RA Fatigue is Complex, Poorly Understood, and not Treated
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Hardly a day goes by on the rheumatoid arthritis Facebook site that a person doesn’t mention their persistent battle with fatigue. It’s one of the most frustrating symptoms of RA and there’s no treatment that directly affects it.

Fatigue is a common problem seen in almost all autoimmune diseases.[1] Your body feels completely wiped out, energy levels are low, it’s hard to move, and your cognitive function is poor. It’s difficult to communicate RA fatigue to those who don’t have the disease. Fatigue symptoms can come and go in seemingly random cycles.[2] It’s silent and invisible to those around us. One of the best explanations of how it feels is to compare it to dealing with an infection like influenza. Depending on the study, it has been found that between 40-80% of RA patients experience fatigue and 40% experience severe fatigue.[3] Pain and fatigue are among the two most common symptom complaints with RA patients. But while pain has been the target of treatment measures and systems, fatigue has largely been ignored.[4]

Research on disease related fatigue has increased dramatically over the past few decades. While there are numerous surveys (over 250 identified by one group of researchers![5]) designed to measure disease related fatigue, there is no consensus and commonly accepted measures. One important finding in disease related fatigue research is that it has many complex dimensions including mental, physical, motivation, sensory, mood, social, intensity, duration, quality of life impact, and activity impact.[6] Researchers also believe that fatigue symptoms may be disease specific.[7]

There has been a prevailing view amongst the medical community that if RA is effectively treated, then fatigue will automatically be lessened. But this simplistic and linear thinking was recently challenged by a study on the impact of treatment with an anti TNF drug (e.g. Enbrel, Humira, Remicade). The researchers followed RA patients over a six-month period after they began anti TNF treatment. They found that in some patients, fatigue did improve after treatment. But the drug treatment only explained a small portion of the changes in fatigue and the researchers stated that alternative explanations are needed.[8] Unfortunately, fatigue is not usually viewed as a treatment target in spite of the fact that it is so debilitating.[9]

Fatigue is a real, incapacitating, and poorly understood aspect of rheumatoid arthritis. It’s important to learn how to deal with it. The Hospital for Special Surgery in New York proposed a detailed set of strategies.

  1. Acknowledge it and realize that you can’t predict or control it.
  2. Realize that those around you won’t understand it.
  3. Recognize that fatigue creates a feedback loop of symptoms-reactions-symptoms.
  4. Find balance and compromise when necessary.
  5. Adapt and give into fatigue when needed.
  6. Work with your doctor on medication adjustments.
  7. Try to rest and get sleep.
  8. Exercise as practical.
  9. Get help with depression.
  10. Adjust your work schedule.[10]
view references
  1. http://www.seattlecca.org/diseases/autoimmune-diseases-facts.cfm
  2. http://www.hss.edu/conditions_mastering-impact-fatigue-ra.asp#.U-T3QmRDuGc
  3. http://rheumatology.oxfordjournals.org/content/48/3/207.long
  4. http://www.ncbi.nlm.nih.gov/pubmed/8507213?dopt=Abstract
  5. http://www.hqlo.com/content/5/1/12
  6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1808447/
  7. http://www.ncbi.nlm.nih.gov/pubmed/15016573?dopt=Abstract&holding=f1000,f1000m,isrctn
  8. http://onlinelibrary.wiley.com/doi/10.1002/acr.22387/abstract
  9. http://www.ncbi.nlm.nih.gov/pubmed/16208668?dopt=Abstract
  10. http://www.hss.edu/conditions_mastering-impact-fatigue-ra.asp#.U-T3QmRDuGc 
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