Managing fatigue

Fatigue and arthritis

Arthritis is commonly associated with pain, fatigue and stiffness. It can affect your general health, sleep, weight, emotional wellbeing and the amount of activity you feel able to do. Many people with arthritis say fatigue is one of their biggest challenges.

Fatigue can be linked to many types of arthritis and related conditions. It’s commonly a symptom of autoimmune conditions, such as rheumatoid arthritis, reactive arthritis and lupus. In autoimmune conditions, the immune system mistakenly attacks the body’s own healthy tissues.

It’s also strongly linked to conditions that can cause long-term pain, such as fibromyalgia, polymyalgia rheumatica and complex regional pain syndrome.

People with osteoarthritis have also reported having fatigue.

What is fatigue?

Fatigue is an extreme, sometimes overwhelming, physical and mental tiredness, that doesn’t significantly improve with rest or sleep. It’s a common problem associated with arthritis and can make other symptoms, such as pain and joint stiffness feel more severe and limiting.

It can affect your motivation and your ability to concentrate, this is sometimes described as having brain fog. Some people find it affects their emotional wellbeing making them feel irritable or depressed.

People with fatigue often say it’s similar to having the flu, with symptoms such as:

• their body and limbs feeling heavy and difficult to move
• exhaustion
• feeling their energy has drained away.

Fatigue is unpredictable. It can start suddenly at any time of the day. Some days you may feel exhausted from the moment you wake up, even if you think you slept well.

It can last an hour, a day, or several days. Some people may find it lasts longer. It can make you feel as though you haven’t the strength or energy to achieve even simple everyday tasks.

People with fatigue often feel they have to miss out on things they enjoy doing, to save energy for jobs or tasks. However, missing out on the things that lift your mood can make fatigue worse.

Fatigue is more extreme than simple tiredness. However, there are ways you can manage it and reduce its impact on your life.

What causes fatigue?

Fatigue is your body’s reaction to a build-up of stressful events, experiences, health issues or feelings. Usually, there isn’t a single reason for fatigue, it tends to be caused by a combination of factors.

The causes can be different for everyone. It could be the result of:

• inflammation, which can cause swelling, redness, heat and pain as the body tries to heal an infection or injury by sending more blood and fluid to the area
• anaemia, where a lack of red blood cells, which deliver oxygen around your body, can lead to weaker muscles and lower energy levels. It can be caused by iron deficiency. Anaemia can be linked to conditions such as rheumatoid arthritis, lupus and axial spondyloarthritis. It can be a side effect of some arthritis treatments.
• some treatments, such as some drugs to stop seizures, anti-depressants and anxiety medications, opioid-based painkillers, some muscle relaxants, antibiotics, and long-term use of oral steroids. Drug treatments can affect people in different ways, talk to your doctor or pharmacist if you have any concerns.
• long-term conditions, such as inflammatory arthritis or autoimmune conditions
• pain
• muscle weakness caused by pain and inactivity
• overdoing it with boom and bust behaviour. This is when you carry on with your tasks, ignoring your pain or tiredness, until you physically and mentally cannot continue.
• poor quality sleep
• stress and anxiety
• missing meals, poor diet or not drinking enough water and other healthy non-alcoholic drinks means your body has less energy to rely on.

Fatigue isn’t the same as tiredness. It’s extreme mental and physical exhaustion that doesn’t improve with rest or sleep.

It’s unsurprising that many people with arthritis feel fatigued. Living in constant joint pain can wear you down. Many arthritis medicines can make you feel sleepy. Plus, sleep disturbance and low mood can make you feel exhausted.

Fatigue is an invisible symptom, but it can be debilitating and affect your day-to-day life. However, you can help make your energy last a bit longer by:

• practising joint protection
• pacing yourself and avoiding the ‘boom-and-bust' cycle — this is when you might do too much on one day and feel unable to do anything the next
• planning and setting priorities - you might find it helpful to use a calendar
• finding a less tiring position to do activities in
• becoming better organised
• taking time to rest throughout the day
• practising relaxation techniques, such as meditation or deep breathing.

Talking to your doctor about fatigue

There are several things that can reduce the impact of fatigue. Firstly, it helps if you can work out what could be causing it.

There aren’t any specific tests for fatigue. However, you can help your doctor’s diagnosis by writing down how you feel, what could be causing it and how it’s affecting your life. They may also be able to provide you with a self-assessment questionnaire to fill out.

Depending on your symptoms your doctor may recommend you have blood tests to check your fatigue hasn’t been caused by another condition. If it has been, treating this condition may improve your fatigue.

There aren’t any specific drug treatments for fatigue. However, your doctor, physiotherapist, occupational therapist or rheumatology team, should be able to help you recognise the signs and learn to manage them.

Fatigue research and new developments

Arthritis UK-funded research has found talking therapies can help reduce the impact fatigue has on people with arthritis. Our researchers are currently testing whether these therapies can be provided as a treatment by rheumatology teams.

Arthritis UK is also funding a review of the interventions that can be offered to help combat fatigue in people with rheumatoid arthritis. Most new drug treatments for inflammation in arthritis are now also tested to see if they reduce fatigue.