Fatigue is a common symptom of RA and can be a difficult problem to manage. To improve fatigue, it is important to find out why you are fatigued. Your doctor can help by taking a good medical history, including asking about the duration and quality of your sleep, the amount of pain you are having, the amount of joint swelling and stiffness you are experiencing, and any signs of stomach ulcers or blood loss that might cause anemia. The physical exam should not only concentrate on your joints, but also include checks for other physical problems that could make you more fatigued, such as heart, lung, or thyroid disease.
You should review each of the common causes of fatigue and work with your physician to treat them.
The Inflammatory Process Itself
The amount of inflammation your body is experiencing will have an effect on your energy level. People with RA often state that their level of fatigue increases with the amount of joint pain and tenderness. Treatment of the inflammation reduces fatigue. Therefore, compliance with your medication is an important way to improve fatigue. You should inform your doctor about any disease flares. He or she may suggest a temporary increase in the dose of one medication or the temporary addition of another medication to relieve the increased inflammation.
Chronic Pain
Treating your pain is important, because chronic pain can cause a lack of sleep or nonrefreshing sleep, increased fatigue, and depression. Discuss your level of pain with your physician. Localized pain may be treated with hot packs, massages, or steroid injections into inflamed joints. More diffuse pain can be treated with nonsteroidal pain relievers or stronger medications, including morphine and its derivatives. If your pain is not under control despite the best efforts of your rheumatologist, he or she may suggest that you consult with a pain specialist.
In some cases, some painful joints may improve dramatically after surgery. For this reason, a consultation with an orthopedic surgeon is appropriate in some cases of chronic pain.
Poor Sleep Quality
Tell your doctor if you're not sleeping well, because poor sleep quality is one measure of the effectiveness of your RA treatment regimen. Discuss with your physician what kind of problem is keeping you from getting a full night's sleep. Is it pain? Is it anxiety? Is it an inability to get out of bed to go to the bathroom? Each of these issues can be treated and can improve the quality of your sleep.
Depression
Signs of depression include lack of motivation, tearfulness, and inability to enjoy the things that once brought you pleasure. Your physician can often diagnose depression quickly in his or her office by asking a set of standardized questions. Treatment of depression may include psychological counseling, medication, or both. A psychologist, for example, may be able to help you identify coping mechanisms that will allow you to deal with your disease more effectively. In addition, many new antidepressant medications that are highly effective and have few side effects are available.
Anemia
Anemia can be diagnosed with a simple blood test. If anemia (that is, a low red blood cell count) is found, your physician will have to identify its cause. This investigation may involve a test of your stool for signs of blood loss indicating internal bleeding from the stomach or intestines. You should report abdominal pain and any changes in the color of your stool, as they may be signs of stomach ulcers. The medications used to treat the inflammation of your RA can improve or eliminate the anemia of chronic disease.
Lack of Exercise
Medical research has consistently demonstrated the benefits of exercise for people with RA. Exercise improves the functioning of the heart, lungs, muscles, and joints. It also reduces your risk for coronary artery disease, osteoporosis, and overweight and obesity. Patients who participate in regular exercise programs typically report that they begin to sleep better and that their pain and fatigue levels decrease.
If you find it difficult to start an exercise regimen, consult with a physical therapist or rehabilitation specialist. He or she can design an exercise program that's tailored to your age and condition.
All people with RA will suffer from fatigue from time to time. If your fatigue is debilitating or prolonged, discuss it with your doctor and get it treated.
All people with RA will suffer from fatigue from time to time. If your fatigue is debilitating or prolonged, discuss it with your doctor and get it treated.