Fatigue and Arthritis
An Information Sheet
What is fatigue?
Everyone knows what fatigue is, but how can it be described? Fatigue is a feeling of both physical and mental weariness. Most people feel tired after a long day at work but recover after a night's rest. People with conditions such as rheumatoid arthritis, fibromyalgia and many other rheumatic diseases can experience fatigue day after day, no matter what they have been doing or how much sleep they get. Fatigue is common and, like pain, is invisible. Fatigue is associated with exhaustion and lack of energy. It drains people, disrupts their life and makes everyday tasks seem impossible. Fatigue can seriously impair quality of life.
What causes fatigue?
There are a number of factors which can contribute to fatigue:
- The disease process – for example inflammation of joints and other tissues in rheumatoid arthritis – can cause fatigue. In rheumatoid arthritis fatigue and disease activity often change together. Cytokines (chemicals found in inflamed tissues) are the likely culprits. Similar chemicals are released in viral illnesses such as colds and flu and cause the extreme fatigue often seen in these conditions.
- Pain, especially constant pain, wears you down and contributes to tiredness. Pain can also wake you up at night, causing poor quality, disturbed sleep.
- Certain drugs used in arthritis may also make fatigue worse. Painkillers may cause drowsiness and interfere with concentration. Anti-inflammatory drugs may also interfere with concentration and cause a feeling of light-headedness.
- Weakness and wasting of the muscles, often seen in arthritis as a result of inactivity, along with pain and inflammation, will also contribute to fatigue since more effort will be required to perform certain activities. What seemed easy before the onset of arthritis will now seem difficult.
- Anaemia – often found with inflammation – may also contribute to tiredness and fatigue.
- Sleep disturbance due to pain and anxiety will contribute, as will other stressful events.
- Any chronic illness will cause distress and uncertainty about the future. This can, and frequently does, lead to depression. Depression is associated not only with a low mood but also with various physical symptoms, one of which is fatigue.
In summary, there are many possible causes of fatigue. It may be due to activity of the disease itself, to pain, to certain drugs, to anaemia, or to lack of sleep, and it may be associated with depression. As you would therefore expect, there are also many different approaches to treating fatigue, and more than one may have to be tried before success can be achieved.
How is fatigue measured?
There is no direct way of measuring fatigue. There are a number of questionnaires which give people the chance to express the severity of their symptoms in a variety of ways. One of these questionnaires estimates fatigue in terms of severity, timing, distress, and interference with daily activities. Questionnaires are useful for assessing the extent of fatigue in a particular person, and provide a tool with which to measure the effect of his/her treatment.
What treatments are available?
There are both medical and non-medical treatments for fatigue. You may be prescribed drugs by your doctor but there are other, non-drug, treatments for fatigue which provide a way for you to help yourself. Advice on these can be obtained from members of your hospital rheumatology multidisciplinary team. The team itself may vary from hospital to hospital but generally will consist of a doctor, a rheumatology nurse specialist, a physiotherapist and an occupational therapist.
- Drugs As you would expect, drugs which can control inflammation in diseases such as rheumatoid arthritis will result in improvement of pain, stiffness and fatigue and in an increase in general well-being. (See arc leaflet 'Drugs and Arthritis'.)
- Diet Many people consult their local health food shop but there are no products which have been proved to help treat fatigue in arthritis. Eating a well-balanced diet will help to provide all the vitamins you need and will also help in controlling your weight. (See arc booklet 'Diet and Arthritis'.)
- Pacing yourself Getting enough rest and pacing activities may help you regain some control over your disease. Try to prioritise jobs so that you don't spend time doing unnecessary tasks. Do the hardest jobs when you are feeling at your best. Simplify tasks and use appliances to make them easier. (See arc booklet 'Looking After Your Joints When You Have Arthritis'.)
- Exercise Yes, even exercise can help fatigue! People with arthritis often become unfit because of the impact of the disease, but some of the fitness can be restored with the right sort of exercise. The exercise must be done slowly at first, gradually increasing the amount and the time spent on it. Gradually you will feel an increase in well-being and strength and energy. If you are unsure about this speak to your physiotherapist. (See arc leaflets 'Keep Moving', 'Physiotherapy and Arthritis'.)
- Relaxation It is important to realise that taking enough rest periods is just as important as taking exercise. How much rest and how often will vary from person to person, but resting for 10 minutes every hour is often recommended. Relaxation can also mean having fun – reading a book, watching a favourite TV programme or having a warm bath. You may also benefit from learning relaxation techniques.
- Sleep Try to get a good night's sleep. Get into a routine. Avoid caffeine in the evening. Try to relax just before going to bed – by having a hot bath, for example. If you are on painkillers, taking the painkiller in the evening may also help you sleep better. If particular joints are troublesome, splinting (usually carried out by an occupational therapist) or an injection of steroid may prevent pain from disturbing sleep. (See arc leaflets 'Occupational Therapy and Arthritis', 'Local Steroid Injections'.) Make sure that your mattress and pillow are comfortable.
Finally, people who are anxious and depressed, even if it is a reaction to their disease, may feel better and more energetic on antidepressant medication. If possible, share any worries you have with someone else. It often helps to acknowledge negative feelings and thoughts.
Self-help groups
Many people find that joining a self-help group helps them to feel better and less fatigued. There may well be locally run self-help groups for your particular condition, so ask your doctor or rheumatology nurse specialist about these. In addition, some larger organisations run self-management courses for people with long-term conditions such as arthritis:
- Arthritis Care : 'Challenging Arthritis' programme
18 Stephenson Way
London NW1 2HD
Phone: 020 7380 6500
Helpline (freephone): 0808 800 4050
www.arthritiscare.org.uk - National Health Service (NHS) : 'Expert Patients Programme'
For details of courses in your area, visit: www.expertpatients.nhs.uk
