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For some, being tired is an understatement. The fatigue felt by people with rheumatoid arthritis (RA) can be overwhelming.

If you have RA fatigue, you may feel you have low energy throughout the day or at certain times in the day. You feel tired regardless of whether you slept well or not.

You may find simple chores — like responding to emails or getting groceries — taxing. It can even feel tough at times to get out of a chair or bed.

The causes of RA fatigue are complex, and that means that there is no one simple solution. But various lifestyle and treatment changes can work together to reduce your fatigue — and the impact it has on your life.

What Causes RA Fatigue?

Rheumatoid arthritis is an autoimmune disease. It’s usually diagnosed between the ages of 30 and 50. Women are more likely to get RA, as 75% of those affected by the condition are women.

Fatigue and rheumatoid arthritis often go hand in hand. According to a recent survey of people with rheumatoid arthritis, 90% said fatigue was one of their RA symptoms.

There are many causes of fatigue in RA, including:

• Uncontrolled inflammation. In RA, the immune system mistakenly attacks healthy cells in the body. This causes immune-fighting proteins to build up in the blood, leading to painful swelling in the joints. Your overactive immune system can impact how your cells use energy from food, causing you to feel drained.
• Pain. Pain can make it difficult for someone with RA to fall asleep or cause them to wake in the night.
• Depression. For some people, their RA symptoms can cause them to cut back on once-loved activities or avoid social events.
• Anemia. Another possible cause of RA fatigue is low iron. People with RA are more likely to have low iron. That’s because the disease can reduce your body’s ability to use stored iron.
• Medication side effects. Medications that treat RA can also cause fatigue as a side effect.

How to Reduce RA Fatigue

If you have RA and are struggling with fatigue, there are some things that can help.

Get your RA under control

One of the best ways to reduce fatigue is to get your rheumatoid arthritis under control. Research shows that people experience less fatigue when their RA is in remission. Research also shows that early treatment, or seeking care as soon as symptoms develop, reduces RA fatigue.

Discuss medication side effect with your doctor

Some medications used to treat RA, including azathioprine and methotrexate, can cause fatigue as a side effect. Prescription painkillers may also lead to fatigue.

If you’re experiencing fatigue, talk to your doctor about your medications and whether any could impact your energy levels. Your doctor can adjust your dosage or switch you to a different medication.

Watch your iron

People with RA sometimes have low iron levels. This can negatively impact your body’s ability to produce red blood cells, which carry oxygen through your body. Your doctor can test your iron levels to determine if you might benefit from iron supplements and/or different medications to treat your underlying RA.

Try light exercise

While you may not feel motivated to exercise, some people with RA find that exercise helps combat fatigue symptoms.

Stretching and yoga exercises — as well as walking, cycling, or swimming — are exercises that are easier on the joints. Starting slow and gradually increasing your exercise levels will help you stick to a good regimen, as the new routine won’t feel so daunting. You can start with a 10-minute daily walk, and increase this after a week or two, if you feel able.

See an occupational therapist

An occupational therapist can also help you adjust daily tasks to reduce the pressure and pain on your joints. Reducing pain can help relieve the emotional and mental load that can contribute to your fatigue.

Look out for signs of depression

People with chronic pain are four times more likely to experience depression than the general population. Symptoms of depression include:

• Anxiety.
• Feelings of hopelessness.
• Reduced motivation.
• Low mood.
• Low self-worth.
• Sadness.

People with depression may also have marked changes in their appetite and sleep habits.

If you have symptoms of depression along with fatigue, talk to your doctor. They can prescribe antidepressants or talk therapy, or both. Since fatigue is a symptom of depression, treating your depression may help relieve your fatigue too.

Lifestyle Changes to Cope with Fatigue and Rheumatoid Arthritis

Even with the best treatment, many people with RA still experience some fatigue. This fatigue may hit every few days, weeks, or months. Some people with RA may experience a bout of fatigue almost every day, often at the same time each day.

You may not be able to eliminate fatigue in your life, but you may be able to decrease the impact that fatigue has on your day-to-day life with these steps.

• Try cognitive behavioral therapy. This can help you address negative thought patterns that fatigue can trigger. For example, rather than saying “people can’t rely on me,” you can consider how respecting your limits is showing compassion to yourself.
• Schedule rest before and after activities that require extra physical exertion or brain power. In other words, don’t schedule social activities, errands, or appointments back-to-back. Doing too much can leave you without the attention or energy you need for activities that are important to you.
• Take power naps. Sometimes it’s best to submit to fatigue rather than trying to fight it. A 15-minute rest, even if you lie down rather than sleep, can help restore your energy when you’re feeling wiped out.
• Talk to your friends. If you explain your fatigue symptoms, your friends can adjust social activities to make them less taxing. Rather than bottling your emotions in, it helps to share feelings about RA fatigue and get support from others.
• Eat a healthy diet high in proteins and complex carbohydrates (whole grain bread, brown rice or pasta, and starchy vegetables). While foods high in sugar and low in fiber can give you a quick burst, they often cause a ‘crash.’ Complex carbohydrates and protein give you energy that is more steadily released throughout the day.
• Consider adjusting your work hours. You may find that you have a few productive hours in the morning, but your fatigue hits in the afternoon. Reducing your schedule to part-time could let you accomplish your work tasks without feeling overwhelmed.

It can take time for medication and lifestyle changes to make a difference in how you feel day to day. In the meantime, go easy on yourself, and remember that fatigue often comes and goes in RA.

Learn more about the UPMC Rheumatoid Arthritis Center and call 1-800-533-8762 to schedule an appointment.