Rheumatoid arthritis (RA) and chronic fatigue are close companions, unfortunately. Experts estimate that 40 to 90% of people with RA deal with chronic fatigue—a condition that goes way beyond feeling a little tired.
Learn more: Rheumatoid Arthritis and Fatigue
Experts aren’t really sure why many (if not most) people with RA experience chronic fatigue. The relationship between the two is complicated.
Causes of RA fatigue
Research has indicated several factors about RA that seem to connect it to chronic fatigue:
RA flare-ups are the result of the immune system releasing too much of a substance called cytokines, which causes inflammation and tissue destruction in the joints. This joint pain and inflammation can trigger fatigue, say some experts. Others say that disease activity and chronic fatigue levels aren’t always related, so more research is needed to understand the relationship.
Read more: Rheumatoid Arthritis (RA) Symptoms
Up to 60% of people with RA have anemia, a condition caused by too few red blood cells. In addition to fatigue, anemia can also cause dizziness and an erratic heart rate. Sometimes anemia is caused by RA itself and sometimes by RA medications like non-steroidal anti-inflammatory medications (NSAIDs). Again, experts are split on whether RA chronic fatigue is caused by anemia, and more research is needed.
Medication side effects
Several medications used to treat RA can cause fatigue as a side effect, including:
- Methotrexate (Rheumatrex, Trexall, Otrexup)
- Hydroxychloroquine (Plaquenil)
- Oral NSAIDs
- Medications used to treat conditions such as high cholesterol, high blood pressure, and diabetes
For an overview of medications used to treat RA, read: Rheumatoid Arthritis (RA) Treatment.
In addition to these possible causes of fatigue that are directly connected to RA, there are also fatigue-causing conditions that commonly coexist with RA. Examples of these are depression, poor sleep, inactivity, and diseases like fibromyalgia or diabetes.
Let your doctor know about your fatigue symptoms
Combating fatigue—let alone determining what's causing it—is not an easy task for doctors or patients. But the more information you give your doctor about when you feel fatigue and how it affects your life, the better the chance that, together, you can take steps to alleviate it.