Fatigue is one of the most common complaints of patients suffering from autoimmune diseases like systemic lupus erythematosus, rheumatoid arthritis, Sjogren’s Syndrome, autoimmune thyroiditis, or Crohn’s disease.
But fatigue is different from just being tired.
You most likely feel tired after a night of not sleeping well or after finishing an intense workout.
What is fatigue?
Most of my patients with autoimmune disease will describe fatigue as a persistent, overwhelming, and uncontrollable state of tiredness that interferes with their daily activities. Fatigue is that feeling of being constantly won out and drained of energy. This may cause you to miss work, create difficulties in engaging with your family and limit your performance or ability to do routine activities and hobbies. In time, people experiencing fatigue will lose interest in their life, creating frustrations and problems in their relationships with others who do not understand fatigue.
What are the seven most common causes of fatigue in people with autoimmune diseases?
1. Persistent inflammation
People with autoimmune diseases deal with excessive inflammation. The number one cause of fatigue is ongoing, persistent inflammation. For example, in patients with rheumatoid arthritis with an uncontrolled disease with persistent swollen and painful joints, the uncontrolled inflammation induces fatigue. Why? Your immune system is in a constant battle with your body, which will consume much of your body’s energy.
Anemia is a disorder where your blood has fewer red blood cells or less hemoglobin than normal. Hemoglobin is an iron-rich protein in your red blood cells, allowing them to carry oxygen from your lungs to all your tissues. If you are anemic, less oxygen reaches your tissues, which will induce this state of “fatigue”. Inflammation can influence your red blood cells (due to improper use of iron) to carry less oxygen to your tissues.
Ongoing and uncontrolled inflammation in autoimmune diseases can cause anemia of chronic disease.
However, anemia in people with autoimmune diseases can be related to the disease directly affecting the bone marrow (like in systemic erythematous lupus) or due to exposure to medications that can affect the bone marrow red cells production (like methotrexate, cyclophosphamide or rituximab). The excessive use of nonsteroidal anti-inflammatory medications or NSAIDs (like ibuprofen, naproxen) can cause gastrointestinal bleeding that can lead to anemia. That is why , talk to your doctor before taking any medications.
3. Thyroid dysfunction
Autoimmune diseases can affect your thyroid, causing autoimmune thyroiditis or Hashimoto’s disease (hypothyroidism). But inflammation and severe chronic diseases (e.g lupus, Sjogren’s disease) can also affect your thyroid and decrease the level of your thyroid hormones. That will slow down your metabolism and cause fatigue.
4. Vitamin D Deficiency
Vitamin D deficiency causes fatigue, muscle weakness, and cognitive impairment. Interestingly, patients with autoimmune diseases (e.g lupus, rheumatoid arthritis) are frequently found to be deficient in vitamin D. Patients with lupus tend to avoid the sun or use sunscreen, which will decrease the vitamin D activation that needs to happen in the skin. Vitamin D deficiency was recently associated with an increase of 22% in the risk of developing autoimmune diseases. So, when you have an autoimmune disease and feel fatigued, ask your doctor to check your vitamin D level yearly. If your vitamin D level is low, ensure you get proper supplementation from your doctor. If you do not suffer from lupus, spend 10 minutes in the sun to activate your vitamin D.
5. Medication-induced fatigue
Treatments in autoimmune diseases tend to be very powerful and require special attention and frequent monitoring, from clinical visits to laboratory tests. Some medications can have fatigue as a side effect. For example, methotrexate is notorious for causing fatigue and sometimes depressed mood. However, using folic acid or leucovorin supplementation can counteract the fatigue feeling.
Depression is also a well-known cause of fatigue. Dealing with an autoimmune disease can be very challenging for your body and mind. After all, your mind and body are well connected. Dealing with chronic pain can also cause anxiety and depressed mood. Some researchers support the idea of antibodies that can cause inflammation at the brain level and cause mood changes.
7. Sleep disturbance
Patients with rheumatoid arthritis or psoriatic arthritis may experience extensive episodes of pain that can lead to many sleepless nights. Dealing with pain can cause difficulties in falling asleep or staying asleep. Patients experiencing pain frequently wake up to reposition their bodies to feel better. This will affect their sleep pattern. Poor sleep or sleepless nights lead to chronic sleep deprivation, poor concentration, and memory, decreased work performance, and fatigue. Unfortunately, less sleep will cause more pain, creating a vicious cycle.
Tips for managing fatigue in autoimmune diseases
Fatigue can have a profound, negative impact on your life. I often educate my patients about managing their bodies while dealing with an autoimmune disease.
Here are a couple of techniques you can use to minimize fatigue and its impact on you.
One of the best ways to stay productive throughout the day is to plan your activities, and it turns out that it is also beneficial when dealing with fatigue. By planning your activities and sticking to them, you will not only have a clear picture of what you are going to do, but you will also have control over how much work you have. You know your limits, so do not plan too much when you can. You can plan meals and shopping and schedule some time for self-care.
Planning is a great tool, but another skill you need is prioritization. Sometimes, we have a lot of things we have or want to do, so it is essential to make a list of priorities and address those before other things. These can be for work, family life, hobbies, necessities (including sleep), and even people you need to meet. The truth is, you can’t do everything, so learn to say “no” to things that aren’t on your list. It isn’t being rude; it’s maintaining your health. That way, you can stay on track and feel good.
There are days when you can get everything you want to be done, but there are others you cannot, whether it be because you’ve bitten off more than you can chew or simply because you aren’t feeling well. You must learn that it’s okay if you can’t complete everything you have put on your list, and from there, adapt. Reconsider your goals and make new goals that are smarter and more achievable.
It’s easy to surround yourself with work, especially during busier and tougher periods. This is normal, but never forget to prioritize connecting with yourself and other people. This is a must. Not only will you feel less tired, but it will boost your mood and help you be more productive. So, even on your busiest days, take a few breaks. Practice a breathing or relaxation technique, write in a gratitude journal, or stare out the window and admire your surroundings. I frequently teach all of these mindful techniques in my office, but if you are interested in learning them, you can find them in my online course. Also, remember to connect yourself with family, friends, and other patients. You’ll be able to express your feelings and struggles and learn from others. Check out my Facebook community “Autoimmune and Arthritis Support Group” if you want a positive and supportive group.
This is an educational article that aims to broaden your knowledge, but it does not offer you medical advice. If you have an autoimmune disease, like rheumatoid, and need help, you are welcome to check out our practice and get the help you need when you need it the most. Rheumatologist OnCall is a telemedicine rheumatology practice that broadens access to a specialist in a very short time when you need it the most and breaks geographical barriers. Check out the states where we are licensed to see patients in the US and reach out to us if needed. We are happy to serve you.