The connection between rheumatoid arthritis and fatigue is complex. Fatigue is one of the most common symptoms of rheumatoid arthritis, and the absence of fatigue can indicate that rheumatoid arthritis is in remission. Rheumatoid arthritis patients may assume their fatigue is directly related to the joint inflammation and associated pain of their arthritis, but there are many other factors that can contribute to the feelings of fatigue, including lack of sleep, medication, poor nutrition and co-existing illnesses.
Much like what happens when one has a severe cold or the flu, inflammatory cytokines, or protein molecules, are released during a rheumatoid arthritis episode. The inflammation is systemic and, therefore, does not affect only the joints. The feeling of pain is throughout one’s body.
People experiencing rheumatoid arthritis and fatigue may blame the fatigue on the pain itself. They will sometimes feel guilty and perceive themselves as lazy for not being able to maintain their activity level. Rheumatoid arthritis patients may think the fatigue is a result of overdoing it or not getting a good night’s sleep. These factors may play a part in the link between rheumatoid arthritis and fatigue, but they are usually compounded by other elements.
In addition to pain, the causes for fatigue associated with rheumatoid arthritis can include overexertion, medication side effects, depression, co-existing conditions such as fibromyalgia, lack of sleep, poor nutrition, and stress. Patients with rheumatoid arthritis and fatigue need to identify the specific causes for their individual symptoms, so they can be treated more effectively. Being aware of when the fatigue is at its worst can help patients identify the causes and provide them with a schedule of when they are likely to have more energy to complete necessary or desired activities.
Rheumatoid arthritis and fatigue occur in a cycle. The patient feels increased pain because of inflammation, and the pain can affect one’s desire to eat, ability to sleep, level of depression, and ability to interact socially, all of which can ultimately exacerbate feelings of fatigue. Patients can feel frustrated or angry by the increased fatigue, which again may impact their sleep, eating, depression, and social interactions. Lack of sleep, anemia stemming from of the lack of eating, depression, and lack of contact with social supports can all feed into the fatigue.
Someone with rheumatoid arthritis will usually take multiple medications. Prescription drugs for depression or pain can increase fatigue, so the patient’s doctor may need to adjust the dosage. Some medications for pain, when increased or taken with other drugs, can reduce the fatigue associated with joint pain and inflammation. Patients also may have diseases such as fibromyalgia, lupus, depression or chronic fatigue syndrome that need to be treated along with rheumatoid arthritis to lessen the fatigue.