Causes of Fatigue in Arthritis

Everyone gets worn out from time to time. But exhaustion that disrupts your daily life and doesn’t get better after a good night’s sleep has its own medical term: fatigue. Fatigue significantly affects the quality of life for people with many forms of arthritis-related diseases, including rheumatoid arthritis , psoriatic arthritis , spondyloarthritis , lupus , fibromyalgia and osteoarthritis . Your lack of energy may be caused by your inflammatory disease and other health conditions you have, as well as medications side effects and lifestyle habits.

Disease Activity and Sleep

Fatigue and sleep problems go hand-in-hand for many people with arthritis. The main culprits are the inflammatory disease process and the accompanying chronic pain.

• Inflammation. If you have an autoimmune disease, your immune system attacks your body and inflammation is the result. The body undergoes stress as it tries to cope with the release of inflammatory cytokines (proteins) in the blood. That can cause fatigue, especially when disease activity is high or low-grade inflammation remains for a long time.
• Chronic Pain. The pain-fatigue connection can be a vicious circle. Dealing with arthritis pain for months at a time over many years can wear you down. It can affect your sleep habits, which adds to your exhaustion. Being fatigued, in turn, can worsen pain and make it more difficult to manage.

Other Sources of Fatigue

Your fatigue is not always directly related to your arthritis disease activity, inflammation or pain. In fact, according to a 2017 study published in Current Rheumatology Reports, your fatigue level probably has more to do with other contributing factors, including obesity, physical inactivity, sleep disturbance and depression. Several of them may work together to cause your extreme tiredness, but identifying and treating even one of these factors can provide relief.

• Medication side effects. Several medications , including some you may take for arthritis, can cause drowsiness or fatigue. Common culprits include certain antidepressants; blood pressure medication; narcotic pain relievers; some prescription nonsteroidal anti-inflammatories (NSAIDs); and certain disease-modifying antirheumatic drugs (DMARDs), such as azathioprine and methotrexate. Corticosteroids may cause daytime tiredness by keeping you awake at night.
• Inactivity. The more you lie around, the more exhausted you feel. Unused muscles — including the heart muscle — can weaken, and you get tired more easily. A 2017 study published in Scandinavian Journal of Medicine & Science in Sports found that people with fibromyalgia who spent less time sitting and more time doing light physical activity had lower levels of fatigue and pain than those who were inactive.
• Anemia. Fatigue in arthritis may be caused by anemia — a shortage of red blood cells. Without enough red blood cells, your muscles get tired fast, resulting in fatigue. Up to two-thirds of people with arthritis have a condition called anemia of chronic disease, which occurs when inflammatory chemicals interfere with the body’s production of red blood cells.
• Lack of Sleep. Fatigue may be triggered by insomnia and unrefreshing sleep . Getting into a comfortable position or staying asleep can be a challenge when joints are swollen and sore. Tossing and turning in bed or waking up repeatedly is a reality for some people with arthritis pain. Sleep apnea, a condition in which breathing is interrupted during sleep, can also contribute to poor sleep.
• Obesity. Being very overweight can cause sleep apnea or other sleep problems, resulting in daytime fatigue. But studies show that obese people with no sleep disturbance are also fatigued. Lack of exercise, using extra energy to move more bodyweight and metabolic changes that often accompany obesity also contribute to fatigue.
• Poor nutrition. Not getting adequate and healthy food and fluids can be causes of fatigue that fly under the radar. Your body needs plenty of water, vitamins and minerals to operate efficiently. If you love junk food and don’t drink enough water or other healthy beverages, your fatigue could be from dehydration and vitamin deficiency.
• Depression. Arthritis pain can take you away from doing the things you enjoy, so it’s no surprise depression often goes hand-in-hand with the disease. Research shows depression may also result from changes in your hormones and brain caused by dealing with the stress of a chronic illness.
• Loss of muscle mass. When you lose muscle tissue, the remaining muscles have to bear the burden of moving your body. Loss of muscle can come from inactivity. But some people with severe inflammatory arthritis have a condition called cachexia, in which muscle mass decreases and fatigue increases.
• Other medical conditions. Having arthritis increases your risk of other health problems, such as heart disease, lung disease, diabetes and inflammatory bowel disease — all of which can be associated with fatigue. Other conditions not specifically related to arthritis may also lead to fatigue. These include infection, liver or kidney disease, thyroid disease and chronic fatigue syndrome.

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