What Causes Rheumatoid Arthritis Fatigue? | Rheumatoid Arthritis Warrior

What Causes Rheumatoid Arthritis Fatigue?

What Causes Rheumatoid Arthritis Fatigue? (UPDATED 2016)

Rheumatoid Arthritis fatigue 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 symptom. It is counted second only to pain as the greatest difficulty of living with RA.
Blue glass jar

“Unlike normal fatigue, pathological fatigue does not improve with rest. This kind of fatigue is seen in most acute and chronic inflammatory diseases, including arthritis” (Louati and Berenbaum in Arthritis Research & Therapy, below)

Where does this weariness come from? What causes us to feel precisely like Superman with Kryptonite pushed in his face? Does anybody know?

Cytokines and Rheumatoid Arthritis Fatigue

causes rheumatoid arthritis fatigueLikely, 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 people with Rheumatoid Arthritis, excess amounts of them are produced and dumped off into the bloodstream. Some theorize that cytokines cause several RA symptoms, including fatigue, anemia, sleep problems, and skeletal muscle shrinkage (Conquering Rheumatoid Arthritis by Thomas Lee, Ph.D., p.47).

One reason that I’m 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 improve.

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 necessarily prevent fatigue.

Funny thing about Rheumatoid arthritis fatigue

I have read as many times that depression causes Rheumatoid Arthritis 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 so nutrition may suffer. The impact of diet and nutrition in RA is being studied, including Vitamin D and potassium.

Rheumatoid Arthritis fatigue is related to rheumatoid disease activity

causes rheumatoid arthritis fatigueIn 2009, I read several abstracts and medical journals to see if anything new was 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. More recent studies, reviewed in Fatigue in chronic inflammation – a link to pain pathways, confirm that inflammatory activity is a likely source of fatigue symptoms in Rheumatoid Arthritis. Specifically, IL-1, IL-6, and TNFα have been studied.

Evidence shows “fatigue is clearly a symptom included in rheumatic diseases: in rheumatoid arthritis (RA), it is an important outcome to evaluate according to OMERACT, and it has been associated with the Disease Activity Score in 28 joints (DAS28) and the Clinical Disease Activity Index.”

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 his Kryptonite problem, by the way? It was blue Kryptonite.

More on Rheumatoid Arthritis fatigue: 25 Tips to Manage

Recommended reading:

Kelly O'Neill Young

Kelly O'Neill (formerly Kelly Young) has worked over 10 years as an advocate helping patients to be better informed and have a greater voice in their healthcare. She is the author of the best-selling book Rheumatoid Arthritis Unmasked: 10 Dangers of Rheumatoid Disease. Kelly received national acknowledgement with the 2011 WebMD Health Hero award. She is the president of the Rheumatoid Patient Foundation. Through her writing and speaking, she builds a more accurate awareness of rheumatoid disease (RD) aka rheumatoid arthritis (RA) geared toward the public and medical community; creates ways to empower patients to advocate for improved diagnosis and treatment; and brings recognition and visibility to the RA patient journey. In addition to RA Warrior, she writes periodically for newsletters, magazines, and websites. There are over 60,000 connections of her highly interactive Facebook page. You can also connect with Kelly by on Twitter or YouTube, or LinkedIn. She created the hashtag: #rheum. Kelly is a mother of five, longtime home-schooler, NASA enthusiast, and NFL fan. She has lived over thirteen years with unrelenting RD. See also https:/rawarrior.com/kelly-young-press/

103 thoughts on “What Causes Rheumatoid Arthritis Fatigue?

  • January 2, 2013 at 4:06 pm
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    Living with RA is a daily battle. by evening my joints are working fairly well then by morning “WhooYaa”! someone has taken over my body and I am stiff and sore. Sometimes I get up by 5am and ride my stationery bike, hot shower lay back down for a short rest then I can get dressed and ready for work. It is not the life I have chosen but the life I led. The worst thing is the fatigue…you can’t see it but somedays are like I have run a marathon.
    Methotrexate and I have a love/hate relationship…I feel like I am in a bad marriage with no way out. Peppermint tea is my friend. I look the same to my friends and family but inside I am different. RA has changed me. I will NEVER be the same. One day at a time. That is how I am trying to live.

    Reply
  • March 29, 2013 at 12:13 pm
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    Hi. thank you for this post. I have has RA for 17 years but in the Last month my fatigue has been crushing. Yet I have trouble sleeping and I feel really bad. Like you feel when you have the bad flu. This type of fatigue is new to me. The dr wants to switch me off Enbrel to Orencia. My question to you is have you heard or experienced fatigue that is also accompanied with feeling rnreally bad like something is just not right? I’m having trouble sleeping and this is also not helping. Something is just different this past month with me with my RA

    So crushing fatigue but trouble sleeping accompanied by feeling really poorly like the flu (yet I’m not sick)

    thanks for your site !

    Reply
    • March 29, 2013 at 1:54 pm
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      Judy, I wish I had a solution to the fatigue. Strong fatigue from RA is hard to explain until you feel it – it is so powerful like you said “crushing.” There are some things you can have your doctor check such as blood counts, and vitamin D and mineral levels to be sure a deficiency is not making it worse.
      Did you talk with your doc about why he wants you to switch? Maybe he sees something in your tests or what you’re saying that makes him think you could be doing better than you are.
      Here’s a list of articles here on fatigue – there is a “tips” post with ideas to fight it as much as you can https://www.rawarrior.com/tag/rheumatoid-arthritis-fatigue/
      A list of sleep related articles also have a lot of comments from others that might help you. https://www.rawarrior.com/tag/rheumatoid-arthritis-sleep/ Sleep is one of the most important things you can do to help relieve the fatigue and feel as well as possible.

      Reply
  • June 21, 2013 at 3:57 pm
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    This is a great website. I was diagnosed with RA about 2 yrs ago. The fatigue is grinding and it is worse than the pain. I’m a horticulturist and have a very demanding job that requires a lot of energy.Also,2 young children that suck the energy out of me(in a good way).CKD prevents me from taking some medications so I just push on.I have been taking hydrocodone and it somewhat helps with the pain.Nobody can quite grasp what I go through each day! Thank god I have a high tolerance for pain.

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  • May 14, 2014 at 6:03 pm
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    This is an issue I think which needs attention.

    I have been struggling with severe fatigue for many, many years. A few years ago I had positive CCP antibodies which got me a diagnoses of Rheumatoid Arthritis.

    Here is the issue, my Rheumatologist downplays the fatigue and tries to blame other things for it. Says RA doesn’t cause fatigue unless there is a lot of inflammation. And me being on heavy treatment along with Remicade infusions, the inflammation was controlled and so the fatigue could be from other factors. Well what factors?

    The issue is that for disability, Social Security says that fatigue and other symptoms will be evaluated if there is a diagnoses of a condition which can reasonably be expected to produce those symptoms.

    I think that RA plays a big part in the fatigue that I’m experiencing on a continuous basis. Some of the DMARDS I take relieve that fatigue, but never to a point to be fatigue free.

    I think this is the reason it took me about 3 years to get awarded disability, but there are also periodic reviews.

    Social Security will believe the Rheumatologist more then me, and where I live I have to drive 2 hours to see a Rheumatologist.

    Anyways, I wish it could be established that RA does cause debilitating fatigue and is an illness that extends beyond the joints.

    Reply
  • November 13, 2014 at 12:02 pm
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    I see that the last posting on this topic/article was in 2012…well, it’s November of 2014 now and I’m here to tell you that the RA fatigue is still well and strong (haha). I was diagnosed about 3 years or so ago, but quit my medication about 4 months ago. Was very big mistake!! The RA came roaring back, but different from my first introduction all those years ago, and it’s worse. Especially the fatigue. I didn’t have that before and yep, it’s tough. Well, more than tough. So damn frustrating. There’s so much I want to do but get exhausted so quickly. Horrible. I’m back on Methyl shots and Placquenil, but they are not working this time and probably I will be starting a biologic (eeeeek! scared!). Can’t see my specialist for 5 months, but see my family doctor Friday and will obv. tell her I can’t wait 5 months for medication that will help. Well, hopefully it will help. I keep reading about people trying multiple drugs b/f finding one that works for them.
    OK, I’m tired now, gonna lay down.

    Reply
    • November 13, 2014 at 12:05 pm
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      Sorry! I hadn’t seen those newer posts! I need to change my first line to 2014!!

      Reply
  • January 19, 2015 at 2:57 pm
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    I have ra for 15 yrs. And yes the fatique is the biggest problem now. It has very bad for the last 6 months. My wife of 37 years tries to fix me all the time. If you do this different,or try this or whatever, nothing works, but she dont get it. all she does id get me upset with all the help she tries to give. So after a few not so kind words , itold her to quit trying to fix it. She did and things are alot better now. She has a big noye on the frig saying. Don’t try to fix it! Ha ha, it worked.

    Reply
  • June 16, 2015 at 8:20 pm
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    What a great explanation of the fatigue that many RA sufferers experience!

    Reply
  • June 16, 2015 at 8:50 pm
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    You know… I too am so tired of being tired and sometimes I really feel like even the doctors don’t get it. I feel like a big drug experiment. I just want my life back. So depressing 8-(

    Reply
  • July 24, 2015 at 12:24 am
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    I’m new here having just been diagnosed with RA, and Kelly, I just wanted to thank you for this site and all of the information.

    I realise now that I’ve had RA symptoms for years even though I’ve just been diagnosed. I was even told by a rheumatologist 18mths ago that there was no rheumatological basis to my pain and fatigue. Thank goodness I’ve now found my way to a different rheumatologist who thinks my high ESR, joint fluid and weight loss (and did I say FATIGUE!??! 😉 mean something.

    But even with a diagnosis of RA, until I found this site nothing I read really described what I was feeling. In particular, crushing fatigue has been the worst. But mostly all any doctors, specialists, etc talk about, and the bulk of what I’ve found to read elsewhere online, is about joint pain. Yes, I have swollen sore finger, hand and feet joints but they don’t restrict me anywhere near as much as the fatigue and just feeling horribly awful.

    So, thank you for the multitude of articles, posts and comments you’ve put together. I can’t tell if you’re still active here on the site but I just wanted to say thank you from the bottom of my heart. I was up until early in the morning reading through one blog post after another in delight, and today for the first time I feel as though everything I’ve been feeling is real and not a figment of my imagination.

    This is a wonderful resource!

    xxx

    Reply
  • January 7, 2016 at 12:28 pm
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    Thank you. Thank you. Now back to bed.

    Reply
  • January 7, 2016 at 12:38 pm
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    I’m currently on methotrexate and plaquenil for my RA, been on it since around March 2012 and I’m basically pain and inflammation (joints) free, but I go through bouts of severe fatigue.

    I’ve recently been diagnosed with Crohns disease so after few tries on different meds I’ve been put on Remicade, I believe it is also used in RA treatment. My symptoms have cleared up a small bit but my fatigue is about the same. I don’t know if it’s the inflammation, the lack of sleep (yet always so tired), or the meds that cause it. I just know it is very frustrating and it is so hard for others to understand. I can’t do a whole day of shopping, I can’t stay up all night to ring in the new year, I can’t keep up with people and it starts to become depressing. But it is what it is and I try to stay optimistic and hope that some day things will get better.

    Reply
  • January 7, 2016 at 2:24 pm
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    All of these responses are amazing. Seems most of us could deal with the pain, but the fatigue can’t be understood unless you’ve had it. I’m off work today. I think I’ll sleep it away.

    PS: Anyone have difficulty breathing?

    Reply
  • January 7, 2016 at 7:31 pm
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    I have been diagnosed for 4 years and been on most of the drugs. My fatigue just gets worse every year. I can be up 1 hour and all of a sudden brain fog hits and I lay down and fall asleep for a couple of hours. This happens at least 3 times a day. Just to go to the grocery store once a week is killer! Yes, there are tummy problems, inflammation and infusions, but being tired is the worst.

    Reply
  • January 8, 2016 at 8:09 am
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    I have been living with RA for over 15 years and have seen many changes to the way some people are treated by the NHS if you live in England the treatment is very limited as they do not tend to try out new drugs. Where if you live in Wales there seems to be a lot more that they are willing to do for you.

    I work with the condition and I know that it is not life threatening but I currant spend around £95.00 per month on drugs
    Just to keep me on my feet how can this be far if I was a type 2 diabetic all my med would be free this dose not make any sense if I stope working all my med would be free surely it makes more sense to keep me working and keep paying my taxes.

    That’s it rant over

    Gareth Eddy

    Reply
  • January 8, 2016 at 3:35 pm
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    “Fatigue” was such an accute yet unexplained symptom of RA until now.. My fatigue is so often taken as me being lazy.. Feeling so tired to even get out of the bed, though its 8 hours of sleep that I had, is something no one understand.. It might be the most common struggle for almost all RA patients.. But this article would be a great help now.. Explains a lot . myThanks for sharing.. :*

    Reply
  • January 9, 2016 at 7:54 am
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    No one seems to.understand when you look fine, and you say you feel Exhausted, it really gets you down being in contact pain, or discomfort, and all you want to do is lie down and sleep

    Reply
  • January 18, 2016 at 8:52 pm
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    Really enjoyed this article. Besides fatigue and pain I think the worst thing is trying to explain what you are feeling to the people around you. They think you look okay so you must be okay. Some of us just put a mask on and stuck it up, when what we’d really like to do is crawl in a bed and try and rest! To all the warriors out there battling this disease prayers are with you!

    Reply
  • February 7, 2016 at 10:41 pm
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    Hi KELLY,MY life has taken a Down Hill spiral,every since two car accidents one in 2006 and the other in 2007 . Well,In 2006,I was going across the street from my job,when a truck hit me and knocked me unconscious. Then, In 2007 my manager and I were leaving a Clients house when woman in a Dodge truck hit the passenger side I was on and I got the brunt of all the injuries ! Wow, I thought I was use to pain from developing Costcontritis as a child , after my stepfather hit me inmy chest at 15yrs. Old as I got older and had my kids, that pain increased. But,During the accident, I was diagnosed with Three Blown Discs,in my neck and back. Had treatments,and by 2008 I was diagnosed with Mitral Valve Prolapse in my heart. Then in 2009 I was having sharp pain in my hips and thighs,Fibromyalgia and Osteoarthritis was the diagnosis by the end of 2010. I already had to deal with Fibro. Fog and tiredness In 2012 the Doctor’s said my discs are being eaten away by the Osteoarthritis and curving. So,I became depressed,because I knew something was wrong in 2011.Then one day my Cardialogist asked,me to answer questions about my sleep, and I did and I agreed to do a sleep study for Sleep Apnea and I did the study and my breathing stopped in my sleep and they diagnosed me with Sleep Apnea. My doctor s did a blood test and with my pain I was told I have Rheumatoid arthritis.So,I’m happy for your site! But,This year my hands and feet are in pain and Neuropathy and when I wake-up I’m in pain when my feet touch the ground .Also ,when I’m on the cellphone my hands lock up on me. I’m always sleepy ,I’m T-I-R-E-D !!!! I’m in the process of getting a new Rheumatologist ,cause my old one left with her husband. What questions should I ask and what should My Rheumatologist ?

    Reply
  • February 29, 2016 at 6:15 pm
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    been diagnosed six months ago I’m 66 but the problem is I have a mechanical heart valve so the only meds to be safe is hydroxychlor 400 mil, have depression and fatigue any suggestions from a doctor on line
    thank u

    Reply
  • April 22, 2016 at 8:57 am
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    Getting rid of fatigue and brain fog with AIP diet has become all the more common place. Since the fatigue and brain fog is directly linked to the cytokines and the pathlogical process in RA then it stands to reason that when diet works it’s usually more effective than mtx. This is something the docs should take more seriously.

    Reply
  • July 2, 2016 at 4:31 pm
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    Any one suffer from raynauds and Hashimoto as well? Wondering if they are linked to RA. Diagnosed with raynauds about 12 years ago and recently diagnosed with RA and Hashimoto.

    Reply
  • July 17, 2016 at 7:29 pm
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    Thank you all for comments. I have been serologically negative for the past 7 years and was diagnosed in February with RA due to anti-CCP. So, I have had the diagnosis of chronic fatigue syndrome and fibromyalgia for the past 7 years. I have withdrawn from life because I live alone, cannot miss work and have to save every drop of energy to get through work. I have been told for 7 years to push through the fatigue and pain. I was placed on a SSRI because it was in my mind, depression, hormone imbalance. It is helpful to know that there are others that understand. My closest friends think that I need to alter diet and exercise and will be fine.

    Reply
  • August 10, 2016 at 8:57 pm
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    I currently take Enbrel, Methotrexate and Diclofenac. However I am experiencing increased pain and fatigue at the moment. Tomorrow is shot day – will see how quickly this dissapates….
    Sometimes it’s really hard to tell what is causing what!

    Reply
  • September 25, 2016 at 5:12 pm
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    I am a male formerly in good health bot now on the 8th year since being diagnosed with severe RA and recently turned 65. Was using MTX and Prednisone for about the first 5 years but the MTX was loosing effect. A new RA specialist took me off the MTX and proceeded to stack alternatives with little effect. The RA continued to advance and I was loosing strength, stamina and over two years 30 lbs loss from my normal 165.At that time I changed to another DR who put me back on MTX plus another along with the Prednisone. Still not effective enough so he went to Enbril for two months then finally Orencia which within 2 months had almost completely removed the pain and inflammation. I still had major weakness and was easily fatigued. Since I am vegetarian and have always had difficulty with consuming adequate protein I decided to try a whey protein supplement normally used for muscle building. Within a couple of months I gained quite a bit of the weight back,along with a major increase in strength and stamina as well as loss of most of the fatigue I had. This is still ongoing since several months ago. I suggest that others try supplementing their protein intake with this simple method. The supplement is a powder to mix with milk or juice and I make fruit smoothies daily. Hope this can help someone.

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  • January 4, 2017 at 12:51 pm
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    Well now i’m on an increased injectible mtx dose and Orencia. Had to miss 2 weeks of meds due to stomach flu. This is when I understood just how much they help me especially with fatigue. Today I am so exhausted and foggy I can barely function – not to mention muscle & joint pain. RA is depressing.

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  • March 19, 2017 at 4:46 pm
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    Some days I can’t get out of bed until 3pm or so. I don’t care if the house is burning down, I can not get up. It’s hard not to feel guilty or lazy. I’m not able to travel with my husband because all I would do is sleep. If it weren’t for the TV, I’d go crazy! It’s very hard to tell if it’s fatigue or depression. It really helps to hear other peoples experiences. I’m not the only one!

    Reply
  • April 12, 2017 at 11:03 am
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    I have been in remission from RA for months and my inflammation levels are very low. I eat healthy and exercise. Most nights i am at least in bed for nine hours (if not actually sleeping for that many hours). However I still experience fatigue most afternoons.

    I get up and feel normal energy and am painfree, yet most afternoons between 1-6 I feel so tired and energy-less. Is there anything I can do to dispel this fatigue. Do you think it is due to the RA?

    Thanks.
    Ann

    Reply
  • April 13, 2017 at 5:10 pm
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    Hello all I think I may have RA I was diagnosed with carpel tunnel at 23 and given splints for my hands it never helped the pain would be so bad wearing these things I would wake up all night wanting to cut my hands off. The other main problems were the fatigue and brain fog. I would say sound like bark bark for the word dog or maybe say a sound I was hearing instead of a word. Like put in the bark bark. I thought I said trunk but I had said bark bark as there was a dog barking. My kids found this funny and still call the trunk the bark bark. At any rate I gave up going to dr. For this and have lived with it for 20 plus years. It comes and goes I have months that I have no symptoms but they will flare up and some times stay for years at a time. Ever time it goes away and comes back it is worse. I am 45 now and I just feel so depressed about it. I don’t have friends they take too much energy to do things with. I think about seeing a dr but when I see all of you still suffering I think why bother there is nothing anyone can do. My symptoms when I looked up carpel tunnel don’t seem to match up. I am wondering if you have hot hands during a flare up.?
    My symptoms:
    Pain in both hands, very warm to the touch, swelling all over not just my hands, nodules or lumps pea size in forearm near elbow they are tinder if touched but mainly I don’t notice them. Point tenderness like in pressure points all over body. Extreme fatigue insomnia brain fog joints feel tight all over not just hands. Visual changes like floaters and flash of light. Much like a migraine. Loss of use of my hand at times due to pain. Cafe au lait spots I had two even as a child now I have eight or more. I have pointed them out to my dr who said yeah people have them nothing to worry about. Along with the lumps in arm which she says they are fatty cysts but my husband has one and it feels different than mine and his is not tinder to touch. I just wonder if it is worth finding a new doctor and exploring treatments. Do you feel better?

    Reply
    • January 12, 2019 at 8:56 pm
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      Definitely see a new doctor. Do not overthink it. You have too many things going on. See another dr. You should not have to suffer like this.

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  • August 14, 2017 at 12:10 am
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    I was diagnosed 2 years ago aged almost 73. Actually diagnosed myself after being dismissed by a doctor who missed typical symptoms. Now being treated by specialist. So far the pain is only in one knee and is tolerable.
    It is fatigue and brain fog which gets me down. One day of exercise lays me low for three days. So frustrating.
    Reading this site has given me the assurance that I am not a hypochondriac.

    Reply
  • September 13, 2017 at 3:57 am
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    Great descriptions and explanations.

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  • September 15, 2017 at 10:40 am
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    I was dianosed at Age 24 I am 58 now.RA makes life very difficult.I have had total knee and both total shoulders replaced.I worked until 5 years ago,it was a struggle everyday.My husband is very kind he does my hair helps with my jewelry and getting dressed on the bad days.Every aspect of our lives has been affected by RA.The fatigue is almost worse than the pain,it leaves me feeling dejected sad and angry.Thank you for all the information and thanks to all who leave comments.I think it helps to talk with others who actually know RA.

    Reply
  • September 15, 2017 at 11:22 am
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    My Rheumatoid Arthritis started back in 2011. I was brushed off with plain Arthritis. It wasn’t until Oct 2015 that a dr tookbit serious. My fingers in joints are all twisted? Anyways I have fought w sever depression chronic pain n fatigue. I have been on Humira for 6 months still no change. I am at my wits in. Will this ever work.

    Reply
  • January 6, 2018 at 8:49 pm
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    I’m 67 yrs old and was diagnosed 10 yrs ago; however, in hindsight had RA pain and symptoms 30 yrs ago. Four weeks ago my internist put me on a total grain-free diet. He provided me an article which said this diet could greatly benefit inflammation caused by RA. I’ve been getting different infusions for RA over 9 yrs and am currently taking Actemra which has worked the best by far. The good news is after being on the grain-free diet for four weeks, I am pain free. I wake up with complete mobility in my hands and knees. An additional perk has been a weight loss of 14 pounds. AARP also has a bit in it’s latest magazine advising people to “wave off the bread because a family of proteins found in wheat has been linked to an increase in inflammation and may worsen the symptoms of RA, plus those of asthma and inflammatory bowel disease”. This is an easy diet to maintain and I am thrilled with the results. I haven’t felt this good in years.

    Reply

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