Living and dealing with fatigue
In rheumatoid arthritis some joints in the body are permanently inflamed. The inflammatory processes that occur 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 to deal with.
Other typical symptoms are joint pain and swelling, and also joint stiffness and physical weakness later on. Non-specific symptoms like exhaustion may start earlier. But rheumatoid arthritis can develop in many different ways. Also, people may deal with the condition in various ways. But as much as perception of symptoms and coping strategies differ, 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 affected by it describe it as being overwhelming and uncontrollable. They feel worn down and weak, sometimes even lethargic. Fatigue can come and go in bouts, and may become especially bad at some times or milder at others. It can increase the need for sleep and lead to listlessness and trouble with concentration. 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 can vary a lot. Many people find the unpredictability of the symptoms hard to take: Not knowing how you'll feel the next day and wondering whether you'll be feeling better or worse can make it difficult to plan ahead. This means that people with rheumatoid arthritis sometimes feel like they have lost control of their lives. When the exhaustion is too great, there may not be enough energy even for simpler activities like playing with 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 condition 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 realize plans you make together. Exhaustion can also affect sex drive.
And at work it may be difficult to not be able to take on as much as before. This could mean you need more breaks or that certain tasks need to be reassigned, which has the potential of leading to friction.
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 are more attentive to their body's signals and then adjust what kinds of activities they do depending on how bad the symptoms are at that time. Aside from 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 goals that you can still achieve anyway. Some people say that the condition has helped them to be more conscious of how they're living.
Many mention in interviews that they've discovered practical ways of dealing with fatigue:
- Learn to say "no" sometimes. Don't plan to do everything all at once. Reconsider and adapt your goals.
- Plan activities carefully and take your time to scatter difficult tasks throughout the week.
- Take a break before you become too exhausted
- Get to bed early, take naps and learn relaxation techniques
- Avoid busy times of the day, whether you are shopping or traveling
- Talk with others about your condition so that they can better understand its effects
- Share with 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 improving their conditioning with milder physical exercise to overcome the exhaustion. A number of different activities are well-suited for this, including aerobics, strengthening exercises, yoga, tai chi, brisk walking, bicycling, water aerobics and swimming. These may also be part of a specialized exercise therapy.
A systematic overview of the research on different types of exercise shows that physical activity can be beneficial for fatigue. About 15 out of 100 people felt less exhausted by exercising. It's still unclear what form of exercise would be most suitable, though.
What kind of treatment could help against fatigue?
Sometimes fatigue remains a major problem despite adjusting your daily schedule, getting physical exercise and making use of support. Then professional help may be an option, possibly in the form of psychotherapeutic 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 help plan activities and ways of distributing your strength.
Strategies from cognitive behavioral therapy (CBT) can also be learned to help cope with fatigue. Some involve recognizing and then changing certain thoughts, convictions and behaviors that make it more difficult to live with the disease.
Studies on non-drug treatments show that methods used in occupational therapy and psychotherapy can be effective against 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 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.
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