Arthritis Today

How To Beat Fatigue

Learn more about fatigue, its causes and how to treat it, so you can feel your energetic self again.


Everyone gets tired from time to time. But when your need for rest seems excessive or becomes disruptive to your daily life, what once may have been run-of-the-mill tiredness has morphed into full-fledged fatigue. Many people with arthritis-related conditions experience fatigue. Up to 98 percent of people with rheumatoid arthritis (RA) report fatigue, as do 50 percent or more of those with lupus or Sjögren’s syndrome. The percentage grows higher when obesity, depression, fibromyalgia, congestive heart failure, lung problems or chronic headaches are present, too.

Many people describe fatigue as severe weariness and overwhelming exhaustion that doesn’t get better with sleep. If you find yourself with no energy even after a full night’s rest, it may be fatigue. People with chronic diseases can have fatigue that comes and goes, but many experience long-lasting fatigue. The bouts may seem to come out of nowhere because they aren’t preceded by extra activity, and they may occur even when the joints are feeling good.

Common Causes of Fatigue

To find an effective treatment to your fatigue, first you need to know the cause. Factors that contribute to fatigue include inflammation, chronic pain, hormonal changes, anemia, poor sleep, depression and stress. Also, the majority of people with fibromyalgia have chronic fatigue. Other conditions that can lead to fatigue are celiac disease, cardiovascular problems or lung problems associated with inflammation (such as interstitial lung disease). Several of these factors may be at work. But treating even one issue may provide significant relief.

Sleep and pain. For many people with arthritis, fatigue often is triggered by insomnia and unrefreshing sleep due to pain. Getting into a comfortable sleeping position is a challenge when joints are swollen and sore. Quality of sleep tends to be more important than quantity. Getting six or seven hours of deep sleep makes you feel better than spending eight hours in bed tossing, turning and waking up repeatedly.

Depression. People with inflammatory diseases are more likely to develop depression, which can increase fatigue. In people with arthritis, depression can also be a side effect of some medications, like prednisone. In addition, the depression may be heightened by the draining effect of dealing with the chronic pain of the disease. Chronic pain also affects the brain, causing unstable levels of hormones and neurotransmitters, like serotonin, which can lead to depression.

Medication side effects and fatigue. Some medicines can cause drowsiness in some people, which may contribute to fatigue. These include antidepressants called selective serotonin-reuptake inhibitors (SSRIs), including Paxil, Prozac, and Zoloft. About 20 percent of people with fibromyalgia who take SSRIs report drowsiness as a side effect. Other medications have drowsiness as a common side effect, including pain medications such as oxycodone (OxyContin); some prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac (Voltaren) or naproxen (Naprosyn); tricyclic antidepressants such as amitriptyline hydrochloride (Elavil, Endep, Vanatrip); disease-modifying antirheumatic drugs (DMARDs) such as azathioprine and methotrexate; and antihistamines such as diphenhydramine (Benadryl).

Inflammation. Your body’s immune system normally helps to keep you healthy by fighting off germs that cause illness. But if you have an autoimmune disease such as rheumatoid arthritis (RA), your immune system attacks your own body. When your immune system is activated, it produces cytokines -- chemical messengers that regulate the intensity and length of the immune response. People with inflammatory forms of arthritis have constant high levels of these messengers, which lead to inflammation and can result in fatigue. It is as if your body were constantly fighting off the flu.

Anemia. Anemia is when you don’t have enough red blood cells. It affects up to two-thirds of RA patients and is common in people with severe joint disease. Chronic illness can lower the longevity of red blood cells. With too few or too-small red blood cells, your body doesn’t have enough iron, which normally holds onto the oxygen we breathe and distributes it around the body for energy production. Your body then has to work extra hard whenever you move. Even when performing normal daily activities, the muscles get tired faster, resulting in fatigue.

Loss of muscle mass. When you lose too much muscle tissue, the remaining muscles have to bear the burden of moving your body. Many people with severe RA are affected by a condition called cachexia, in which muscle mass decreases and fatigue increases. Cachexia is linked with high levels of cytokines produced by the overactive immune system. The biologic medications, such as adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade), block cytokines and may slow the progressions of cachexia.

Other underlying conditions. Other conditions may lead to fatigue. These include underlying infection; low levels of electrolytes (minerals in your blood that carry an electric charge, including calcium, potassium, and sodium); low levels of certain vitamins (vitamin D and B12), which help cells produce energy; problems with metabolism in the liver or kidneys; problems with thyroid function (hypothyroidism); or other chronic conditions, like hypoglycemia.

Medications to Treat Symptoms of Fatigue

To make it easier to find the cause of your fatigue, it is helpful to keep a diary of how you feel. Sometimes you may run out of time to discuss issues like fatigue during an appointment with your physician, so make a point to let your doctor know ahead of time that you want to talk about it. Then both of you will be better prepared to address the issue. Once you and your doctor have found possible causes for your fatigue, you can create a treatment plan.

If you have anemia, you will get iron treatments or the hormone epoietin (Epogen, Procrit). If your fatigue is more of a problem than your pain, you may need “activating” medications that increase energy. These include some antidepressants, like bupropion (Wellbutrin), and psychostimulants, like modafinil (Provigil), which reduces the excessive sleepiness brought on by sleep disorders such as narcolepsy or sleep apnea. For many people, a combination of these drugs and non-drug therapies, like exercise and cognitive behavior therapy (CBT), reduces fatigue and increases energy.

For people whose fatigue is sleep-related – those who have trouble falling asleep or staying asleep at night due to anxiety or insomnia – sleeping pills may help promote restorative sleep while reducing or preventing next-day grogginess. The newer medications, including eszopiclone (Lunesta), lorazepam (Ativan), zaleplon (Sonata), and zolpidem (Ambien), are less likely to trigger dependence than older sleep medications or mild tranquilizers, like alprazolam (Xanax), clonazepam (Klonopin), and diazepam (Valium). Headaches and daytime sleepiness may still occur in some of people.

Lifestyle Changes to Beat Fatigue

Exercise regularly. Exercise helps with fatigue in several ways. It increases muscle mass and strength, which make movement easier. It also increases blood circulation and flexibility, which reduce pain. In addition, exercise generates endorphins, which are brain chemicals that produce a sense of well-being and energy. If you are new to exercise, consult with your doctor or physical therapist. Gradually work up to two or three days per week of strength training and three to four days per week of cardiovascular exercise, such as walking, cycling or swimming, all of which increase your endurance and strength. Yoga and tai chi increase your range of motion and reduce stress.

Eat well. Eating is a pleasure with purpose: to nourish your body. Choose what you eat with care—healthy foods are your energy source. Reaching for nuts, fruits and vegetables, and whole grains will help your body make the energy it needs. Always start your day with breakfast. Make sure to include some protein, like an egg or yogurt, along with carbohydrates such as whole-grain bread or oatmeal.

Support your joints. Wearing a brace or using a cane when necessary can help take stress off your joints and the muscles surrounding them, which can help with fatigue.

Maintain good sleep habits. Be consistent. Go to bed and get up at about the same time every day. Each night, follow the same bedtime routine; this will signal your body that it’s time to sleep. Whether it’s taking a warm bath, reading a book, listening to music or doing a crossword puzzle, the ritual is right if it works for you.

Take a break. Listen to your body and rest between activities. Rest allows muscles to refuel for more activity. Plan regular time for breaks each day. You shouldn’t rest longer than you are active, unless you have a fever or an infection.

It may take some time and detective work to beat your fatigue. Try to stay positive and work with your doctor to find the right combination of treatments at the right doses to treat your fatigue. Remember that each person is unique in what causes their fatigue; likewise, each person is unique in what treatments work for them.