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
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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.
Eg. lack of or inability to exercise
Eg. disrupted or poor sleep,
imbalance of rest and activity
Eg. few studies report the impact of
drugs on fatigue. Disease modifying drugs
in RA improve fatigue but the effect is small.
Eg. inadequate nutritional intake
Eg. Depression, anxiety, stress
Eg. anaemia, diabetes, renal
impairment
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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.
@synovialjoints
Views are my own. These
are opinions and cannot replace the need to see your physician for review of
your individual medical condition.
