Sunday, 6 April 2014

Feeling tired all the time

Feeling tired all the time

Fatigue is a major component of rheumatic diseases. Despite its high prevalence, recognising and treating it remains an unmet need. In ankylosing spondylitis and rheumatoid arthritis, up to 70% of patients are affected by fatigue. It has a profound effect on physical and psychosocial outcomes in rheumatic conditions.

          Fatigue is caused by a host of factors. It means that no one single treatment may improve or cure fatigue. An individual but yet wholistic view of fatigue is necessary to address multifactorial nature of the symptom.

The multifactorial nature of fatigue also means that is not easily measured or assessed. Fatigue measurement include the use of the functional assessment of chronic illness therapy-fatigue (FACIT-F) or short-form 36 (SF-36) vitality scores. Assessing both the frequency and severity of fatigue is important.

Fatigue is caused by
  • Biological factors
Eg. Cytokines that are produced during inflammation such as TNF-a, IL-1, IL-6, IL-12, IL-17 can cause central effects to cause fatigue. Using biologic drugs to block these signals in treating inflammatory arthritis may improve fatigue.

  • Physical activity
Eg. lack of or inability to exercise

  • Sleep
Eg. disrupted or poor sleep, imbalance of rest and activity

  • Drugs
Eg. few studies report the impact of drugs on fatigue. Disease modifying drugs  in RA improve fatigue but the effect is small.

  • Nutrition
Eg. inadequate nutritional intake

  • Emotional
Eg. Depression, anxiety, stress

  • Other medical conditions
Eg. anaemia, diabetes, renal impairment

Steps that can be taken include pacing, exercise, sleep hygiene and treating the underlying condition. There are useful resources by Arthritis Research UK (ARUK) and patient groups NASS and NRAS on managing fatigue.

In managing fatigue the confounding factors such as depression, sleep disorders and pain need to be evaluated and managed. This is an area for active research in the future especially on the effect of fatigue in arthritis and its impact on work. The challenge is to link the clinical observations of fatigue with the immunologic, biochemical and genetic data, so that there can be a wholistic understanding of why some feel tired all the time.


Views are my own. These are opinions and cannot replace the need to see your physician for review of your individual medical condition.

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