9 Reasons Why RA Makes You Tired

Eighty percent of RA patients experience significant fatigue. The reason: “RA causes the body to make inflammatory proteins, called Tumor Necrosis Factor, or TNF, and we’ve known for a very long time that they cause fatigue,”, says Jonathan M. Greer, M.D., a rheumatology and internal medicine specialist in Palm Beach County, FL, and assistant clinical professor of medicine at both Nova Southeastern University and the University of Miami. But that doesn’t mean all is lost. ARheumatologystudy found that patients receiving anti-TNF therapies experienced “clinically important” improvements in RA-related fatigue.

Sure, you can point to RA for your fatigue, but it could have an accomplice. Underlying conditions contribute to the problem. “For example, it’s common in RA patients to have anemia, or low red blood count,” Dr. Greer says. “Another cause of fatigue may be thyroid disease, or hypothyroidism. We always check for that as well. So it’s not just assuming that the rheumatoid arthritis is the cause.” He says even something as simple as low potassium or salt levels could be the culprit and should be tested.

Whether you’re in pain or worried about complications related to your diagnosis, know that insomnia is common in RA patients. “Virtually all of my patients suffer with chronic fatigue during bouts of active rheumatoid disease,” says Robert G. Hylland, M.D., assistant clinical professor of medicine at Michigan State University College of Osteopathic Medicine in North Shores, MI. He suggests examining your sleep habits (such as not taking your electronics into bed) and discussing the possibility of using sleep medication with your physician. “And if you’re prone to worry and guilt, ask to be referred to a cognitive behavioral therapist,” he advises.

Feeling pain in your wallet is exhausting, too. Don’t be shy about asking for help with medication costs. “Many pharmaceutical companies have programs to assist patients who use their medicines,” says Dr. Hylland. For instance, the treatment Xeljanz offersa co-paying cardthat helps offset the cost of the medication. Also, explore discount programs likeGood Rx. “And inform your doctor. He can sometimes tailor a less expensive program for you or direct you to social workers who can help find organizations that assist in costs of medicines,” Dr. Hylland says.

“Patients with rheumatoid arthritis have chronic pain, and they can be depressed,” Dr. Greer says. “That depression magnifies or causes fatigues itself.” TheInternational Journal of Clinical Rheumatologynotes that major depressive disorder is common with RA patients affecting 13% to 42% of this population. In comparison, that’s two- to four-times higher than the general population. “Mild depression can exhaust brain cells,” says Dr. Hylland. On the other hand, certain meds to treat depression can also make you tired, so “if you’re prescribed antidepressants, report to your primary care physician if it worsens fatigue,” he says.

Speaking of antidepressants possibly causing fatigue, medications also come with a dose of this debilitating side effect. “Certain drugs, for example, beta blockers that slow down the heart rate, can cause fatigue,” Dr. Greer says. What makes things worse is that even the medications prescribed to help with RA pain can also make patients tired, Dr. Cohen says. For instance, methotrexate—an anti-rheumatic, is prescribed to help control active RA, but this medication may also induce fatigue by negatively impacting the body’s metabolism.

For patients new to RA, there can be a lot of emotions tied to the initial diagnosis. First, there’s the overwhelming nature of this disease, which can have so many painful and scary physical effects. Then there’s the realization that this is a long-term condition, which Dr. Greer says can weigh heavily on the minds of patients. While a rheumatologist will be the principal provider for RA care, there are times when a specialist—perhaps a psychologist or psychiatrist—should be consulted to ensure well-rounded care.

For the average person, maintaining relationships and a social calendar can take a toll on energy, but RA patients have an extra layer of complexity to contend with. “There’s always an issue with interpersonal relationships with your spouse, with your children, being able to go out, social interactions, and working your job,” Dr. Greer says. “All of those areas, if they are impaired, can lead to fatigue.” All of this may culminate into the aforementioned depression, as well.

Finally, those with RA often spend more time at doctors’ appointments and often face painful treatments, which can be disruptive to their schedule and well-being. All of which can lead to increased fatigue. One tip Dr. Hylland recommends to his patients is to invite your spouse to your doctor appointments at least once. This gives them a glimpse into what you’re facing in these appointments. Asking for help is key to alleviating RA fatigue, and it’s easier to do that when your partner is an active participant in your care.