Rheumatoid Arthritis Fatigue: Cause, Better Habits, Triggers

Rheumatoid arthritis (RA) is known for causing severe and debilitating fatigue. RA fatigue is more than just being tired. This type of fatigue makes a person feel drained and out of energy and can toll on the body and mind.

RA is a type of inflammatory arthritis that affects many joints throughout the body, especially the hands and feet. RA is also an autoimmune disease where the immune system malfunctions and attacks the body’s healthy tissues.

With RA, those attacks are mainly targeted at the (the linings of the joints). But symptoms of RA do not stop at the joints, and RA can affect the organs and cause systemic (whole-body) symptoms. Fatigue is one of those secondary symptoms.

Keep reading to learn more about RA fatigue, including how it feels, what causes it, daily effects, tips to improve RA fatigue, and more.

What Is RA Fatigue?

No two people with RA experience the same disease symptoms, but some RA symptoms are more common than others, mainly fatigue.

According to a 2020 report in RMD Open, fatigue in RA affects about three-quarters of the people with the condition. This report also finds that fatigue affects the quality of life and is related to pain, co-morbidities (co-existing conditions), low mood, and sleep troubles.

How RA Fatigue Feels

RA fatigue can be “multidimensional, overwhelming, and unpredictable, with physical, cognitive, and emotional components,” according to a 2016 report in BMC Musculoskeletal Disorders.

RA fatigue can feel like whole-body all-over exhaustion. Some people with the condition might describe it as deep tiredness or the slowing down of the body as if you are recovering from an illness like the flu.

Contributing Role of Inflammation

High levels of inflammation might be a cause of RA fatigue. According to a 2018 review, chronic low-grade inflammation might create imbalances in cellular energy availability and expenditure. That imbalance ultimately causes you to become drained and worn when RA symptoms are active.

RA inflammation also increases pain, leaving a person feeling further worn out. When joints hurt, pain makes it harder to sleep and get good quality sleep. When your rest is unrefreshing, you experience more fatigue. It is a vicious cycle.

Day-to-Day Life

The severity of RA fatigue varies day by day, which makes it hard to plan. You might feel well today with plenty of energy, but you have no idea if tomorrow will be the same or worse.  

On the days you are exhausted, you may not have enough energy for simple everyday activities, such as getting dressed or completing household tasks. You may also struggle to care for your children or grandchildren.

The effects of RA fatigue can lead to problems in your relationships. You might have to cancel plans or give up on favorite activities, and family and friends may not understand why or the effects RA has on you. RA fatigue may affect your sex drive or limit your time with your partner.

Fatigue may also make it challenging to be productive at your job. You may need to take more breaks, miss time from work, or need help from co-workers who may not want the added responsibility.

Co-Occurring Conditions That Cause Fatigue

Severe or untreated RA can lead to co-occurring conditions. These include heart disease, infections, osteoporosis (weakening of the bones), anxiety, and depression. Many conditions can contribute to fatigue and leave you even further depleted.

One 2019 study aimed to identify fatigue related to comorbidities in people with RA. Researchers found that 40% of study participants were experiencing fatigue, with anxiety or depression being the most common related cause. The people most affected were women, people not working, and those who were inactive.

The researchers also found RA fatigue correlated with disease duration and activity, sleep troubles, pain, and emotional struggles. Severe fatigue in RA was related to the following comorbid conditions: hypertension (high blood pressure), chronic obstructive pulmonary disease, anxiety, and depression.

People using nonsteroidal anti-inflammatory drugs (NSAIDs)  and biologics, those with multiple comorbid conditions, and people who were overweight also had higher levels of fatigue.  

People with RA can also experience anemia, including anemia of inflammation and iron deficiency anemia, which further adds to the fatigue burden of RA. Anemia is a condition where there is a lack of healthy red blood cells available to carry oxygen to the body’s tissues. People with anemia often feel tired and weak.

6 Ways to Ramp Up RA Energy Levels

With time, people with RA learn to better conserve their energy and deal with the challenges of the condition. They also learn practical ways to manage fatigue, including:

1. Movement

The last thing you want to do is exercise when you feel fatigued, but exercise can improve your RA fatigue. It also strengths the muscles and joints, keeps bones strong, and improves joint function.  

If you are struggling to get moving, start with a few minutes of brisk walking and gradually work your way up to 30 minutes per day. Other good exercise options for people with RA are swimming, yoga, and tai chi. If you are too tired to do anything, try stretching and moving as much as possible.  

2. Diet

Your body gets energy from the foods you eat. Foods that help you to feel healthy and refreshed include fruits, vegetables, lean proteins, low-fat dairy, and healthy fats. Consider adding foods to your diet that are considered anti-inflammatory, such as nuts and cold-water fish.

You will want to drink plenty of water to keep you moving. Fatigue is sometimes a sign of dehydration. Aim to drink at least eight glasses of water a day—more if you are active or when it is hot outside.  

3. Breaks

It is OK to rest when you feel more tired. Consider regular rest breaks throughout your day. A break can be a 10-minute warm bath, a short nap, or even a few minutes of quiet in the dark. Taking short breaks can give you a needed boost of energy.  

4. Pacing

Living with RA is hard enough, so don’t push yourself to keep up with others who do not have your limitations. Conserve your energy by breaking tasks down or working at your own pace. And if you need help with household chores, childcare, or errands, let your family and friends know.

5. Sleep

Good sleep habits can help you get the rest you need, so you experience less fatigue. Go to bed at the same time every night and wake up at the same time each morning. Keep your bedroom dark and quiet.  

Cut back on caffeine close to bedtime and avoid alcohol and nicotine—all of these can disrupt sleep. At bedtime, turn off devices, such as your smartphone or tablet.

6. Other Health Conditions

If you have tried everything and still experience severe fatigue, talk to your healthcare provider. Anemia can result from long-term inflammation or a side effect of your RA medicines. Your healthcare provider can request bloodwork and get you started on treatment.

If other factors (like pain, depression, and medication side effects) cause your fatigue, you should discuss those with your healthcare provider. Getting these things under control can improve your sleep and reduce the amount of fatigue you experience.

Does RA Medication Treat Fatigue?

Your medications for treating RA can reduce both inflammation and fatigue. To address both, be sure to follow your treatment plan as prescribed by your healthcare provider.

If you find treatments aren’t working and you are experiencing fatigue that affects your ability to enjoy and participate in your life, reach out to your healthcare provider.  

You might also consider asking your healthcare provider about medications that treat chronic fatigue, such as Provigil (modafinil). Medications like Provigil need to be taken with caution because they can be difficult to stop once you start taking them

Your doctor might be able to prescribe pain medications, like Ultram (tramadol), which can relieve pain and improve sleep. Low doses of anti-depressants, taken at bedtime, might also manage pain, improve sleep, and reduce fatigue.  

Using Caffeine Wisely

Regular caffeine consumption can disturb sleep and lead to daytime sleepiness (fatigue). Caffeine can significantly reduce slow-wave sleep, the stage of deep, restful sleep that allows you to feel refreshed and alert in the morning.

Caffeine-interrupted sleep leads to daytime fatigue and problems with concentration, learning, memory, problem-solving, and emotional response. For people with RA who already experience fatigue, this might be an even more significant challenge.

The Sleep Foundation recommends a cut-off time for caffeine consumption of at least six hours before bedtime. If you find that the six-hour recommendation is not enough, note how much caffeine you consume throughout the day and work to reduce that amount.

Summary

Rheumatoid arthritis is a type of inflammatory arthritis that mainly affects the linings of the joints. RA is also a systemic condition, which means it causes whole-body symptoms, primarily fatigue.

RA fatigue is debilitating and can affect your quality of life. Contributing factors for fatigue are inflammation, pain, and co-occurring health conditions.

There is plenty you can do to manage fatigue and its effects on your life. These can include following your treatment plan, being active and eating healthy, being wise with caffeine, and finding ways to improve sleep.

A Word From Verywell

The stress of living with rheumatoid arthritis pain and fatigue is a constant battle. As you experience these effects day in and day out, it can be easy to feel down or become depressed. But a little bit of optimism can go a long way.

Focusing on being grateful and having a purpose can improve your mental well-being and help you live a full life with RA. It might even allow you to manage pain and fatigue better.  

Good coping is a vital part of living with and managing the effects of RA. But if you are struggling to cope on your own or find you are feeling anxious or depressed, ask your healthcare provider about a referral to a mental health professional.