Simple Fatigue Fighters for Psoriatic Arthritis

Patient Expert
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When was the last time you leapt out of bed full of zest for the day ahead? Probably a while ago. Or certainly before you developed psoriatic arthritis. Fatigue, low energy, and exhaustion are some of the toughest parts of having this chronic inflammatory condition. Half of all people with PsA struggle with fatigue, and some mightily; a third say their lack of energy is severe, according to research published in the journal Rheumatology.

Short of a magic potion, where can you find more energy? We pumped a bunch of sources–rheumatology experts, popular PsA bloggers, and our friends on social media–to find out.


But First: Why You’re So Tired

Scientists still puzzle over why fatigue hits some people with PsA so hard, but it likely stems from a complex mix of physiological, psychological, and social factors. Technically defined as a feeling of exhaustion and lessened physical and mental capacity, it may be explained in part by the immune system working overtime.

“It seems that the inflammatory state is the driving force behind chronic tiredness,” explains Arthur M. Mandellin, M.D., Ph.D, an associate professor of medicine at Northwestern University in Evanston, IL. “We often find that if we can lift the inflammatory burden, we don’t need to do anything separate about fatigue, because the exhaustion goes away naturally.”


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Why Lax Treatment Fuels Fatigue

If you’re inclined to hold back on taking your meds, at least be aware that this can affect your energy levels. “It’s important for patients to realize that if they are minimizing their medication use and choosing instead to live with a little pain, a little swelling, and a little skin disease, they are in essence choosing to live with incompletely resolved fatigue, too,” explains Dr. Mandellin. “The best solution we know of is to push for tight control of the inflammatory burden, to attempt to shove the disease as far into dormancy as we can reasonably get it.”


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Try Being a Stickler

To control inflammation well, medications like biologics are often needed, says Dr. Mandellin. He adds that even though you may be weary of using biologics or think it might be easier living with a little bit of tiredness, the result of holding back can be a more difficult disease course.

Following medicine dosages as prescribed and being open and honest with doctors if a medication isn’t working (so you can think through another plan), will do more for energy levels and overall health than veering off your treatment course or stopping medications altogether.


Why Mornings Are Rough

Mornings can be an especially low-energy time for people with PsA, likely due in part to hormone levels. “Cortisol, one of the body’s key natural anti-inflammatory hormones, is less abundant at night and peaks [later] in the morning,” says Dr. Mandellin. “Therefore we suspect that our patients are simply ‘bottoming out’ when they first wake up, waiting for their cortisol to kick in." In some cases, though, the wait can take hours.


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Try Rescheduling Your Meds

To counter the morning energy dip, Dr. Mandellin instructs some patients to take a steroid-based anti-inflammatory such as prednisone as soon as they wake up. “Prednisone and drugs like it mimick cortisol and support this natural morning rush that the body is expecting,” Dr. Mandellin says. That boost can give you the get-up-and-go you need to really start your day.


Why Emotions Can Make Things Harder

Feeling down and depressed can be draining for a lot of reasons, but there is a physiological one at play: Depression can affect levels of dopamine and norepinephrine, two neurotransmitters that can impact your ability to fall asleep, stay asleep, and get enough restorative sleep. If you're not snoozing, you have even less energy to do the things that can actually help you feel better (and thus the vicious cycle begins). Thankfully, there are a number of ways to tackle depression and raise up a low mood.


Try Setting Small Goals

Victories are energizing, so try setting yourself up for one or more every day. This strategy works for Judy Lenn, 68, who has had psoriasis and psoriatic arthritis for 10 years. “What gets me through a difficult flare is setting a goal every day. It can even be something as simple as writing a letter to one of the boys I sponsor through Compassion International or World Vision.”

Each little accomplishment propels you toward the next one, which can help you reverse that vicious cycle into something much more positive. Lenn adds: “Goals keep me moving, especially when I don’t feel like doing anything—which is when I need to move the most!”


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Why Exercise Helps

Although you might find it difficult to walk, stretch, and move your body much when you’re having an arthritis flare, keeping at it can have a huge impact on your energy level and quality of life. Exercise of almost any type  keeps your joints and tendons looser and limber, and can help reduce inflammation and pain of psoriatic arthritis, according to the National Psoriasis Foundation.


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How to Stay in Motion (Even During a Flare)

Try parking at the far end of the lot when you go to the store, or sticking to your dog-walking schedule instead of asking someone to take over for you. Finding even little ways to stay active will make a difference.

David Parker, a father of six with psoriatic arthritis, swears by the “stay in motion” approach. “Once I get up in the morning, I keep moving and don’t stop,” he says. “If I stop, then it’s hard to get going again. On weekends when I know I have yard work, I don’t stop until it’s all done.”


Why Self-Care Is Energizing

“On the days I need more energy, I listen to my body. By following its lead, resting and sleeping when it wants, I'm able to accomplish more than if I fought my body,” says Cynthia Covert, a psoriatic arthritis advocate and blogger at The Disabled Diva. “Indulge in a little self-care like reading, meditating or just listening to some upbeat music. This will give you body the time it needs to recharge and take on the rest of the day.”


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Why Laughter Helps

“Having a positive mind and positive outlook with this disease is everything,” says Emily Hertzberg, psoriatic arthritis advocate and blogger at Psoriatic Arthritis Warriors, who was diagnosed with PsA at age 23.  "I try to embrace my good days and smile and laugh through the pain on my bad days. It helps boost my mood and energy. Laughing and having a positive outlook just gives me strength and determination to get through the day when it feels like I can’t sometimes.”


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Where to Find the Funny

Laughter also soothes tension, stimulates circulation, and helps your muscles relax—all of which can help reduce some of the physical symptoms of stress, according to the Mayo Clinic. So if it’s been a while since you’ve had a knee-slapper, hunt around for material that works for you. Turn on a favorite TV show or comedy bit. Watch silly YouTube videos. Filter for comedy. Some of our faves include clips from comedian Sebastian Maniscalco, reruns of Parks and Recreation and The Big Bang Theory, and anything by Celeste Barber on Insta!