Be sure to warm up before and cool down after your workout and listen to your body. Don’t push too hard if you’re in pain. It’s also important to protect your joints: the best exercises for people with RA are often low-impact activities like stationary cycling, swimming, and walking. Aim for a total of 150 minutes per week of exercise.
4. Sleep Well
When you turn in, keep your bedroom quiet, dark, and comfortable, and avoid making it an entertainment center (that means no electronics). Also, skip alcohol and heavy meals before bedtime, and limit caffeine after noon. Going to bed and waking up at the same time every day can help you establish a quality sleep routine that leaves you feeling refreshed.
5. Conserve Your Energy With 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, as well as 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.
6. Consider Psychotherapy and Emotional Support
Having a chronic and unpredictable physical condition is exhausting, and it can take a toll on your emotional health. Mood disorders like anxiety and depression are common in people with RA and are also linked to sleep disorders.
Psychotherapy can help address mood disorders. Cognitive behavioral therapy, 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.
A study of people with RA found that psychological flexibility variables — which included participating in a valued activity, mindfulness, cognitive fusion (or getting entangled in negative thoughts), and fatigue avoidance — were directly associated with fatigue-related disability. To the extent that psychological interventions can target this, they may be helpful in reducing fatigue-related disability.
Joining a support group, whether in person or virtually, can help improve your emotional health, which in turn might affect your fatigue. Research shows that peer support, while it can vary quite a bit, is generally viewed by people with rheumatic diseases “as a favorable and necessary tool for helping manage their conditions,” according to study authors.
7. Ask Your Doctor About Medications to Treat Fatigue
Certain medications may help chronic fatigue, such as modafinil (Provigil). 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.”
A low-dose antidepressant given at bedtime has been shown to reduce pain, increase sleep, and reduce fatigue in some people with RA, he says.
8. Learn Relaxing Mind-Body Techniques
Research has shown that mind-body interventions like yoga and mindfulness meditation can be helpful in terms of reducing fatigue.
A randomized, controlled trial of a 12-week yoga program including breathing exercises and meditation found that it significantly improved both mood and fatigue in people with RA.
And another controlled trial showed that a 10-session mindfulness-based group intervention (with a booster session after six months) significantly improved psychological distress and fatigue in people with inflammatory rheumatic conditions.
Progressive muscle relaxation is another deep relaxation technique shown to enhance sleep and reduce fatigue in people with RA. Progressive muscle relaxation involves tensing various muscle groups throughout your body for intervals of about 10 seconds, then releasing them. This is combined with deep breathing.
9. Pace Yourself and Set Boundaries
An important part of energy conservation when you have RA is learning to say no sometimes. Overextending yourself will likely increase stress and fatigue.
Take time to plan activities carefully and try to spread out any demanding tasks you may have to do. Be sure to take breaks before you become too exhausted and don’t be afraid to ask for help when you need it.
The Takeaway
- Managing rheumatoid arthritis fatigue starts with working closely with your doctor to control inflammation. Talk with your healthcare provider if you experience unexpected fatigue, as this can sometimes be a side effect of medications like methotrexate.
- Addressing other health issues such as depression, anemia, sleep apnea, and hypothyroidism — all of which can contribute to fatigue — is vital for managing energy levels with RA. Ensure that these potential causes are evaluated by your doctor.
- Incorporating regular low-impact exercise, adequate rest, and healthy sleep practices into your routine can provide a substantial boost to your energy levels. Activities like yoga, mindfulness meditation, and progressive muscle relaxation have been shown to reduce fatigue in individuals with RA.
- Utilizing assistive devices and learning energy conservation techniques can help you manage daily tasks more effectively without overexerting yourself. Proper planning, pacing, and setting boundaries to avoid overstretching can help maintain energy levels throughout the day.
Additional reporting by Erica Patino and Brian Dunleavy.
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