How to Beat Arthritis Fatigue
Arthritis-related fatigue may feel overwhelming, but there are effective ways to manage it.
Updated by Linda Rath | Nov. 14, 2023
Fatigue is different from the kind of tiredness you feel when you miss a few nights’ sleep or are sick or under stress. Most people can push through that kind of exhaustion. Chronic disease-related fatigue, on the other hand, is overwhelming and impossible to ignore.
People with severe fatigue — and that includes about one in six people with rheumatoid arthritis (RA) — say it disrupts daily life more than any other symptom, including pain. Yet according to studies, most patients who have RA never talk to their primary care physician about fatigue, and just over half bring it up with rheumatologists. Patients say health care providers rarely discuss it, either. There’s a reason for that: Fatigue is subjective, varies by disease, and there is no universally agreed-upon medical definition or way measure it.
What causes it?
You might think high disease activity and inflammation would cause fatigue, but some, though not all, research suggests there’s not much connection. Fatigue is more closely related to pain perception, depression, lack of exercise, obesity, poor sleep and co-existing conditions like diabetes. Common arthritis drugs like methotrexate can also contribute.
Patty Katz, PhD, a researcher and professor of medicine at the University of California, San Francisco, says teasing out cause and effect in fatigue is challenging. “Fatigue may lead to inactivity and depression, and inactivity worsens fatigue, depression and poor sleep,” she says.
Managing fatigue: A multi-pronged approach
Reduce disease activity. Although there may not be a direct correlation between low disease activity and fatigue in all cases, reducing disease activity can help many other arthritis symptoms, including pain, poor sleep and depression. Studies have shown that even when patients achieve remission, fatigue doesn’t improve immediately. It may take a year or more for it to get better.
Fatigue is complicated, and there is no one-size-fits-all fix. But several approaches to manage fatigue have proved somewhat effective. The more of them you can incorporate into your life, the more relief you’re likely to get.
Move more. Most people with arthritis aren’t nearly active enough, possibly due to fatigue or the mistaken belief that exercise will damage their joints. Hundreds of studies have shown that neither is true, and exercise is considered a key part of standard arthritis care. Physical activity relieves fatigue by acting directly on the nervous system. It also benefits joints by keeping them flexible and strengthening supporting muscles. This was confirmed by a 2023 Cochrane review of 92 studies involving more than 10,000 patients. It found that regular exercise relieved fatigue, improved hand function and boosted muscle strength. Exercise is also known to help other arthritis-related conditions, including poor sleep and depression, both of which play a role in fatigue.
The general recommendation for most people, whether they have arthritis or not, is a minimum of 30 minutes of activity every day. Ideally, activities include a combination of aerobic exercise, such as swimming, brisk walking or biking, resistance and mobility training. Newer studies suggest that for some people, short bursts of intense exercise called high intensity interval training, or HIIT, may be more effective than longer, less strenuous workouts.
Some people have to overcome mental and emotional barriers to start exercising. When you’re exhausted, it’s the last thing you may want to do, but once you get over the mental hurdle, you’ll realize how much better movement makes you feel. Even a quick five-minute walk can make a difference. Create your own reward system by choosing an activity you enjoy and look forward to, then stick with it.
Sleep better. As many as half of people who have rheumatoid arthritis have insomnia. They may have trouble falling or staying asleep or wake up too early. Insomnia in arthritis patients is complicated by depression, inactivity and conditions that disrupt sleep, such as restless legs syndrome and sleep apnea. Sleep quality may be more important than quantity. High-quality sleep is restorative and mostly uninterrupted, helps you feel and function better and has a positive effect on the immune system. If you’ve tried all the usual tricks, including going to bed at the same time every night in a cool, dark room without electronic devices and you still toss and turn, you might be tempted to try sleeping pills. But sleep meds can worsen depression, lead to next-day fatigue and lose effectiveness over time. Experts say they should only be used temporarily and as a last resort. One alternative to consider is a mindfulness meditation app. In a recent survey of nearly 10,000 people who used a meditation app, a majority said it helped them go to sleep, stay asleep and improved their sleep quality overall.
Cognitive behavioral therapy. Your mood and how you perceive pain and other aspects of arthritis play a role in fatigue. CBT, a short-term talk therapy that helps people quickly identify and deal with challenges, is the most effective treatment for insomnia and is successfully used to treat a variety of mental health issues. CBT also has been moderately successful in relieving arthritis-related fatigue. A large randomized controlled trial called Reducing Arthritis Fatigue (RAFT), found that group behavioral cognitive therapy delivered by rheumatologists improved all measures of fatigue in RA patients for two years, the length of the trial. Mind-body interventions like yoga, breath therapy and meditation have also been shown to be helpful. One randomized controlled trial of a 12-week yoga program that included breathwork and meditation showed it was safe for people with arthritis, and significantly improved both mood and fatigue.
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