Does Rheumatoid Arthritis Cause Fatigue?

Does Rheumatoid Arthritis Cause Fatigue?

RA Fatigue and How to Manage It

For so many with rheumatoid arthritis (RA), fatigue is as debilitating as the joint pain and swelling. It is estimated up to 90 percent of people with RA experience chronic fatigue, this according to the National Rheumatoid Arthritis Society of the United Kingdom.

What is RA Fatigue?

Fatigue is a general state of physical or mental exhaustion. When someone is fatigued, they are tired and drained, and accomplishing even the simplest tasks can seem nearly impossible.

Fatigue is a relatively common symptom of RA. According to a study out of the Radboud University Nijmegen Medical Centre, The Netherlands, RA fatigue may include:

  • Abnormal and extreme whole-body exhaustion
  • Physical tiredness or weakness, not related exertion
  • Ongoing fatigue lasting more than a month
  • Fatigue that is not resolvable by sleep or rest

Causes of RA Fatigue

RA fatigue is a symptom that doctors and researchers struggle to understand well. This is because the type of exhaustion experienced by people with RA is systemic (all-over) inflammation and people with RA have described it similarly to the fatigue of battling the flu.

There are also other potential causes of fatigue associated with RA, including depression and anemia, and these can also deplete energy. One 2015 study reported in the Pakistan Journal of Medical Science found up to three-fourths of people with RA are also depressed, and depression played a role in the severity of their symptoms, including fatigue.

Another cause of RA-related fatigue is the strong medications used to treat the disease, especially methotrexate, a disease modifying anti-rheumatic drug (DMARD). Doctors will prescribe folic acid with methotrexate to counter the effects of fatigue and other side effects.


RA fatigue may also result from not getting quality sleep due to pain and RA symptoms. Depression and stress may also keep you up at night.

How Does Fatigue Affect Quality of Life?

Fatigue can be one of the most debilitating symptoms of rheumatoid arthritis. Numerous studies have found RA fatigue is associated with poor sleep, increased pain, depressive symptoms, and high levels of disability.

One study from King’s College London, United Kingdom, finds fatigue is closely associated with pain, which was most severe in people with additional conditions, such as fibromyalgia, and RA related complications, such as those affecting the heart or lungs.

In addition to feeling tired all the time, fatigue affects the quality of life for people with RA by causing:

  • Coping Troubles. RA patients who experience high levels of fatigue have a harder time coping with pain, which ultimately makes pain worse.
  • Concentration Problems. High levels of fatigue can affect critical thinking and decision making. Fatigue makes it hard to grasp and understand ideas, find focus, and break down problems.
  • Feeling Helpless. Feeling physically and emotionally exhausted can make a person feel like they have little control over their lives. Fatigue also makes to harder to find the motivation to take control.
  • Irritability. Being physically and emotionally tired affects mood and can make a person feel grouchy and irritable.

10 Ways to Fight Back Against RA Fatigue

Even though RA can leave you drained, you can find ways to cope, manage fatigue, and improve your energy levels.

  1. Activity. You may wonder if being active can worsen fatigue, but exercise can help to boost your energy. Try to incorporate some moderate activity throughout your day to keep fatigue managed.
  2. Better Sleep. You should try to get seven to eight hours of sleep each night. Healthy sleep can also prevent pain and fatigue.
  3. Manage Pain. Pain zaps your energy so staying on top of pain can reduce fatigue. Talk to your doctor about the best ways to manage pain before it becomes bad.
  4. Control Inflammation. RA fatigue is linked to inflammation levels. Discuss fatigue with your doctor so he or she can find better ways to keep inflammation down.
  5. Talk to Doctor. If your current medication regime is causing you to experience fatigue, adjusting or reducing medication dosages may help. Your doctor can also prescribe medication to reduce fatigue and to help you to sleep better at night.
  6. Stay Hydrated. Dehydration can cause fatigue, so make sure you are drinking at least 64 ounces of fluids daily. You may need more of you are exercising, spending a lot of time outdoors, or depending on how hot and dry the weather is.
  1. Eat Well. Make sure you’re eating good, whole foods, including plenty of fruits and vegetables and enough lean protein, low-fat dairy and healthy fats.
  2. Rest. While you should remain active, you should also rest between activities, as rest will help your joints and muscles relax and recharge for what’s next. Spread out tasks throughout your day and save tasks that require more energy for times you have more energy
  3. Get Help. There will be times when you don’t have the energy to do it all. Therefore, it is important to ask for help from loved ones.
  4. Prioritize Mental and Emotional Health. When depression and stress are adding to your fatigue or keeping you up at night, enlisting the help of a therapist may help. Moreover, mindfulness-based stress reduction activities, such as yoga or tai-chi, can help calm your thoughts and give you more energy.

The Takeaway

There is no one-size-fits-all-solution to managing rheumatoid arthritis fatigue. You are unique in what causes your fatigue and what works to manage it.

It may take some time and creativity to find the best ways to manage your fatigue. Work with your doctor to find the right treatment plan to manage RA fatigue and boost energy levels, while emphasizing on making wise and helpful lifestyle changes.


National Institutes of Health (Fatigue in patients with rheumatoid arthritis: British and Dutch nurses’ knowledge, attitudes and management)

National Rheumatoid Arthritis Society (Invisible Disease: Rheumatoid Arthritis and Chronic Fatigue Survey)

Rheumatology (Fatigue in rheumatoid arthritis reflects pain, not disease activity)

National Institutes of Health (Depression in Rheumatoid Arthritis and its relation to disease activity)

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