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Addressing RA Fatigue

In recent years, it feels like more attention is being paid to understanding fatigue experienced by rheumatoid arthritis (RA) patients.

Rheumatology Advisor recently published a summary article about the issue of fatigue, tools for assessing fatigue, with physician commentary on addressing fatigue.

How fatigue affects RA patients

The article notes that fatigue is one of the most commonly experienced symptoms by people with rheumatoid arthritis at 40 to 80 percent. Patients also say addressing it is one of the most important treatment outcomes.1

As RA patients, we can testify to previous research that indicates fatigue impacts relationships and daily activities, including the ability to work. And whether or not treatment is reducing inflammation, continuing fatigue makes us feel the RA is worse.1

Other factors impact fatigue

The article indicates a long list (12 instruments) that are validated for measuring fatigue in RA. But it also notes that pain, sleep, and functional disabilities may also contribute to fatigue issues and should be assessed. Fatigue can continue even when pain and disease activity is reduced, so there are multiple issues contributing to RA fatigue.1

The rheumatologist interviewed for commentary on the issue agrees that patients’ fatigue should be addressed. She notes that providing guidance on sleep hygiene (or good sleep habits) for patients is important. She also says that because evidence-based treatment for RA fatigue is lacking, she suggests looking at fatigue in other conditions for any lessons learned.1

The limits of rehashing the fatigue problem

While it’s good to have a summary of where we are at in addressing fatigue, this overview of the research doesn’t really add much to advancing the issue. For example, patients are already well aware that fatigue is a huge problem and a major cause of disability or limited function.

Assessing and measuring in practice

Additionally, while I’m glad to see there are some assessment tools for fatigue, I have yet to encounter anyone in healthcare who has used it or asked me questions to better understand my fatigue. Generally, my experience is that healthcare providers don’t have treatments to offer. And, since they can’t do anything about fatigue, they don’t spend time measuring, assessing, or understanding it. What would be the point in practice?

As much as I like the idea of looking at other conditions where fatigue is a common symptom, I don’t think any other specialists know any better how to treat fatigue. Even with chronic fatigue syndrome, I’ve only ever heard “rest more” is the direction given. So, while it’s nice to think answers exist elsewhere, I’ve yet to see it.

Where are the solutions?

What we really need is a directed push to treat fatigue. We get it: it’s a problem. But where are the solutions?

Can we study people who rest more versus people who don’t to see if this helps fatigue? Could we study people with flexible work schedules to see if rest periods help them continue to stay employed? Could we compare different medication treatments to see if any help with fatigue or are more effective in treating fatigue? Could we look at long-term RA patients to see how they cope with fatigue and if anything works better? Could we research biomarkers for fatigue?

We know that multiple factors play into fatigue. How about studying the interaction to see if treating the factors brings down overall fatigue? Such as improving sleep, controlling (or managing) pain, reducing stress, minimizing inflammation, and so forth.

We need actionable next steps

Any of these options would be a move forward rather than reviewing over and over that fatigue seems to be an unsolvable problem. I know that as much as I like my doctor and trust his experience, fatigue is not something he focuses on for my care. While it effects my daily life in huge ways, he doesn’t have a way to treat it.

Let’s give our healthcare team some fatigue tools to try out and see if that makes a difference.

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