9 Ways to Fight Back Against RA Fatigue

by Patty Onderko Health Writer

Rheumatoid arthritis (RA) warriors often say the lay-you-flat fatigue that comes with this disease is worse than the pain itself. Up to 80% of people with RA complain of tiredness, and more than 50% have high levels of fatigue, according to the Arthritis Foundation. “When your body is inflamed from RA, your body diverts its energy to healing,” explains Kevin Deane, M.D., Ph.D., a professor of rheumatology and rheumatologist at UCHealth at the University of Colorado in Aurora, CO. Worse, fatigue begets more fatigue. Don’t give up hope! These vitality-boosting strategies can help break the fatigue cycle.

Woman talking to her rheumatologist

Check in With Your Rheumatologist

If your RA isn't under control, your fatigue won’t be either. RA is a complex disease and your symptoms may change over time. Luckily, advances in treatment happen frequently and your arthritis—and bonkers exhaustion!—might benefit from a new or additional treatment. Although some RA drugs can cause fatigue (methotrexate, a weekly medication, for example, may cause tiredness in the day or two after it is taken), “most RA treatments are thought to improve fatigue by improving inflammation,” says Dr. Deane. If your energy level has dipped, start with a visit to your rheumatologist.


Meditate and Breathe

They’re more than just phrases on a mug. Studies have shown that meditation and mindfulness (including deep-breathing, present-moment awareness, and reminders to savor positive experiences) can help lessen pain, ease stress, and boost mood. One study looked specifically at mindfulness in RA patients. What they found will make you want to download a meditation app stat (like Calm or Headspace): Mindfulness strategies worked significantly better than both cognitive behavioral therapy for pain and arthritis education in reducing morning disability, daily stress, and fatigue—in the short and long term!

sleep alone

Ask for a Sleep Divorce

You know the basics: Avoid screens, caffeine, and alcohol before bed; sleep in a dark room; try relaxation exercises before hitting the hay. But more significant changes to your household sleeping arrangements might be in order to reduce sleep disturbances. If you share a bed with pets or children, work toward having them stay in their own space. If your partner snores or sheet-hogs, you may want to consider a “sleep divorce,” a.k.a. sleeping in separate beds, Brady-Bunch style, or in separate rooms. “A good night’s sleep can help you fight daytime RA fatigue—and spend more quality time with your partner.”

sleep app

Treat Insomnia Safely

If sleep-hygiene tips don’t work, you may have insomnia (trouble falling and/or staying asleep at least three nights a week for three or more months), a common symptom of conditions that cause chronic pain. In general, says Dr. Deane, sedative medications are not recommended for patients with RA; many have been associated with dementia, Alzheimer’s disease, and falls. But talk to your rheumatologist about the Rx amitriptyline, he says, which can help with both pain and sleep. Cognitive behavioral therapy for insomnia (CBT-I) can also be effective. Try an app like CBT-I Coach.

Red blood cells.

Check for Anemia

In addition to feeling like a zombie, do you have shortness of breath, dizziness, cold hands or feet, paleness, or chest pain? You might have anemia, a deficiency of red blood cells, which will compound your fatigue, says Laura Cappelli, M.D.,a rheumatologist and assistant professor of medicine at John Hopkins School of Medicine. Anemia can be caused by the RA itself, says the American College of Rheumatology, which RA treatment can resolve. Or, the anemia is ignited by something else, like low iron, and will need to be treated separately. A simple blood test can determine if anemia is behind your exhaustion.

thyroid exam

Check for Thyroid Issues

RA is, as you know, an autoimmune disease. People with an autoimmune condition are more likely to develop another autoimmune condition. (No, it’s not fair!) One of those conditions that often pairs up with RA is thyroid disease, says Dr. Cappelli. Low thyroid activity, hypothyroidism, causes—you guessed it—fatigue. It’s reasonable to ask your doctor for a blood test to check for hypothyroidism, she says, even if you don’t have some of the other symptoms of the condition, including weight gain, constipation, dizziness, muscle cramps, a hoarse voice, and dry, scaly skin.


Walk—or Swim or Bike—More!

You don’t have the energy to wash your coffee cup, let alone work out. Paradoxically though, exercise is one of the best ways to get some of that energy back. Multiple studies have found that low-impact exercise, two to three times a week, can reduce overall fatigue, possibly by helping you sleep better (just don’t exercise right before bed). Start slow and take it easy, says Dr. Deane. Work up to taking a 30-minute walk a few times a week. Hop on a stationary bike when you can. Try tai chi or water aerobics. And talk to your doctor about gentle strengthening and flexibility exercises.

Mediterranean diet

Eat Like the Greeks

Hello, olive oil! A Mediterranean diet—rich in whole grains, nuts and legumes, vegetables, fruits, some fish and dairy, and, yes, olive oil—is a healthy option for everyone, but especially if you have RA. These foods, unlike red meat and processed snacks and meals, actually fight inflammation, says Dr. Deane. A Mediterranean diet is also recommended for weight loss. Since extra pounds can increase fatigue, it’s worth giving a try—or at least cutting back on the number of times per week you get fast food. Plus, hummus is yummy!


Be Kind to Yourself!

RA FOMO is real. You may not be able to do all of the things you want to do or that your friends and family are doing and, well, that’s really hard. Your life has changed, and it's normal to be sad. RA experts and warriors all say the same thing, though: Accept the changes and focus on the positive to keep your spirits up and avoid depression (a major energy drain). After all, the lower your mood, the higher your fatigue. And, hey, you’ve got a great excuse to never mop the floors again! You also have a very real reason to slow down, appreciate all that you are capable of, and put less pressure on yourself.

Patty Onderko
Meet Our Writer
Patty Onderko

Patty Onderko is a writer and editor who has covered health, parenting, psychology, travel, and more for more than 20 years. She lives in Brooklyn, NY with her wife and two sons.