From the Guidelines
Elevated histone levels with fatigue should be addressed through a comprehensive approach that incorporates physical activity, psychoeducational interventions, and evaluation of inflammatory disease activity status, as recommended by the 2023 EULAR guidelines 1. To manage fatigue associated with elevated histone levels, consider the following strategies:
- Offer access to tailored physical activity interventions and encourage long-term physical activity, as supervised physical activity interventions have been shown to reduce fatigue in people with inflammatory rheumatic and musculoskeletal diseases 1.
- Provide access to structured and tailored psychoeducational interventions, which can help reduce fatigue by exploring thoughts, feelings, and behaviors related to fatigue 1.
- Evaluate inflammatory disease activity status and consider immunomodulatory treatment initiation or change if clinically indicated, as pharmacological interventions that reduce disease activity can also reduce fatigue 1. Additionally, consider the following general recommendations:
- Ensure adequate sleep (7-9 hours nightly) and stay well-hydrated with 2-3 liters of water daily.
- Incorporate stress management techniques, such as daily meditation or deep breathing exercises, to help alleviate fatigue.
- Review current medications and consider adjusting or deleting medications that may contribute to fatigue.
- Assess for noncancer comorbidities and optimize management of these conditions to improve fatigue symptoms 1. It is essential to note that fatigue can be a complex symptom with multiple underlying causes, and a comprehensive evaluation and management plan should be tailored to the individual's specific needs. If symptoms persist after 2-3 weeks of these interventions, consult with a healthcare provider for further evaluation, as elevated histone levels could be related to underlying conditions such as inflammatory rheumatic and musculoskeletal diseases or other comorbidities.
From the Research
Elevated Histone and Fatigue
- Elevated histones have been linked to various diseases, including inflammatory diseases, autoimmune diseases, and sepsis 2, 3.
- Histones play a crucial role in regulating the innate immune response, and their modifications can affect the expression of defense genes 2, 4.
- Fatigue is a common symptom in many of these diseases, but there is no direct evidence linking elevated histones to fatigue.
- However, it is possible that the inflammatory response triggered by elevated histones could contribute to fatigue, as inflammation is known to affect energy metabolism and cause fatigue 4, 5.
- Further research is needed to fully understand the relationship between elevated histones and fatigue.
Histone Modifications and Inflammatory Diseases
- Histone modifications, such as acetylation and methylation, play a significant role in regulating inflammation and are associated with various inflammatory diseases 4.
- Studies have shown that histone acetylation levels can vary daily and are affected by circadian rhythms, which could impact the development of inflammatory diseases 6.
- Elevated histones have been found to trigger exacerbated inflammatory and coagulation responses, depending on the cell type affected 3.
Autoinflammatory Disorders and Histones
- Autoinflammatory disorders are characterized by unchecked activation of the innate immune system, and histones have been implicated in the pathogenesis of these disorders 5.
- Biologic therapies targeting specific components of the innate immune system have provided clinical benefit in treating autoinflammatory disorders, highlighting the importance of understanding the role of histones in these diseases 5.