For Autoimmune Disease Patients, Fatigue Isn't Just Another Word for Being Tired

The fatigue suggests tiredness and maybe sleepiness. But the fatigue experienced by many patients with an autoimmune disease is much more than that and results in complex array of problems and challenges.

In addition to making it difficult, fatigue affects a number of areas, including quality of life, pain, sleep, depression and physical functioning.

In a recent Danish study of 487 patients with rheumatoid arthritis, psoriatric arthritis and axial spondyloarthritis published in PLOS ONE, the researchers found “significant correlations” between fatigue and work impairment, quality of life, pain, sleep, depression and physical functioning.

Patients with these disease, sometimes grouped under the term “inflammatory arthritis, say that fatigue is an issue that rheumatologists frequently overlook, so they often believe they should accept fatigue as a part of their condition,” wrote Bente Appel Esbensen of the Copenhange Centre for Arthritis Research, and her Danish colleagues.

Bente Appel Esbensen

“However, based on the complexity of fatigue as we identified, rheumatologists and other health professionals instead need not only to be aware of the impact of fatigue on the individual patient’s life, but also to focus their care specifically on the relationship of fatigue with other aspects of the patient’s everyday life,” they wrote.

In the study, patients with the three different inflammatory disorders had around the same level of fatigue. However, fatigue was more present in women, patients who had the disease for a longer period of time, and patients who changed medication in the past 12 month. It was also more common among those who were unemployed, who had less education, and who had lower household income, the researchers found.

“Low socioeconomic status is shown to be associated with obesity and unhealthy behaviors such as smoking, heavy alcohol use, and physical inactivity,” the researchers wrote. “It is important not only for rheumatologists but for all health professionals to be aware of patients with widespread fatigue and whether patients also have low socioeconomic status, because they are expected to be more vulnerable.”

Fortunately, more clinicians are recognizing the need to manage fatigue in inflammatory arthritis patients, the researchers said.

There are some ways to help address fatigue, including mindfulness, exercise, and cognitive behavioral therapy. “However,” wrote Esbensen and her colleagues “these studies have mainly focused on patients with RA (rheumatoid arthritis) and have not necessarily considered fatigue as a multidimensional symptom. Our results suggest this needs to be considered in future planning of interventions.”