Tuesday, July 9, 2013

Doctor...Why Does Arthritis Cause Fatigue?

Fatigue is extremely common in patients who have arthritis. While it is a common complaint in patients who have "bread and butter" types of arthritis like osteoarthritis, it is even more common in patients who have inflammatory disorders such as rheumatoid arthritis and systemic lupus erythematosus. Fatigue is often a sign of a flare of disease.

Another condition often accompanied by fatigue is fibromyalgia.

There are many factors that may be responsible for fatigue.

Sometimes it is the body's method for dealing with a chronic painful condition. The body craves rest because it uses so much energy to combat the pain.

Another common reason is that arthritis often interrupts sleep. Not only is it more difficult to get to sleep but patients will wake up during the night, they will have difficulty falling back to sleep, and they will awaken early in the morning. This early morning awakening may also signal the presence of depression which is also a common problem in patients who have arthritis. Depression is also a cause of fatigue in patients with arthritis.

A corollary to this is stress. Stress not only aggravates the pain of arthritis; it can also aggravate fatigue.

Patients with more serious types of disease may have anemia which compounds the fatigue problem.

Medications can also contribute to fatigue. For instance some patients who are on methotrexate often report a "washed-out" feeling that occurs for one to two days after taking their methotrexate dose.

Fatigue has a major impact on the life of a person with arthritis. It causes daytime sleepiness, difficulty concentrating, and limits interpersonal relationships. Participating in all types of activities becomes more difficult. Also, some people fall into a nasty cycle of feeling tired, taking a nap during the day, which prevents them from getting to sleep that night.

So what can be done?

The most important thing is to get the arthritis under good control. That often improves fatigue by itself. Effective medications often make a big difference!

Correcting anemia is another action step. Sometimes the anemia will correct itself when the disease is controlled. Other times iron deficiency or other problems need to be addressed.

Improving the quality of sleep can help. Changing to a mattress made of memory foam is reported by some patients to be useful.

Getting into a regular sleep cycle is a good idea. Avoid large meals and caffeinated beverages before going to sleep. Sounds like common sense but too many people don't follow common sense rules1

Medicines that adversely affect sleep like prednisone and hydroxychloroquine (Plaquenil) should be taken in the morning rather than in the evening.

A nice hot bath or shower before going to bed sometimes is helpful. Using warm moist heating pads is also a nice thing to try. Getting into a regular relaxing routine that consists of reading, listening to soft music, etc. can also ensure good quality sleep.

Regular exercise is another contributor to good quality sleep. Lack of exercise often causes fatigue. Regular exercise provides more energy, increases stamina, and improves sleep.

Stress reduction is an obvious benefit.

Eating a well-balanced diet can also contribute to less fatigue.

Patients should try to avoid prescription sleeping pills if possible. Herbal remedies may be useful though.

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