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Fatigue in Rheumatoid Arthritis

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Rheumatoid Arthritis related image Photo: Getty Images

Fatigue is one of the most significant symptoms of rheumatoid arthritis (RA), perhaps second only to joint pain. It has been reported to affect 40 to 80 percent of RA patients. Possible causes for fatigue include anemia, inflammatory cytokines, pain, sleep disturbance, and depression. A recent medical journal article suggests that patients don't always complain about fatigue to their doctors, because they assume it's inevitable.

Since anemia has also been reported in about 50 percent of RA patients, a research team in Brazil looked for a correlation between anemia and fatigue. Anemia of inflammation is believed to be related to the body's sequestration of iron, as part of our defense against microbes. However, they found no association between hemoglobin levels and degree of fatigue. There was instead a correlation between fatigue and the Disease Activity Scores (DAS) for general health and number of swollen and painful joints.

Inflammation has been associated with fatigue in many situations. I know I always feel fatigued with any kind of infection: cold, flu, stomach bug, etc. A research group in Philadelphia studied fatigue in relation to inflammatory factors in RA patients, and found the following:

1. Weak association with erythrocyte sedimentation rate and swollen joint count
2. Weak to fair associations with tender joint count, physician global assessment of RA activity, and Disease Activity Score (DAS28)
3. Strong correlation with patient global assessment of severity

They concluded that fatigue is not an inflammatory variable.

A British group found that fatigue in RA patients is correlated with poor sleeping patterns, possibly due to joint pain and discomfort at night. These authors suggest more attention to treatment of insomnia.

Fatigue is also related to depression in RA patients. An article from University of Kansas School of Medicine recommends assessment of pain, fatigue, and depression together in rheumatology practice.


1. Escobar ME et al, “Anemia versus disease activity as cause of fatigue in rheumatoid arthritis”, Acta Rheumatol. Port. 2010; 35:24-8.

2. Bergman MJ et al, “Is fatigue an inflammatory variable in rheumatoid arthritis (RA)? Analysis of fatigue in RA, osteoarthritis, and fibromyalgia”, J Rheumatol. 2009 Dec; 36(12): 2788-94.

3. Goodchild CE et al, “Daytime patterning of fatigue and its associations with the previous night's discomfort and poor sleep among women with primary Sjogren's syndrome or rheumatoid arthritis”, Musculoskeletal Care. 2010 Jun; 8(2): 107-17.

4. Wolfe F et al, “Predicting depression in rheumatoid arthritis: the signal importance of pain extent and fatigue, and comorbidity”, Arthritis Rheum. 2009 May 15; 61(5): 667-73.

Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.

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EmpowHER Guest

I was 36 years old and my 2nd child was one year old when I noticed one of my fingers was inflamed, swollen. The swelling wouldn't subside. Tests showed RA (Rheumatoid arthritis). Then progressively other joints started to get affected and I had much pain, dressing myself was very painful. I would ring my mother in tears not knowing what was happening to my body. I tried numerous medicines nothing worked. Finally, the rheumatologist suggested i try natural medicines and suggested NewLife Clinic, i immediately ordered their Rheumatoid Arthritis Herbal formula and start on the 3 months treatment plan, the treatment is totally incredible, i had a total decline of symptoms with this treatment, the pains, stiffness, swelling, body weakness and skin redness has subsided. Visit NewLife Clinic website ww w. newlifeherbalclinic. com or email info @ newlifeherbalclinic. com. Incredible!

August 24, 2017 - 3:56pm
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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