I was exhausted for many years prior to first flare up of RA. I thought something might be wrong health wise but nothing was found on exams, labs. I thought it’s from having a full time job, my son at that time was a toddler. I’ve been on biologics since fall of 2021. It was a roller coaster: Enbrel, Actemra, Rinvoq, Orencia, now back to Rinvoq. The only one that decreases my fatigue significantly is Rinvoq. I’m on it now. I still have aches, pain, migraines, stiffness- but they are manageable. I can exercise- aerobic exercise and weight lifting without being punished next day w pain and immobiIity . I take Tylenol and Tramadol for pain. Tramadol also contributed to my quality of life. I used to have days when I could not get out of bed from exhaustion and pain. From December 2021 through August 2022 I couldn’t work. Now I have maybe here and there tough day due to pain and stiffness, but energy level remains decent and steady. I have now a full time job since August 2022. Going to sleep before midnight for me is also critical. Something about going to bed early helps RA symptoms. I tried keto diet ( I did lose weight) but it was unsustainable for me and my energy level didn’t improve.
Exercise does help. Start low and slow.
Rinvoq though made the biggest deference .
Hope this helps.