What Causes Rheumatoid Arthritis Fatigue? (UPDATED 2016)
Rheumatoid Arthritis fatigue is a weariness that rest cannot cure. It is tiredness without the benefit of the pleasure of activity. Over 90% of RA patients report fatigue as a symptom. It is counted second only to pain as the greatest difficulty of living with RA.
“Unlike normal fatigue, pathological fatigue does not improve with rest. This kind of fatigue is seen in most acute and chronic inflammatory diseases, including arthritis” (Louati and Berenbaum in Arthritis Research & Therapy, below)
Where does this weariness come from? What causes us to feel precisely like Superman with Kryptonite pushed in his face? Does anybody know?
Cytokines and Rheumatoid Arthritis Fatigue
Likely, there are multiple contributing factors. Most suspicious-sounding to me are the cytokines. These are chemicals which some scientists believe cause the fatigue of colds and flu. They are the chemical messengers of the immune system. There are over 150 different kinds of these protein-based molecules.
These chemicals are used by cells as a means of communication. Cells can talk to each other through cytokines, but in people with Rheumatoid Arthritis, excess amounts of them are produced and dumped off into the bloodstream. Some theorize that cytokines cause several RA symptoms, including fatigue, anemia, sleep problems, and skeletal muscle shrinkage (Conquering Rheumatoid Arthritis by Thomas Lee, Ph.D., p.47).
One reason that I’m willing to blame the cytokines is that they are reduced by TNF blocking medications (like Enbrel). And guess what results? Yes, usually fatigue is lessened. This is one of the reasons that fatigue is said by some to mirror disease activity or reflect inflammation levels: when medications slow inflammation, fatigue tends to improve.
The fatigue of Rheumatoid Arthritis is not caused by exertion. However, activity can aggravate it. It sounds like “heads I win; tails you lose.” Rest is critical to surviving life with Rheumatoid Arthritis, but it will not necessarily prevent fatigue.
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