by Kimberly Allen R.N.
Fatigue, though one of the most common symptoms of rhuematoid arthrits (RA), is also one of the least talked about or treated. There are numerous causes for the fatigue associated with RA.
As a person living with RA I have always found coping with the fatigue to be one of my greatest challenges. In the process of trying to find a solution I made a few discoveries. Other than the disease itself, the fatigue seems to be associated with and affected by what I call ‘cycles’. The first and most common begins with the chronic pain of RA. Pain leads to poor deminished activity and poor sleep which leads to increased pain, and the increased pain leads to more increased fatigue. Therefore one of the first priorities of treatment is adequate pain management. It’s important to sit with your doctor and develop a pain management plan that works for you. I was fortunate that both my Rheumatologist and my General Practitioner also believed effective pain management to be imperative in the treatment of my RA. If you are not getting relief and your doctor is unwilling to treat your pain, you need to look for a doctor that is willing to treat and help you manage your pain. There are numerous pain clinics out there.
The other major cycle occurs when the fatigue leads to increased stress, which leads to increased pain, which leads to depression which leads back to increased fatigue. If left untreated these ‘cycles’ merge only increasing symptoms and the potential for other complications. I went to my doctors and told them that I refuse to be a couch potato. I know the person I am and if I have to sit around because I’m in too much pain I knew I would sink into a severe depression. They agreed and began to treat my pain aggressively. This allowed me to significantly increase my activity. Which was not only my goal but my doctor’s as well.
Once you have achieved pain management that is acceptable to you it’s imperative to avoid what I call “the cycle of my own demise”. I was so excited to be moving again that I would repeatedly over do it and would have to spend 1-2 days in bed recovering. I soon started getting depressed because I wasn’t able to accomplish all I wanted, by the time I would finish cleaning my large farmhouse, I was too tired to do all the other things I wanted to do. I realized I needed to set priorities. Once I realized I didn’t need to vaccum and dust the whole house everyday I was able to use my energy more of the things I enjoy like gardening.
It’s important that part of your pain and fatigue management program include exercise. Exercise increases muscle mass and endorphines. When muscle mass decreases ther are decreased energy producing cells. More than half the people suffering from severe RA loose muscle mass and as muscle mass decreases fatigue increases. Endorphines are the bodies natural treatment for pain and depression. As you are able to increase your endorphine levels your fatigue should decrease and pain be easier to manage.
Another contributing factor is your medications. I remember when I first began treatment for my RA I was taking 14 pills every morning. I would joke that the ones in one hand were for the disease and the ones in the other for the side effects of the ones in the other. Joking aside, many of the medications that are used to treat RA also increase fatigue so talk to your doctor about then possibility of adjusting your medication regime.
There are numerous other factors that are associated more with the disease itself like inflamation and anemia that contribute to the fatigue. As part of any fatigue management plan your doctor will address these issues also.
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.