Fighting Back Against Rheumatoid Arthritis Fatigue
The word “arthritis" literally means pain and inflammation in the joints, so it shouldn’t be much of a surprise that people are living with rheumatoid arthritis (RA) experience symptoms like joint pain and swelling. However, it turns out that RA is a lot more complicated than just a little joint pain.
RA is an autoimmune disease where a person’s immune system mistakenly attacks healthy joints in the body. It’s also a systemic disease, meaning that it can also affect other tissues and organs in addition to the joints. And, as anyone personally living with RA can likely tell you, in addition to joint pain one of the most frustrating symptoms associated with the disease is debilitating chronic fatigue.
Fatigue is very different from normal tiredness and can have an enormous impact on individuals living with RA. Personally, I think fatigue can be overwhelming from both a physical and cognitive perspective.
When I am particularly fatigued, I feel physically drained and exhausted, and I tend to struggle significantly just to get through an ordinary day. Additionally, sometimes I’m so worn out that I can’t seem to concentrate or focus, making it a real cognitive challenge to complete everyday tasks. Chronic fatigue can feel a bit like you are constantly fighting the flu.
While chronic fatigue can be just as debilitating as joint pain, unfortunately, there is no quick fix. In fact, sometimes fatigue is a separate problem.
According to a study presented at the 2017 American College of Rheumatology Annual Meeting, a considerable proportion of patients who are otherwise considered to be in clinical remission still report that they experience fatigue. So if you are facing RA fatigue, here are seven strategies to consider that might help you cope on a daily basis.
1. Discuss Fatigue With Your Doctor
If your fatigue is feeling out of hand, a great place to start is by discussing the problem with your doctor.
Tell your doctor how often you feel fatigued, how long it lasts, how it affects your daily life or your ability to concentrate, the quality of your sleep, and whether your fatigue is accompanied by feelings of depression or anxiety. If your doctor has an accurate idea of exactly what you are experiencing, he or she will be far better equipped to treat any underlying medical conditions and offer specific suggestions to improve your situation.
While fatigue and RA pain may sometimes be separate, chronic pain can undoubtedly contribute to fatigue. So it also makes sense to work with your doctor to make sure your RA inflammation is as under control as possible. Uncontrolled inflammation can have a direct impact on the brain receptors that cause fatigue, so medications that decrease inflammation may also help reduce fatigue.
2. Get Some Exercise
This strategy may seem a bit counterintuitive when you are struggling just to get through an ordinary day, but getting some exercise can help with fatigue in many ways.
For starters, exercise strengthens your muscles and increases your circulation and flexibility, all of which can reduce pain and boost your energy levels. Physical activity also generates endorphins, which are brain chemicals that produce a sense of well-being. And if poor sleep is contributing to your fatigue, getting a little exercise during the day may help improve your sleep at night.
But don’t worry – you don’t have to run a marathon or spend hours upon hours at the gym to reap the benefits of exercise when it comes to improving fatigue. Even taking a short walk, a yoga class, or just doing some slow stretching can help.
If you are having a lot of trouble finding a type of exercise that your body is comfortable with, it may help to start by working with a physical therapist.
3. Pace Yourself and Prioritize Tasks
While light exercise tends to be beneficial when it comes to fatigue, it’s also important not to over-exert yourself. Likewise, you also need to figure out how to pace yourself and prioritize tasks in your everyday life. When your energy is so limited, you need a plan to help you allocate it as wisely as possible.
Start by figuring out which activities are the most important each day, and allocate your energy to those first. This may mean letting less important tasks wait for another time, delegating some tasks to loved ones if they are willing, or hiring some help. Being selective about which tasks you personally complete will help you conserve energy for what matters most to you.
When it comes to completing the tasks you have allocated for yourself, it may help to alternate short periods of activity with short periods of rest. While it may be a bit frustrating to try to accomplish daily tasks in 15 or 20-minute bursts, it’s a lot better than working for an hour or two straight and completely draining yourself.
If you end up accidentally expending your limited energy too quickly, it may help to keep a diary to track your activity level and resulting symptoms for a couple of weeks. Having a written record may help you identify patterns you otherwise wouldn’t have noticed. And, if you’re still struggling, consider visiting an occupational therapist to help you develop a pacing strategy to fit your own unique needs.
4. Eat Healthy and Hydrate
Unfortunately, there’s no scientific evidence that any particular diet will lessen your RA symptoms. There is, however, a lot of anecdotal evidence that how you eat can directly influence how you feel. For this reason, a change of diet may be worth a try.
In general, eating a nutritious diet can help boost your energy reserves. A healthy, well-balanced diet should include a lot of nutrient-dense foods such as fruits and vegetables, whole grains, low-fat dairy, and lean proteins such as fish, nuts, or beans. Eating a healthy breakfast is also particularly important to make sure you have enough energy to last throughout the day.
In addition to a nutritious diet, it’s also important to make sure you stay hydrated. Dehydration can be very taxing to the body, contributing to fatigue. Most people need at least eight 8-ounce glasses of water each day, though this amount varies depending on your activity level and how hot and dry the weather currently is in your location.
5. Work on Your Sleep Hygiene
This is another strategy that can sometimes be easier said than done, but if you’re struggling with fatigue, it’s worthwhile to evaluate your sleep hygiene and see if there is anything you can do to change or improve your habits.
A good place to start is by considering your sleep routine. It can be helpful to try to go to bed at the same time every night and wake up at the same time every morning. This may help your internal clock realize more naturally when it’s time to go to sleep.
A sleep routine can also include a warm bath or shower or other relaxation techniques such as deep breathing, progressive muscle relaxation, or meditation. While a warm drink might also be part of a sleep routine, it’s a good idea to avoid caffeine close to bedtime.
It’s also important to make sure your bedroom is as conducive to good sleep as possible. It may help to regulate the temperature, keep noise to a minimum, and make sure the room is suitably dark.
Most experts advise using your bed as a place only for sleep and intimate activities. Doing other things in bed, like watching TV, playing on your phone, or working on a computer, can teach your body not to be ready to go to sleep when you get into bed.
However, if you find you are still struggling to get sufficient or quality sleep, talk with your doctor. You may need to have your RA or pain medications adjusted. It may make sense to consider your emotional state and whether medication or therapy to help with depression or anxiety would help improve your sleep. Your doctor may even recommend medications specifically to help with sleep.
6. Ask About Accommodations at Work
Chronic fatigue can be particularly problematic if it is interfering with your ability to do your job. In this situation, you may want to consider discussing the issue with your boss to see if adjustments can be made to your work environment or daily schedule that would help you cope.
In the United States, the Americans with Disabilities Act (ADA) is a federal law that protects individuals with disabilities against discrimination, including in the workplace. If you work at a company with 15 or more employees (or if you work at a state or local government, regardless of the number of employees), RA is considered a legal disability for which your employer is legally obligated to provide “reasonable accommodations" under the ADA.
Reasonable accommodations mean that your boss needs to provide you with the tools and environment necessary to help you perform your job. This ranges from making the facility more easily accessible, acquiring or modifying existing equipment to better suit your needs, or potentially changing your hours or allowing for more frequent breaks throughout the day.
The ADA places the initial burden on the worker to initiate the conversation and suggest plausible accommodations that will suit your needs.
To figure out what might be most useful for you, consider contacting the Job Accommodation Network (JAN), which is a free service provided by the U.S. Department of Labor that can help you brainstorm which type of accommodation might best suit your needs. If you encounter resistance or discrimination from your employer when requesting accommodations, you can also contact JAN or the Equal Employment Opportunity Commission (EEOC) for support.
7. Try to Stay Positive
Dealing with chronic fatigue can undoubtedly make daily life more challenging, which can quickly take a toll on your emotional state. Also, living with the RA generally may even make you more prone to stress, anxiety, or depression. Mood changes can also contribute to poor sleep quality. Overall, your emotional state can create a feedback loop that can play a major role in your levels of fatigue.
If you’re having difficulty looking on the bright side, it may help to consider speaking to a therapist to learn strategies for improving your emotional health. Cognitive behavioral therapy, for example, can help you identify unhealthy thought patterns and reframe them to work towards more productive patterns of thinking. If necessary, a psychiatrist can also prescribe antidepressants that might be beneficial.
It may also help to join a support group, whether in person or online, to connect with other people who are facing similar issues. Support from peers who are also facing the challenges of life with RA can help you feel less isolated. Being connected to other individuals with chronic illness can also be a fantastic resource for brainstorming and troubleshooting any specific issues you may be facing.
Lastly, while it may sound a bit cliché, sunshine and fresh air may also help you feel a bit more positive and less fatigued! Sunlight sends waking signals to the brain and body and getting some fresh air during the day may help you sleep better at night.