Can rheumatoid arthritis (RA) cause fatigue?

Rheumatoid Arthritis and Fatigue

Yes, rheumatoid arthritis definitely causes fatigue. Fatigue is prevalent in people with rheumatoid arthritis and is one of the most challenging symptoms to cope with due to its invisible, pervasive and unpredictable nature. 1

Understanding RA-Related Fatigue

Fatigue in rheumatoid arthritis is different from normal tiredness and has several important characteristics:

• People with RA describe fatigue as overwhelming, intrusive, distressing and draining them of physical and mental energy 1
• It significantly impacts quality of life and daily functioning 1
• Survey evidence shows that one out of every two people with inflammatory rheumatic diseases experience severe fatigue 1
• Fatigue persists even when disease activity is low or in remission 1, 2

Mechanisms of Fatigue in RA

Fatigue in RA is multifaceted with several interconnected pathways:

1. Inflammatory processes:

   • Pro-inflammatory cytokines (IL-1, IL-6, TNF-alpha) contribute directly to fatigue 3, 4
   • The immune system, central and autonomic nervous systems play roles in fatigue induction and maintenance 1, 3

2. Non-inflammatory factors that significantly contribute:

   • Pain 5, 4
   • Sleep disturbance 2, 5
   • Depression and mood disorders 5, 6
   • Physical inactivity 2, 6
   • Obesity 2, 5
   • Other comorbidities 5

Impact of RA Fatigue

The consequences of fatigue in RA are substantial:

• Significantly reduces quality of life 1, 2
• Leads to social withdrawal and isolation 1
• Associated with increased healthcare costs 1
• Contributes to employment loss and work disability 1
• Causes absenteeism and presenteeism 1

Clinical Implications

Healthcare professionals should be aware that:

• Fatigue may be present even when disease activity appears controlled 1
• Medications targeting RA inflammation have modest effects on fatigue 2, 5
• Some medications (like methotrexate) may actually contribute to fatigue 5
• Fatigue should be routinely monitored and assessed in RA patients 1

Management Approaches

The 2023 EULAR recommendations suggest:

• Tailored physical activity programs 1, 5
• Psychoeducational interventions including cognitive behavioral therapy 1, 6
• Immunomodulatory treatment when clinically indicated 1
• Patient-centered approach considering individual needs, preferences, disease activity, and comorbidities 1

Important Caveats

• Fatigue in RA is often underrecognized and undertreated despite its significant impact 1
• The causes of fatigue may change over time with disease progression or treatment 3
• Fatigue management requires a tailored approach as mechanisms vary between individuals 1
• Women with RA tend to experience more severe fatigue on average 5

Understanding that fatigue is a legitimate and significant symptom of RA is crucial for both patients and healthcare providers to address this challenging aspect of the disease.