What is fatigue?

Fatigue is a really common symptom experienced by most people at some time in their lives. It’s that feeling of persistent tiredness, exhaustion or low energy levels. Fatigue is often described as having many dimensions by patients:

• physical fatigue – not having enough energy to do physical activities,
• cognitive fatigue – less ability to concentrate and focus,
• emotional fatigue – feeling upset, distressed, and
• living fatigue – inability to carry out daily tasks and social activities.

Some patients may describe their sense of fatigue as overwhelming, not being helped by sleep, and it may top their list as their most disabling symptom.

What causes fatigue?

There are several medical causes for fatigue, some of which can be serious, so it’s important that a patient is screened for these. It is also true that patients with many rheumatic conditions, including fibromyalgia, polymyalgia rheumatica, ankylosing spondylitis, Lupus, rheumatoid arthritis, Sjogren’s syndrome and even osteoarthritis commonly complain of fatigue. For example, fatigue affects up to 4 in 5 of patients with rheumatoid arthritis, and is felt to be severe by half of these. Fatigue associated with arthritis may be related to underlying inflammation, anaemia or medications, but for a large component of arthritis-related fatigue, the cause is unknown. The fact that some disease-modifying anti-rheumatic medications seem to have a beneficial effect on arthritis-related fatigue suggests that inflammation has a pathological role, but it is also likely that fatigue occurs (and persists) due to a combination of medical (e.g. level of inflammation), psychosocial and person-specific factors (such as mood and social support). Some studies have shown that fatigue is associated with mood and pain levels.

The effects of fatigue,

Studies have shown that inflammation can affect neural chemical pathways and the brain, which in turn can lead to fatigue, pain and depression. Patients often report negative effects on their wellbeing, mood, relationships and work. With rheumatoid arthritis, patients’ fatigue has been found to contribute to more than half of the problems these patients experience with physical and social functioning. Unsurprisingly, fatigue is associated with time off work and lack of productivity when at work.

How can we measure fatigue?

Healthcare professionals can use certain scoring systems to calculate the impact and severity of fatigue, and also response to interventions. The best ones capture the multiple areas that fatigue affects and are reliable, valid, sensitive and acceptable e.g. the Bristol Rheumatoid Arthritis Fatigue Scale, the widely-used SF36 and the Chalder Fatigue Scale, which is used in chronic fatigue syndrome.

What should we do?

• Seeking medical advice. It is essential to check whether there might be an underlying medical cause that might need further investigation and specific treatment. Whereas there are many medical treatments to stem inflammation in patients with arthritis-related fatigue, fatigue often persists, and there are other evidence-based treatments that may help.
• Increasingly healthcare professionals are encouraging self-management of fatigue through talking therapies such as cognitive behavioural therapy (CBT), which can have lasting effects on reducing fatigue in some conditions. Initially, CBT usually involves a series of sessions with a CBT therapist, which are designed to explore and challenge health beliefs and ideas about fatigue, followed by resetting or reframing these beliefs and developing achievable goals.
• Trying to conserve energy is often advised, and a useful mnemonic is the Four Ps:
  • Problem solving – how to use less energy when my fatigue levels are high.
  • Planning – how to spread out energy-draining tasks over time to lessen their impact.
  • Prioritising – how to try and do the tasks that are important first.
  • Pacing – how to break tasks down into achievable chunks and allow for rest periods in between.

An Occupational Therapist may be able to assist with these.

• Some medications that are used in depression treatments can interestingly also help with managing fatigue. These need to be prescribed and medically supervised. If persistent pain accompanies the fatigue, the patient might well benefit from seeing a Pain Specialist.
• Exercise – ensuring that the patient sees a good physiotherapist, osteopath or chiropractor is essential for helping to develop a manageable exercise programme. Although doing too much can increase fatigue levels, a lack of exercise reduces fitness levels and contributes to muscle weakness (deconditioning). Exercise therapy may be useful in some patients with persistent fatigue. It’s usual to start slowly and to build up gradually under the supervision of a therapist.

For more information, please look at the Versus Arthritis website information:

https://www.versusarthritis.org/about-arthritis/managing-symptoms/managing-fatigue/