You may think of arthritis as a problem that only causes joint pain. But many people with arthritis also struggle with fatigue –an overwhelming sense of tiredness, loss of energy and exhaustion. “In many cases, the greater the inflammation, the greater the fatigue,” says Dr. Julius Birnbaum, a rheumatologist at Johns Hopkins University Hospital.
Types of Arthritis
Fatigue occurs in both noninflammatory arthritis and inflammatory arthritis.
Noninflammatory arthritis refers to osteoarthritis, which is caused by a wearing away of the cartilage that cushions the bones. The damage is limited to the joint.
Inflammatory arthritis refers to joint inflammation that results when the immune system mistakenly attacks certain parts of the body. The damage and side effects can go well beyond the joints.
There are dozens of types of inflammatory arthritis, including:
— Rheumatoid arthritis: an attack on the lining of the joints, lung and heart.
— Psoriatic arthritis: an attack on the joints and skin.
— Lupus: an attack on the joints, organs and skin.
— Ankylosing spondylitis: an attack on the sacrum (near the base of the spine), ligaments and other joints.
[Read: How to Prevent the Onset of Rheumatoid Arthritis.]
The Fatigue Link
The type of arthritis you have contributes to fatigue in different ways.
Noninflammatory arthritis can lead to fatigue because of joint pain for several reasons:
— Keeps you from sleeping comfortably, leading to sleep deprivation and exhaustion.
— Makes exercising too uncomfortable. “If you don’t exercise, you’ll get fatigued because you’re deconditioned,” says Dr. Howard R. Smith, a rheumatologist at Cleveland Clinic.
— Keeps you from doing activities with friends and family, leading to isolation, loneliness or depression. Fatigue is a side effect of depression.
People with inflammatory arthritis can also become fatigued from joint pain that leads to a lack of sleep, exercise or social contact.
However, inflammatory arthritis sufferers are also at high risk for extreme fatigue caused by a chemical reaction in the body. “The inflammation releases chemicals in the blood called cytokines that can cause fatigue,” Smith says. “I see it in about 50 percent of my patients.”
“We aren’t exactly sure why cytokines make us feel tired,” Birnbaum says, “But we know these proteins are overexpressed in blood and cerebrospinal fluid and can cause overwhelming fatigue.”
Other Conditions
People with inflammatory arthritis frequently have other conditions that lead to fatigue.
For example, people with rheumatoid arthritis or lupus may develop anemia, a lack of red blood cells that deliver oxygen throughout the body. “The arthritis affects the blood-producing tissues in the bones where red blood cells are made. If you don’t have enough red blood cells, you don’t have enough oxygen, and you’ll feel tired,” Smith explains.
Inflammatory diseases are also associated with an increased risk for depression, which is associated with fatigue.
[Read: You’ve Just Been Diagnosed With Rheumatoid Arthritis. What Do You Need to Know?]
Medication Side Effects
Sometimes the culprit for a lack of energy with arthritis is your medication regimen.
Many kinds of prescription drugs can lead to fatigue, including:
— Medications for depression, such as selective serotonin reuptake inhibitors.
— Pain medications such as opioids.
— Muscle relaxants.
— Diuretics for blood pressure control.
— Sleep medications.
Some over-the-counter drugs can also cause drowsiness or fatigue, such as remedies for allergies (antihistamines), motion sickness (antiemetics) or diarrhea (antidiarrheals).
What You Can Do
You don’t have to suffer with fatigue. Your doctor can help you uncover the cause of the problem. “The first step is to distinguish whether a given syndrome is inflammatory versus noninflammatory,” Birnbaum notes.
Both Birnbaum and Smith recommend treating underlying causes that may be causing fatigue first. “In many cases, if we can get RA or lupus under control, the fatigue may go away. If you’re anemic, maybe blood transfusions or B12 or folate will get your blood count back up,” Smith says.
If fatigue persists, the next step is figuring out if lifestyle issues are driving energy loss. In those cases, the solution is likely a do-it-yourself fix, such as:
— Exercise. “It helps you mentally and physically, and it gives you more energy,” Smith says. The recommended amount of exercise is 150 minutes per week of moderate intensity activity, such as brisk walking. That may be tough if you’re deconditioned. “So 150 minutes is a long-term goal,” Birnbaum says. “Start with 15-minute walks and slowly build up, or try tai chi. Even lighter exercise will help.”
— Socializing, to aid depression treatment. “Take the initiative to improve your social interaction with your family and peers,” Birnbaum suggests.
— Cognitive behavioral therapy. “If you’re fatigued, you need coping mechanisms,” Smith points out. “Learn to deal with the emotional problems associated with your fatigue and your disease.” Cognitive behavioral therapy, or CBT, is a type of talk therapy that redirects negative thoughts to positive ones.
— Better sleep. Exercise can help improve sleep and so can staying away from electronic gadgets before sleeping (the blue light from screens stimulates the brain), avoiding alcohol before bedtime and sleeping in an environment that invites sleep (a cool, dark room). “Aim for eight hours of sleep per night,” Birnbaum suggests.
— Energy conservation. If you know you’re typically tired in the afternoon, schedule activities for the morning. Or try to cut down on trips across your house and sit on a chair when doing activities such as cooking or folding laundry.
[Read: How Yoga and Other Exercises Can Relieve Symptoms of Rheumatoid Arthritis.]
What About Caffeine?
It may be tempting to give yourself an energy boost with caffeine, and in some cases it may help. But Smith cautions that you stay away from caffeine supplements or super-charged energy drinks, which can be dangerous. They’re associated with insomnia, nervousness, diabetes and cardiovascular problems, among many adverse health effects.
A better option for caffeine consumption is coffee. A large study published in November 2017 suggested that drinking three or four cups of coffee per day was safe and associated with many health benefits, such as longevity and a lower risk of cardiovascular disease, some cancers, diabetes and liver disease.
But the study also found that drinking coffee is associated with pregnancy complications and osteoporosis in women. “There is a risk with coffee, so you have to talk to your doctor to weigh the risks and benefits. Lupus patients are more prone to osteoporosis, and so are people taking corticosteroids,” Smith says.
A Final Word
Having arthritis fatigue can feel overwhelming. But take heart. Birnbaum says that even if you’ve had fatigue for a long time, taking steps to control it can make a big difference. “I’ve seen patients commit to exercise and other approaches,” he says. “They have significant improvements. Educate yourself, and you’ll find a sense of relief and empowerment.”
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Ways to Boost Your Energy When You Have Arthritis originally appeared on usnews.com
