Managing Fatigue in Inflammatory Arthritis: Practical Tips and Strategies

For many people with inflammatory arthritis, fatigue can be as debilitating as pain

Living with inflammatory arthritis can feel like a relentless cycle of pain, stiffness, and, perhaps most debilitating of all, fatigue. While the physical symptoms of arthritis are well-documented, fatigue often remains misunderstood, even by those experiencing it. Unlike typical tiredness, arthritis-related fatigue can feel like wading through wet cement — heavy, overwhelming, and hard to shake. It's elusive, inconsistent and hard to 'treat'.

Understanding Fatigue in Arthritis

Fatigue in inflammatory arthritis isn’t just about feeling tired. It’s a pervasive, bone-deep and mental exhaustion that can’t be fixed with a nap or a good night’s sleep. It can really affect our mood and influence our outlook on life to one that is less optimistic. According to research published in Rheumatology, up to 80% of people with rheumatoid arthritis report experiencing significant fatigue, and similar rates are seen in other inflammatory conditions, including psoriatic arthritis and lupus.

It's not clearly understood why this happens. We can understand that the immune system’s ongoing inflammatory response may be using up a lot of energy, causing feelings of exhaustion. Also that sleep disturbances caused by pain, and the emotional toll of managing a chronic condition, can contribute.

Practical Tips for Managing Fatigue

While there’s no single solution, there are things to try that may help manage and mitigate fatigue:

1. Pacing Your Day:

   • Our energy is like a battery. To prevent it running too low or burning out, we need to consider breaking tasks into smaller, manageable steps. You may have heard an occupational therapist suggest the "4 Ps" method: Plan, Prioritise, Pace, and Position. Taking a snapshot of activity over a week or two (using a diary or even just piece of paper and pen) can help us see where our 'energy burdens' lie and can give us an insight into where changes might benefit us. For example, if a weekly grocery shop wipes you out, try breaking it into two smaller trips instead of one long one or ordering online. A few small adjustments might help save us a bit of energy.

2. Energy Conservation Techniques:

   • Try alternating between physically demanding tasks and restful activities. We don't always have full control over our days (especially when it comes to things like employment) but small steps such as sitting or 'perching' on a tall stool while cooking, take rest breaks during household chores, and use adaptive or lightweight tools to reduce any extra pain and strain on sore joints.

3. Sleep Hygiene:

   • A solid sleep routine can be transformative but it's a golden chalice that many of us struggle to find. It can help if we keep a consistent bedtime routine, but again this can be tricky if you have young children or others to look after. It is said to help if we limit screen time (TV or digital accessories) an switch them off an hour before sleep. We could also consider relaxation techniques like deep breathing or listening to a guided meditation.

4. Mindful Movement:

   • Gentle, low-impact exercises like walking, swimming, stretching, or tai chi can help maintain joint mobility and boost energy levels - if we can manage them. The key is to plan what works for you to help stay active and keep within your limits without overdoing it. Its a good idea to start with short sessions, see how you go then only gradually increase as tolerated - don't go straight into boom and bust!

5. Mind-Body Techniques:

   • Fatigue isn’t just physical. Stress and anxiety can exacerbate feelings of mental exhaustion too. Mindfulness, journaling, and even short breathing exercises can offer a much-needed reset, perspective and sense of calmer restfulness.

6. Nutrition and Hydration:

   • It goes without saying that staying hydrated and nourishing our body with nutrient-dense foods can also have a positive impact on energy levels. Aim to avoid sugar crashes by opting for balanced meals that include lean proteins, whole grains, and plenty of fruits and vegetables.

     
     

     

     
     

Evidence-Based Resources and Articles:

• A comprehensive review on fatigue in rheumatoid arthritis published in Arthritis Care & Research highlighted the importance of pacing and cognitive-behavioral strategies.

• Versus Arthritis offers accessible, patient-friendly advice on managing fatigue.

• A systematic review in BMC Rheumatology discusses the effectiveness of exercise programs tailored to people with inflammatory arthritis.

Final Thoughts...

Managing fatigue in inflammatory arthritis is an ongoing process, and it’s important to remember that what works for one person may not work for another. Aiming for a balance that works for you is going to be key. It may take a bit of trial and error but by listening to your body, pacing yourself, and incorporating supportive strategies, it will hopefully be possible to reclaim some energy and live more fully. However, if fatigue feels unmanageable, speak to your healthcare team or ask for a referral to an occupational therapist who can help tailor a plan that works for you.

Try not to be too hard on yourself too - you are managing as best you can and thats OK!