A woman yawning and rubbing her face. Behind her are two overlapping circles.

My Overwhelming Fatigue: Is Rheumatoid Arthritis to Blame?

Fatigue is one of my most prevalent symptoms. It can become so overwhelming at times that making the decision to turn off the TV can be too much to handle in the moment. Getting up to get another glass of water seems not worth the effort, although I know drinking plenty of water is one way to help reduce fatigue.

Fatigue can make any task seem impossible no matter how small. When fatigue is behaving its worst, I don’t really care what’s causing it, I just want it to go away. Is it MS? Is it RA? Is it something else? Doesn’t matter. It sucks.

An overlap in RA and MS fatigue symptoms

Overlapping symptoms are those symptoms that could be caused by many different conditions. If you have several conditions, you are bound to have overlapping symptoms. The trouble with that is if you don’t know the cause of a particular symptom, it’s hard to know what you need to do to alleviate the symptom.

Can I blame RA for my joint pain? Not necessarily, joint pain can be associated with osteoarthritis or with multiple sclerosis due to other musculoskeletal symptoms.

Is RA causing my cog-fog? Maybe, maybe not. This one’s tough to decipher and sometimes the effort doesn’t seem worth it. But knowing that cog-fog isn’t about intelligence is somewhat helpful in keeping your morale up.

Does RA cause my fatigue? I didn’t think so, particularly since fatigue is so common in MS. But now I’m not so sure.

If you could dump one symptom...

I informally asked a group of people living with RA what would be the one symptom they would want to “dump” if given the opportunity. I expected responses that mentioned pain, swelling, inflammation, or deformity to top the list. What I didn’t expect that was fatigue was the number one symptom mentioned in more than half of 300+ responses.

Fatigue is a troubling RA symptom

I was surprised by the responses I received that overwhelmingly mentioned fatigue as a symptom people most wanted to get rid of. Not sure why I was surprised; I want to dump fatigue too.

At this point, I can’t honestly imagine what it would be like to not experience daily fatigue. Too many days, I wake up tired. Sometimes I can blame the tiredness on my cats who want attention during the night or insist that breakfast should be served before the sun’s come up. But most of the time, fatigue is just fatigue — ever-present and ever-intrusive — and there doesn’t seem to be any specific reason for it.

What does the research say about fatigue and RA?

I was curious to learn more, so I did what many people living with a chronic disease might do — I searched the internet for more information. My goodness. At first, I found pages and pages of almost identical articles that didn’t really tell me much more than I already knew about fatigue.

However, I did find an editorial published in Rheumatology that describes nicely what is known, or not known, about fatigue and RA. It also highlights a few studies that investigated ways to improve RA-related fatigue with biologic agents, cognitive behavioral therapy, and/or aerobic training.1 But the research was limited and no clear guidance on treatment options could be suggested.

The following quote from the editorial reflects my own experience:1

“RA patients struggle and manage fatigue by trial and error and—with limited success—use self-management strategies. Most patients do not discuss fatigue with their healthcare professionals because they feel it is dismissed or they simply accept fatigue as being part of the disease.”

Fatigue plays a role in MS, but also RA

I suppose that I simply accepted that fatigue was part of living with MS and disregarded its role in RA. But one of the things that I first noticed after starting Rituxan infusions was that my fatigue levels were reduced.

This was a nice surprise and is contrary to an article in Current Rheumatology Reports. “Medications targeting RA have little effect on fatigue. Instead, the most effective interventions seem to address non-RA-specific factors such as physical inactivity or use cognitive-behavioral approaches.”2

However, I do believe I feel less fatigued when I stay physically active through cycling or simply stretch. Routinely talking to a therapist has helped me manage fatigue as well.

Discussing fatigue with my healthcare providers

Many years ago, I mentioned daytime sleepiness and fatigue to my rheumatologist and she ordered a sleep study. Results came back negative for obstructive sleep apnea so she suggested I discuss the fatigue with my neurologist.

My neurologist made suggestions to combat fatigue that included improved sleep hygiene, coffee (caffeine), physical activity, and wakefulness-enhancing medication.

When I mentioned fatigue to my primary care doctor, she asked about sleep and mental health. So I followed-up by talking about fatigue with my therapist who helped me look at fatigue from a different perspective.

Treatment for fatigue may not be unique

A recent literature review published in Rheumatology (Oxford) states that factors leading to fatigue are consistent with RA and other rheumatic diseases, as well as other long-term medical conditions such as multiple sclerosis or cancer.3 It could be that fatigue isn’t all that much different among a range of chronic conditions. Or at least, the treatment of fatigue might overlap between chronic conditions.

What do you do to combat fatigue?

Be well,

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