What Causes Rheumatoid Arthritis Fatigue?

Medically Reviewed

Weary. Exhausted. Bone-tired. Have you used these words to describe your own situation recently? Do you have rheumatoid arthritis (RA)? If so, you’re like many people with the condition: Fatigue affects between 40 percent and 80 percent of those with RA.

Much of the time, fatigue associated with RA is persistent and severe. People with RA report that the fatigue they experience is different from the normal sense of tiredness we all feel from time to time. The fatigue that accompanies RA can be almost as debilitating as the pain and stiffness caused by the disease. It’s also typically described as unpredictable and overwhelming. Sometimes it seems that no amount of sleep is enough to eliminate the weariness.

While some studies have identified a possible correlation between disease activity and fatigue, others have not. And it’s not clear which, if any, RA medications may help with disease-related fatigue. Despite these questions, there’s a lot you can do to help manage this problem.

Suspected factors

Although fatigue is a well-noted symptom of RA, it is not clear whether it is caused directly by the disease process or is the result of other problems. Some experts believe that several factors combine to cause fatigue in people with RA, including:

• The degree of inflammation, pain and physical impairment.

• Mood swings (thoughts, feelings and behaviors), especially depression.

• Personal life issues.

• Gender; women are more likely to suffer from fatigue than are men.

Two studies recently examined the underlying factors contributing to RA fatigue. The first study, published in 2015 in RMD Open, assessed fatigue in 626 adults (average age, 57) with RA over eight years. The researchers found that people with higher levels of inflammation, marked by swollen or tender joints and increased C-reactive protein levels, experienced more fatigue than those with less inflammation.

Although people who took the disease-modifying antirheumatic drug (DMARD) methotrexate or other drugs such as steroids experienced a reduction in pain and physical impairment, their fatigue persisted. Fatigue was more severe in women than in men, and younger participants were more likely to remain fatigued over time. This could suggest that factors other than disease activity may be responsible for RA-related fatigue.

Suspected non-disease-related factors were investigated in the second study, published in 2015 in Arthritis Care & Research. Researchers interviewed 158 adults, ages 48 to 70, with RA who had been managing the disease for an average of 21 years; most were white females. The researchers found that, in addition to RA pain and stiffness, the primary factors associated with fatigue included poor sleep, depression, obesity and inactivity. Because exercise improves energy, mood and sleep quality, say the researchers, increasing physical activity could lead to improvements in the other factors, too.