Ask Me Anything: Answers To Your Questions on RA Flares and Fatigue
Rheumatoid arthritis flare ups
Is it common to have small flare ups when your medication is supposedly working?
Yes, it is indeed common to have small flares of symptoms even when the treatment plan is working fairly well the majority of the time. There are numerous reasons this can happen, such as getting close to your next injection/infusion, overexertion (I call these “activity hangovers”), not sleeping well, or for no particular reason you can put your (swollen) finger on.
Even with minor flares it's a good idea to call your rheumatologist’s office, as it's important for him/her to know how often they're happening. There are tweaks that can be made to the treatment plan, such as temporarily adding a medication such as a steroid or NSAID while symptoms are flaring. Furthermore, if these small flares are happening more frequently, the rheumatologist may want to alter the treatment plan by adding another medication for longer periods of time or changing a medication.
Yes, it is common to have flares even when the medication is working. I hate to say it, but I’ve even had big flares at times and needed temporary measures, but eventually returned to my regular treatment regimen. It’s important to work with your rheumatologist to have a plan for when you experience a flare, or temporary worsening of symptoms.
For example, they may have you increase steroids or call if it lasts more than a couple days. If you do experience a flare, it is best to react to it as quickly as possible to hopefully nip it in the bud. You’ll develop a sense of what a regular day feels like versus a flare and then be able to describe the differences and consult with your doctor to address.
Rheumatoid arthritis and chronic fatigue
Should the chronic fatigue that goes with the disease make you lethargic and sleep a lot?
Unfortunately, fatigue is a symptom of rheumatoid arthritis and can indeed cause people who have the disease to feel very lethargic and to sleep more. When I experience fatigue, I often wake up feeling tired and then trudge through my day feeling very heavy and slow. Fatigue makes every action, including thinking clearly and quickly, more challenging. Fatigue can be debilitating to the person experiencing it, but may not be as evident to a doctor as other symptoms such as pain or inflammation.
Therefore, it is important to discuss the level of fatigue one is experiencing with a rheumatologist. The treatment plan should address fatigue as well as other RA symptoms, so in cases of prolonged fatigue, it may be necessary to alter the treatment plan. Additionally, there are other medical conditions that also cause fatigue, so it’s important for a doctor to be aware of the severity of fatigue in case there may be something else at play.
Sometimes, but unfortunately, there is no clear cut answer here. It’s important to develop a sense of what is normal fatigue for your experience with RA. When on treatment and feeling stabilized, what level of fatigue are you experiencing? If this should worsen significantly, then it is important to call your doctor to discuss. A big shift in fatigue could mean that something else is happening that needs to be addressed or that your medication may not be working as it should. Some days the fatigue should be worse than others, but big changes may be a warning sign. Life with RA may also involve just needing more rest and if you are not getting enough sleep at night, this may make you more lethargic during the day.
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