Many people with rheumatoid arthritis are eager for tips to help manage fatigue, one of the most commonly reported RA symptoms. In fact, 93 percent of members surveyed on myRAteam reported experiencing fatigue, which can have a significant impact on quality of life. Furthermore, 70 percent of these members reported fatigue as a trigger that worsened their RA.

“I’ve been very tired and fatigued (which makes it all worse). How do you all deal with fatigue? Any tips?” one myRAteam member asked. “Sometimes I think the fatigue is worse than the pain,” another member wrote.

Rheumatoid arthritis fatigue can lead to drowsiness, exhaustion, difficulty concentrating, and physical weakness. RA fatigue is much more than ordinary tiredness and can be both physically and emotionally draining. Chronic fatigue from RA can affect mental health and make daily life and physical activity overwhelming. People with RA experience fatigue levels 4 to 8 times higher than those of the general public.

People with RA may feel uncomfortable bringing up fatigue with their rheumatologists or, if they do, may end up feeling dismissed or ignored. Fortunately, research on RA fatigue is expanding and standards of care for fatigue are improving. Meanwhile, you can take proactive steps to help manage fatigue and improve your overall health.

Here are five ways to manage RA fatigue.

1. Get More Exercise and Physical Activity

Research shows that exercise can improve RA symptoms and help people with RA function with more energy. Stretching, short walks, aquatic therapy, and yoga are all recommended exercises for people with RA.

“Look for chair exercises on YouTube. I especially like chair tai chi and chair yoga,” one myRAteam member suggested. Another member wrote, “I have exercised with my RA for many years, and with that and medication, I don’t get many flare-ups. I am 75, and I continue to walk and exercise.”

Appropriate routines that incorporate exercises for range of motion, flexibility, aerobics, and strengthening can improve physical and mental health for people with RA. Regular physical activity can help you maintain a healthy weight, strengthen muscles and bones, and reduce the risk of conditions such as cardiovascular disease, type 2 diabetes, and cancer.

Start slowly and build up your stamina over time. Talk to your health care team about exercise, and ask for a referral to a physical therapist who can develop an exercise program that is right for you, whether you enjoy going to the gym or prefer exercising at home.

“Have you discussed having hand therapy, occupational therapy, and physical therapy with your rheumatologist?” a myRAteam member asked. “They really helped me to be able to do everyday things.”

2. Eat a Healthy Diet

A healthy diet helps regulate energy highs and lows. Reducing sugar levels and pacing smaller meals throughout the day can help you avoid reactive hypoglycemia, otherwise known as a sugar crash. Other healthy eating habits can help reduce fatigue, including:

• Eating breakfast so you don’t get hungry (and deplete your body of fuel)
• Drinking plenty of water to prevent fatiguing dehydration
• Avoiding foods that might upset your stomach or cause heartburn, which may lead to poor sleep

Your doctor can provide a referral to a nutritionist who can help design a healthy diet for you.

A member said, “A healthy snack can give a boost — my favorites for that are unsalted nuts, dried apricots, or one or two dark chocolate candies.”

3. Practice Self-Care

Self-care is essential to managing RA fatigue. Knowing your limits and sticking to them is a good place to start. Sometimes, you may simply need to stop what you’re doing and sit down or take a rest.

“Try to rest more and don’t feel guilty,” said a myRAteam member. Another member advised, “Pick one day a week just for you. Relax, sleep in, or take a nap. Even if you do work, take one day on the weekend for you.”

Keeping a schedule you know you can manage is one way to take care of yourself and your well-being. Arrange your to-do list based on when you know you’ll have the most energy. One member wrote, “I do what I can in the morning because, if I don’t get my chores done early, I’m too tired in the afternoon. I try to rest more in the afternoon.”

4. Ask for the Help You Need

Often, the psychological anxiety of having an invisible illness — a condition other people don’t immediately recognize — can add to fatigue. Letting loved ones and friends know about your fatigue can help you better manage daily activities and social interactions. Family members and friends may need guidance when it comes to offering help.

If your workday is difficult to manage, reach out to your supervisor or human resources manager to discuss work schedules, working from home, or other accommodations that can help you get your job done without it being too fatigue-inducing.

You may also want to ask your health care provider for a referral for psychological counseling. Counseling and therapy can help relieve anxiety and give you tools and techniques to manage stress, mood swings, and communication with others.

Research has shown that psychological therapy can relieve fatigue. In one rheumatology study, people with RA who participated in cognitive behavioral therapy reported feeling less tired. They also reported better sleep.

5. Talk Openly About Fatigue With Your Doctors

Maintaining your RA treatment plan is important for easing symptoms of tiredness and fatigue. By reducing inflammation, chronic pain, and disease activity, you may also help reduce your fatigue. Researchers who conducted a review of 32 studies concluded that treatment for RA with biologic drugs can lead to a small to moderate improvement in levels of fatigue.

Be sure you are getting the support you need from your health care team. If you’re experiencing persistent fatigue, it’s essential to let your doctor know. Talk to your doctor about other conditions you may have, such as anemia (low levels of red blood cells), which could be contributing to fatigue. You may need additional tests to determine if you have a coinciding condition.

Your doctor can also review and adjust medications, as well as determine if you might benefit from supplements, a sleep aid, or an antidepressant to help improve your energy levels. Always get medical advice before taking any new supplements.

What Causes Fatigue in Rheumatoid Arthritis?

The causes of fatigue in RA are linked to the disease itself, along with related conditions that are commonly associated with RA. Chronic inflammation from disorders in the immune system may be a factor that leads to fatigue in people with RA. With inflammatory arthritis, such as RA, inflammation can cause feelings of sickness and lethargy.

Other symptoms and factors related to RA that can also contribute to fatigue include:

• Joint pain
• Depression
• Disability from RA
• Sleep disturbance, such as sleep apnea

A number of related health conditions — or comorbidities — that can occur with RA may increase fatigue as well, such as:

• Asthma
• Cardiovascular disease
• Chronic obstructive pulmonary disease (COPD)
• Diabetes
• Anemia (a possible side effect of methotrexate, which lowers levels of folic acid, or vitamin B9)
• Fibromyalgia

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 200,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.

Are you managing fatigue related to RA? Do you have tips on how to boost energy? Share your experiences in the comments below, or start a conversation by posting on your Activities page.