Living and dealing with fatigue
People with rheumatoid arthritis typically have several permanently inflamed joints. The inflammation inside the body can lead to general physical weakness, drowsiness and exhaustion. This feeling of extreme tiredness is also called "fatigue." Some people find this to be the worst symptom of the disease.
Other typical symptoms are joint pain and swelling, and also joint stiffness and physical weakness later on. Non-specific symptoms like exhaustion often start earlier on in the disease. But the symptoms and course of rheumatoid arthritis can vary greatly. People also deal with the disease in different ways. Although people experience their symptoms differently and cope with the disease in different ways, there are some things that many people with rheumatoid arthritis have in common.
How does fatigue change your life?
Fatigue is different than normal feelings of tiredness. People describe it as being overwhelming and uncontrollable. They feel worn out and drained of energy, and sometimes even lose all interest in anything.
It can increase the need for sleep and make it hard to concentrate or do anything. Constantly feeling exhausted and not being able to maintain an active lifestyle can affect your mood too: Many people who have rheumatoid arthritis also feel depressed, irritable or anxious. These feelings can be hard for others to fully understand.
The severity of rheumatoid arthritis symptoms may vary a lot over time. This can make it difficult to plan ahead. You don't know how you will feel the next day or whether the symptoms will get better or worse. This means that people with rheumatoid arthritis feel like they have lost control of their lives. If they are too exhausted, they may not have enough energy even for simple everyday activities or for playing with their children or grandchildren. Appointments may need to be rescheduled, and some people give up their favorite activities if they prove to be too demanding.
The effects of the disease can also change how you see yourself, as well as your role in your relationship, family or at work. Mutual give-and-take is often an important part of friendships and family relations. But rheumatoid arthritis can make it harder to continue to care for others – and may also mean that you need more and more help yourself. Fatigue can affect relationships because it becomes more difficult to carry out plans you make together. Exhaustion can also affect your sex drive.
And at work it may be difficult to accept that you can't do as much as you used to. You might need more breaks, or certain tasks might need to be reassigned.
How do people cope with exhaustion?
Many people gradually come to learn how to regulate their energy better and to accept the changes associated with the condition. They pay more attention to their body's signals and then adjust what kinds of activities they do based on their symptoms.
As well as the phases where the arthritis gets much worse, there are also periods where it's possible to live a quite normal life. It often helps to start seeing the condition as a part of your life and to set new goals that you can still achieve anyway. Some people say that the disease has helped them to live their lives more consciously.
Many mention in interviews that they've discovered practical ways of dealing with fatigue:
- Learn to say "no" sometimes
- Don't plan to do too much at once
- Reconsider and adapt your goals
- Plan activities carefully, take your time, spread out demanding tasks across the week.
- Take breaks before you become too exhausted
- Get to bed early, take naps and learn relaxation techniques
- Avoid going out at busy times of the day, for instance when you go shopping or on a trip
- Talk with others about your disease so that they can better understand how it affects you
- Talk to others who have rheumatoid arthritis so that you can learn from their experiences
Can physical activity help to lessen fatigue?
Some people who have fatigue try to get fitter by doing gentle physical exercise, with the aim of fighting the exhaustion that way. A number of different activities are well-suited for this, including stretching and strengthening exercises, yoga, tai chi, brisk walking, cycling, water aerobics and swimming. These activities may also be done in specialized exercise therapy.
An analysis summarizing the research on different types of exercise shows that physical activity can help reduce fatigue. About 15 out of 100 people felt less exhausted after exercising. It's still not clear what form of exercise would be most suitable, though.
What kind of treatment could help against fatigue?
Sometimes fatigue is still a major problem despite adjusting your daily schedule, doing physical exercise and getting support from other people. Then professional help may be an option, for instance in the form of psychological treatment or occupational therapy. Some specialized programs have been developed specifically for people who have fatigue as a result of autoimmune diseases like rheumatoid arthritis. They're designed to do things like help you plan activities and make sure you don't use up all of your energy at once.
Cognitive behavioral therapy (CBT) strategies can also be learned to help cope with fatigue. Some involve recognizing and then changing certain thoughts, beliefs and behaviors that make it more difficult to live with the disease.
Studies on non-drug treatments show that approaches used in occupational therapy and psychotherapy can relieve exhaustion.
Cramp F, Hewlett S, Almeida C, Kirwan JR, Choy EH, Chalder T et al. Non-pharmacological interventions for fatigue in rheumatoid arthritis. Cochrane Database Syst Rev 2013; (8): CD008322.
Dures E, Kitchen K, Almeida C, Ambler N, Cliss A, Hammond A et al. "They didn't tell us, they made us work it out ourselves": patient perspectives of a cognitive-behavioral program for rheumatoid arthritis fatigue. Arthritis Care Res (Hoboken) 2012; 64(4): 494-501.
Hewlett S, Cockshott Z, Byron M, Kitchen K, Tipler S, Pope D et al. Patients' perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored. Arthritis Rheum 2005; 53(5): 697-702.
Nikolaus S, Bode C, Taal E, van de Laar MA. New insights into the experience of fatigue among patients with rheumatoid arthritis: a qualitative study. Ann Rheum Dis 2010; 69(5): 895-897.
Repping-Wuts H, Uitterhoeve R, van Riel P, van Achterberg T. Fatigue as experienced by patients with rheumatoid arthritis (RA): a qualitative study. Int J Nurs Stud 2008; 45(7): 995-1002.
IQWiG health information is written with the aim of helping
people understand the advantages and disadvantages of the main treatment options and health
Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.
Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.