Recognizing Rheumatoid Arthritis (RA) Fatigue

While chronic fatigue is debilitating, it often takes a back seat to other concerns for people diagnosed with rheumatoid arthritis (RA).

See Rheumatoid Arthritis (RA) Diagnosis

Some of the more common reasons fatigue is often underestimated and left untreated include:

• Patients tend to rate fatigue as less important than other symptoms, such as pain and the inability to do day-to-day tasks. ¹ Wolfe F, Mechaud K. Fatigue, rheumatoid arthritis and anti-tumor necrosis factor therapy: an invetication in 24,831 patients. J Rheumatol 2004;31:2115-2120, as cited in Rosalind Ramsey-Goldman, Nan Rothrock, Fatigue in Systemic Lupus Erythematosus and Rheumatoid Arthritis, PM&R, Volume 2, Issue 5, May 2010, Pages 384-392, ISSN 1934-1482, http://dx.doi.org/10.1016/j.pmrj.2010.03.026.
• Other medical issues may be prioritized over fatigue. Controlling pain and limiting joint damage tend to be top priorities for both physicians and patients.
• Fatigue is not always discussed during office appointments. Patients may not report fatigue because they have difficulty describing it—symptoms can be elusive—or they may believe that they just have to accept it. Doctors may not ask about fatigue and assume that patients will bring up the subject if it is a problem. ² Repping-Wuts H, van Riel P, van Achterberg T. Fatigue in patients with rheumatoid arthritis: what is known and what is needed (editorial). Rheumatology 2009;48:207-209. doi:10.1093/rheumatology/ken399

  See Chronic Fatigue Syndrome and Myofascial Pain Syndrome vs. Fibromyalgia

• Fatigue can occur independent of RA symptoms. Fatigue is a symptom of many physical and mental conditions. A person with RA can have fatigue even when RA is in remission and joint pain and inflammation has subsided. ³ Inanc N, Yilmaz-Oner S, Can M, et al. The Role of Depression, Anxiety, Fatigue, and Fibromyalgia on the Evaluation of the Remission Status in Patients with Rheumatoid Arthritis. J Rheumatol. (2014) Aug 1. pii: jrheum.131171. [Epub ahead of print]. - See more at: http://www.rheumatologynetwork.com/fatigue-invisible-disease-ra#sthash.lnDRfzIf.dpuf Because fatigue can occur when the disease is clinically under control, physicians may underestimate the effect fatigue is having on their patients. Fatigue can also occur as a symptom of other physical or mental conditions that are separate from RA.

  See Rheumatoid Arthritis (RA) Symptoms

• Fatigue is difficult to measure. Similar to pain, fatigue cannot be detected with a lab test, so patients must report how they feel. Researchers do not yet agree on the best instrument—a specific patient survey, questionnaire, or checklist—to measure fatigue. In fact, a review of 61 academic papers found that clinicians used more than 20 different instruments to measure fatigue in their research. ⁴ Hewlett S, Hehir M, Kirwan JR. Measuring fatigue in rheumatoid arthritis: A systematic review of scales in use. Arthritis Care Res 2007;57:429-439. Moreover, the accuracy of these diagnostic instruments and what constitutes a significant change in fatigue levels is not clear.

Because of the above reasons, researching, recognizing and treating fatigue is difficult. ⁵ Rosalind Ramsey-Goldman, Nan Rothrock, Fatigue in Systemic Lupus Erythematosus and Rheumatoid Arthritis, PM&R, Volume 2, Issue 5, May 2010, Pages 384-392, ISSN 1934-1482, http://dx.doi.org/10.1016/j.pmrj.2010.03.026.

However, patients who experience chronic fatigue are advised to report it to their health care provider as it should be addressed as part of their overall treatment plan.

See Rheumatoid Arthritis (RA) Treatment

How to Report Fatigue to Your Doctor

Patients should tell their providers exactly how chronic fatigue is disrupting their routine. Patients should be as specific as possible. For example:

“I have trouble getting going in the morning”

“I used to cook my dinners but I don’t anymore.”

In addition to fatigue, patients should also identify excessive sleeping or sleeplessness. They should report if they have been told that they snore at night (for a possible sleep apnea diagnosis).

Keeping a diary, filling out a questionnaire (for example, rating fatigue on a scale of 1 to 10), or using a phone app to record symptoms can help patients track fatigue levels and their changes over time. Patients can record fatigue at various times in the day to identify trends.

For example, a patient who has a high level of fatigue in the morning might have sleep issues. The more accurate patients can be in describing their fatigue, the easier it will be for doctors to assess and address it.

See Rheumatologist's Role in Patient Care

A doctor or health care provider may order lab tests to check for anemia, nutritional deficiencies, and liver function. He or she may also evaluate the patient for depression or sleep apnea, both of which can cause chronic fatigue.