Fatigue is not just being tired or sleepy. It is a medical symptom that impacts your physical and mental state and your ability to think clearly, stay motivated, and do the things you need or want to do. Roughly 30 percent to 40 percent of patients with PsA experience fatigue at some point — and many people say it’s one of the most difficult symptoms to live with.
What causes fatigue in patients with PsA and other types of inflammatory arthritis? There’s usually no one single cause. Fatigue is “multifactorial,” or due to several causes. And the causes are often interrelated, which may require some detective work from you and your rheumatologist to figure out what’s going on.
If you have PsA and fatigue, your rheumatologist may screen you for the following factors and conditions that may contribute to your fatigue:
Depending on the underlying cause of your fatigue, different treatments may be needed. These may include lifestyle changes such as changing your diet and exercise patterns, practicing self-care, knowing your limits, medication adjustments (changing the dose, timing, or class of medication), and/or therapy and mental/emotional help through support groups. The good news is there are a lot of steps you can take — both with your doctor and on your own — to help manage and reduce fatigue related to PsA.
Consult your health care provider
Working with your healthcare provider is the best way to determine what’s causing your fatigue — and to come up with a plan for restoring your energy. Even if your doctor doesn’t understand how fatigue feels for you, they can understand how it impacts your daily living, so make sure to convey when it occurs, how long it lasts, and what fatigue prevents you from doing on a daily basis.
Importantly: For most patients with chronic pain, therapy isn’t meant to take the place of medication but complement it as part of an overall treatment plan that aims to help people feel better physically and mentally.
There are a lot of different types of talk therapy, including:
These types of therapy involve working with a mental health professional, which may include a psychiatrist, psychologist, or licensed professional with training and certification in mental health like counselors from your religious group, social workers, and marriage and family therapists.
Many mental health professionals incorporate multiple techniques and types of therapy in order to personalize care for a given patient.
Cognitive behavioral therapy has been studied for arthritis pain for many years and is considered the “gold standard” for psychological treatment of chronic pain. CBT is rooted in the idea that the way you perceive situations influences the way you feel, and that you have the ability to change your thought patterns to feel better.
Dialectical behavioral therapy (DBT) is a type of CBT that is designed to help people to live in the moment and cope with stress and emotions in a healthier way by developing skills like mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation.
Acceptance and commitment therapy (ACT) is a form of behavioral therapy that combines mindfulness with self-acceptance.
Pace Yourself
Carefully monitoring how you spend your energy and activity, known as pacing, is one way of addressing fatigue from PsA. Although “energy pacing” or “activity pacing” doesn’t work for everyone, it may help you to better manage and cope with extreme tiredness. Energy pacing generally works like this: Think of your energy level for the day as a fixed amount like money in a bank account. Then for any activity you need to do, you figure out how much energy it will take so you can make sure you don’t withdraw more than the total amount of energy you have in any given day. It may mean divvying up chores or errands into different days of the week, for example.
Usually, relaxation is considered safe and healthy, but if you’ve had anxiety or depression, check with your provider to make sure it’s okay for you. There are therapists trained to help you learn to do any of these relaxation techniques properly, but you can also teach yourself to do them by using online videos or apps.
Although these practices can help improve mental well-being, they are not a sole solution to serious mental health issues. If you are struggling with mental health issues, talk to your doctor or health care provider to find effective solutions. They may suggest talking to a therapist or taking medications to manage your anxiety, depression, and stress.
In addition to fatigue, joint pain and stiffness can make exercise particularly difficult for people with psoriatic arthritis. Surprisingly, research has found that fighting through initial fatigue in order to do gentle exercise could actually lead to less fatigue in the long run. Start slowly with 10- or 15-minute walks and slowly build up. Other activities to try include tai chi, cycling, stretching, and water aerobics. Just be sure to listen to your body and don’t do anything that could cause an injury.
Manage Mental Health
As anyone with PsA understands, it’s not just a “joint” condition — the pain affects your whole life, including your mental health. Roughly one in five people with PsA may have mild depression. If depression or anxiety is playing a role in your fatigue, getting mental health support is key. Depending on the severity of your anxiety and stress, you can also try relaxation strategies such as meditation, reading a book, and listening to your favorite music.
Fatigue might be a sign that you aren't sleeping long enough or well enough but it could also be a sign that you have a sleeping disorder. In fact, the chances of having sleep problems, including insomnia, sleep apnea, and restless leg syndrome, are significantly greater in people with PsA than in those without the disease. One study found that more than 67 percent of people with PsA reported sleep problems, as well as 59 percent of people with psoriasis.
Poor sleep quality has been linked to chronic pain, mood, and worsened PsA disease activity. Inflammation may also worsen without enough quality sleep. PsA activity involves increases in certain inflammatory chemical messages in your blood cytokines, such as tumor necrosis factor (TNF). These inflammation signaling proteins may interfere with normal sleep patterns.
Fortunately, making some simple lifestyle changes — sometimes known as “sleep hygiene” — can improve your sleep.
● Sleep in a room that’s dark, cool, and quiet
● Unplug your phone, e-books, and other electronic devices
● Go to bed and wake up at about the same time every day
● Wear comfortable clothing made of cotton or silk
● Use high-quality cotton bed linens
● Use the bed only for sleeping and sex
● Avoid reading or watching TV in bed
● Avoid caffeine or other stimulants late in the day
● Eat a well-balanced diet
● Get some daily exercise
● Meditate or practice deep breathing exercises before bed
● Manage your levels of stress
If you have already tried these recommendations, and you’re still troubled by poor sleep, you should talk with your doctor about medications or other ways to improve your sleep. In addition to practicing proper sleep hygiene — a consistent sleep-wake schedule, no electronics or screen time close to bedtime, creating a relaxing bedtime routine — your doctor may suggest undergoing a sleep study to determine any underlying sleep disorders contributing to your fatigue.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5168499/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5519124/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613346/
https://www.hopkinsarthritis.org/arthritis-news/fatigued-wont-exercise-make-tired-fatigued/
https://www.hss.edu/conditions_managing-fatigue-rheumatoid-arthritis.asp
https://creakyjoints.org/living-with-arthritis/chronic-illness-increase-energy/
https://www.ncbi.nlm.nih.gov/books/NBK384467/
https://www.medpagetoday.com/reading-room/acrr/generalrheumatology/74380
Here are some additional articles and videos to help you understand and cope with PsA fatigue.
CreakyJoints
CREAKYJOINTS
Creakyjoints
Creakyjoints
https://www.hopkinsarthritis.org/arthritis-news/fatigued-wont-exercise-make-tired-fatigued/
https://creakyjoints.org/living-with-arthritis/chronic-illness-increase-energy/
https://pubmed.ncbi.nlm.nih.gov/27055727/
https://pubmed.ncbi.nlm.nih.gov/18930991/
https://www.jrheum.org/content/47/4/548
This website is for general health information only. It should not be used as a substitute for medical advice, diagnosis, or treatment. Any questions regarding your own health should be addressed to your own physician or other health care provider. Health-related information changes frequently and therefore information on this website may be outdated, incomplete, or incorrect. Statements made about products have not been evaluated by the U.S. Food and Drug Administration. In using this website, you agree that United Rheumatology, the Global Healthy Living Foundation, and any other party is or will be liable or otherwise responsible for any decision made or any action taken or any action not taken due to your use of any information presented at this website.