What Causes the Rheumatoid Arthritis Fatigue?
What Causes Rheumatoid Arthritis Fatigue?
The fatigue of Rheumatoid Arthritis is a weariness that rest cannot cure. It is tiredness without the benefit of the pleasure of activity. Over 90% of RA patients report fatigue as a clinical symptom. It is counted second only to pain as the greatest difficulty of living with RA.
Where does this weariness come from? What causes us to feel precisely like Superman with Kryptonite pushed in his face? Does anybody know?
Likely, there are multiple contributing factors. Most suspicious-sounding to me are the Cytokines. These are chemicals which some scientists believe cause the fatigue of colds and flu. They are the chemical messengers of the immune system. There are over 150 different kinds of these protein-based molecules.
These chemicals are used by cells as a means of communication. Cells can talk to each other through Cytokines, but in Rheumatoid Arthritis, excess amounts of them are produced and dumped off into the bloodstream. Some theorize that they cause several RA symptoms, including fatigue, anemia, sleep problems, and skeletal muscle shrinkage. (See conquering Rheumatoid Arthritis by Thomas Lee, Ph.D., p.47).
One reason that I’d be willing to blame the Cytokines is that they are reduced by TNF blocking medications (like Enbrel). And guess what results? Yes, usually fatigue is lessened. This is one of the reasons that fatigue is said by some to mirror disease activity or reflect inflammation levels: when medications slow inflammation, fatigue tends to moderate.
The fatigue of Rheumatoid Arthritis is not caused by exertion. However, activity can aggravate it. It sounds like “heads I win; tails you lose.” Rest is critical to surviving life with Rheumatoid Arthritis, but it will not prevent the fatigue.
Funny thing: I have read as many times that depression causes the fatigue as I have read that fatigue causes depression. This is not a fair fight. We have to fight the fatigue while we are in a state of chemically-induced tiredness.
And we must fight back depression from an exhausted state. And how could we be anything BUT fatigued when managing such extreme pain levels over an extended time?
Other legitimate theories for explaining the fatigue of RA include anemia and nutritional deficiencies. Red blood cells can be reduced by both the disease and some of its treatments. Similarly, both Rheumatoid Arthritis and many of the medicines prescribed for it tend to curb normal appetite.
I read some abstracts and medical journals to see if anything new is being uncovered about the fatigue of RA. One experiment was done with mice to show how inflammation impacts the brain. Immune cells infiltrate the brain which, according to one reporter, causes the proverbial brain fog.
I don’t know how the mice are coping, but I’m sure hoping for answers – because I am tired being tired. How did Superman ever solve that Kryptonite problem, by the way? It was blue Kryptonite.
Recommended reading:
- Helpful RA book: Book review: What to Do When the Doctor Says Its R A
- Recognizing RA: What Is the First symptom of Rheumatoid Arthritis?
- Living with RA every day: 24 for Rheumatoid Arthritis Warriors
Copyright © 2009-2010 Kelly Young, All rights reserved.
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I'd love to wash those moncytes right out of my hair! Thanks for this. Going for a little lie down now
BWHAHAHAHA!!
So glad you stopped by, Synovial!
That is my kind of funny!
Hey,
instead of Selsun blue,
we could sell Krytonite blue shampoo.
That must be why my rhuemy was very happy when I told him that my energy level was back up since taking Enbrel.
Glad to hear the good report.
I'm think mine has me up to second gear agsin, too.
Thanks for writing about fatigue. I don't think anyone without ailments that cause such awful exhaustion understands it. I have had friends on chemo that suffer from fatigue and they say no one can understand that either.
I also want to thank-you for explaining all this in easy to understand terms. What is your background, education? MD, medical degree? Whatever, you sure are excellent in research and writing.
(Blushing.)
Thank you Dazey. Your RA Warrior is a humble teacher. And a really hard worker. ;D
Thank you very much. I was diagnosed with RA at the ripe young age of 16. You mentioned Brain fog and that is just what I tried to explain to my rheumy on my last visit. I thought I was going crazy. Do you have any more readings on brain fogs because it really bothers me
Fatigue is less well understood than pain or erosions in RA. Even the tools to measure fatigue are lacking consense, but that’s already on the way to get better.
We see patients who complain about more fatigue after the inflammation has been treated. My hypothesis is – less inflammation, less pain, less stress – leading to more fatigue.
Some TNF-inhibitors may cause fatigue.
That leaves us at a span of 180° – fatigue might get better with a biologic or worse.
OT: off for a coffee before I see my last patient, still patiently receiving her Rituxan.
CU Lothar
Hello, I was just dx about 1 month ago. However I am pretty sure I have had RA for over 3 years. I had an RF result of 16 back then and the Rheumy laughed in my face and asked me why my doctor sent me to him with such a “low positive”. Well, if you ask me that is an oxymoron. A positive, is a positive, is a positive. After all we have all heard “You cant be a “little bit” pregnant” Well I dont care how many “normal” people in the world have RF factor, the FACT is that a very high percentage of RA people have RF present in their blood. Therefore ANY amount should be followed up. A GOOD doctor would do so as to head off the worst possible to come. Anyway, I will jump off my soap box now. This time around I got a RF of 10 and my NEW doctor retested and I doubled to a 20. So I am “officially” dx. I am taking MX at 10mg every Wed. I also take Folic Acid and at night Hydrocodone. While the pain med does make me a bit drowsy it has always worn off before I awaken because the pain comes back and causes me to wake up early.
I have been experiencing SEVERE fatigue over the last two days. I have had EXHAUSTION for many years nows but nothing like this. This is completely debilitating stuff. Like I am afraid to drive. I had to ask my husband to give me my meds because I was afraid I would take the wrong ones and the energy expended on gathering my meds was an intolerable thought.
Anyway, I was directed to this site by a friend at Daily Strengths where they have a RA support board. I truly enjoyed the article and see the perfect logic about the cytokines. Having said that I also see the perfect logic about taking meds == less pain, less stress, less inflamation == more fatigue. Kind of like the “Flight or Fight” deal. When you are facing an intensely dramatic or traumatic time in your life you have all these energy and can become like a super hero. Then when the trauma drama goes away and it is back to average days again, the “Fight or flight” adrenaline leaves you and your body naturally falls into an intense exhaustion. Its like your body understands that you need a break now, after the physical, mental and emotional stress you put it through. This has happened to me several times.
So maybe it is both of these reasons. Cytokines representing the scientific viewpoint and “Fight or Flight” representing the practical viewpoints. However, I must add that I just received a phone call from my doctor telling me that I should quit taking the Methotrexate I have been taking for 4 weeks. He wants me to call on Monday or Tuesday next week to let him know how I am feeling–any fatigue. He said he will probably put me on something else. Maybe, if I am lucky, the fatigue will only last a few days. Good luck!
Tamye,
Wow, what a story. I am so sorry that you have been going through this. I experienced a few weeks of severe fatigue like you mention last spring when I had to forego methotrexate because of a kidney infection. I know exactly what you are describing. I hope it doesn’t last too long.
I hope the doctor can explain why the change and what the next step should be. Can I recommendthis post that might help you with that.
Good luck to you too!
Fatigue and brain fog…..
Fatigue has been and is right now a problem for me. Rest when I can and then coffee is something I truly enjoy and the added benefit of helping to keep me going when necessary. Something that tastes good and helps you feel better too
Brain fog has in the past been a major issue for me. Three things have been the cause of my brain fog issues. #1. Vitamin B12 deficiencies happen to people of all ages, and if you are on RA drugs, then that can become a major issue. Mine is from the inability to absorb it properly. Everyone should have this checked because most people think of it as an old age issue, but the deficiency of this vitamin can eventually kill you and is relatively inexpensive to treat. Memory loss, brain fog, and other physical problems such as nerve damage, peripheral neuropathy, etc… I spent a year falling down and having short term memory loss. It was pretty scary!
#2. Low blood sugar…I have reactive hypoglycemia and if I do not eat enough protein my blood sugar drops causing brain fog, irritability and eventually shaking and crying uncontrollably. I am not diabetic but have a mother who is. Cheese of all kinds or nuts or peanut butter are my favorite foods to keep up my blood sugar level. It is something which can be harder to deal with when you are already tired, to remember to eat. Your muscles NEED protein to function properly and to heal.
#3. Chronic sinusitis: Having allergies tends to keep my sinuses aggravated and having this can lead to infection of the sinuses. Twice a year I usually have this problem, and brain fog certainly can accompany it. Lot of fluids, and decongestants along with an antibiotic when you are unable to fight the infection by yourself. I only use antibiotics when absolutely necessary because otherwise the germs which cause my infection could mutate and become immune to them. This can be a debilitating condition when you are so congested that you literally cannot think properly. Take care of yourself because you are your best defense.