When people think of psoriatic arthritis (PsA), many immediately think of symptoms like joint pain. However, between 30 percent and 40 percent of people with PsA experience fatigue — an extreme sense of exhaustion that does not improve with rest.
Fatigue is an often underestimated symptom of PsA, but it can be severe. Fatigue can affect a person’s cognitive (mental) and physical functioning and interfere with their daily life. Together with other PsA symptoms, fatigue can negatively affect a person’s overall well-being and quality of life.
Understanding this fatigue may help you minimize its effects. Here is what you need to know about fatigue in PsA, including what causes it and how to manage it.
Many MyPsoriasisTeam members have shared how PsA-related fatigue affects their daily lives. One member wrote, “I feel exhausted during the day, especially after work, and take a nap. Then, I can’t sleep at night. When I do, I never feel refreshed. Ugh! When does it end?”
Another member shared that it takes them “ages to go to sleep.” They added, “Then I wake up hours early and lay awake again. When it’s time to get up, I finally want to sleep. I go on like this until the fatigue hits where I’m so tired I can hardly put one foot in front of the other, then sleep during the day. By night, it all starts again.”
One member explained that they live with several conditions that contribute to their fatigue: “On top of my arthritis, I have thyroid problems, which add to the fatigue, so it’s sort of a double whammy.” They added, “When the arthritis is really painful, it’s so tiring, but I still cannot get to sleep. Then, when I do eventually snooze, it’s for very short spells at a time throughout the night. I find I want to sleep during the day when I need to be alert and refreshed to go out to work, but it is something I have just had to put up with over the years. Now it’s a way of life that I am used to.”
PsA is an autoimmune disease that affects how the immune system works and leads to inflammation. Fatigue in psoriatic disease is often triggered by inflammatory processes. Fatigue may also be the result of certain medications used to treat PsA, as well as other complications associated with the disease.
The chronic (long-term) joint pain commonly experienced by people with PsA is a major contributor to fatigue. Joint pain can also hinder a person’s ability to stay physically active, which can further worsen their fatigue.
Sleep disturbances are common in PsA. In fact, nearly 90 percent of people diagnosed with psoriatic disease have trouble sleeping. In many cases, this difficulty is due to “painsomnia” — insomnia (difficulty sleeping) due to chronic pain or discomfort. PsA symptoms like joint pain and swelling can cause a person to have difficulty getting a good night’s sleep.
Losing sleep contributes to fatigue and can even make PsA symptoms worse. In this cycle, poor-quality sleep causes the brain to become fatigued. A tired brain then becomes less effective at dampening pain signals. In other words, pain starts to feel even worse, which can then make getting to sleep even harder.
Depression and other mental health conditions are major factors in fatigue for people with chronic inflammatory diseases like psoriasis. Depression and PsA can intensify one another, leading to worsened symptoms like fatigue.
Anemia refers to a low red blood cell count. People with PsA are more likely to develop anemia, which can lead to fatigue. Two types of anemia may occur in PsA: iron-deficiency anemia and anemia of chronic disease (anemia of inflammation).
People with psoriatic disease are more prone to developing iron deficiency. Iron is a mineral that the body needs but can’t make on its own. Humans take in iron through plant- and animal-based foods. Iron-deficiency anemia, which is the most common type of anemia occurs when the blood doesn’t have enough healthy red blood cells. Red blood cells play a key role in the production of iron. Extreme fatigue, weakness, and lightheadedness are a few common symptoms of iron deficiency.
Anemia of chronic disease occurs when chronic inflammation prevents the body from using the iron it has stored to create red blood cells. Inflammation may also change how the body produces erythropoietin, a hormone that manages the creation of red blood cells. This type of anemia appears to develop more in individuals with inflammatory arthritis such as PsA.
Some of the medications used to treat PsA can contribute to fatigue. These medications include types of methotrexate (sold as Trexall, Otrexup, or Rasuvo) and cyclosporine (Sandimmune, Neoral, or Gengraf). Other medications, including antidepressants and those for anxiety and pain, may cause fatigue in people with PsA. Biologic treatments can also cause extreme fatigue.
As one MyPsoriasisTeam member wrote, “I am on day three of Otezla. Doctor said it could take three to four months before I feel any relief from my psoriatic arthritis. I feel extremely fatigued. Can’t decide if it is my PsA or the Otezla.”
Living with comorbidities (other health conditions) — such as psoriasis, fibromyalgia, or depression — may affect your sleep quality and contribute to fatigue.
If fatigue is interfering with your daily activities, talk to your rheumatologist or health care provider. Your doctor may need to run tests to see if there’s another issue that could be causing your fatigue. After determining the cause of your fatigue, your doctor may recommend certain changes — such as adjusting your PsA treatment or making lifestyle changes — to help control your fatigue. Be sure to speak with your doctor before trying any new therapies.
If your doctor suspects that your fatigue is caused by the PsA medication you’re taking, they may recommend changing your treatment. Let your doctor know if you notice any changes in your levels of fatigue after changing medications, adjusting your dosage, or starting a new treatment for PsA. You can work together to find a medication or combination of treatments that keep your PsA under control while lessening fatigue.
Eating a nutritious diet may help keep fatigue at bay. Try to avoid fatty foods and opt for lean protein, whole grains, and fresh fruits and vegetables instead. Eating fresh, homemade meals instead of prepackaged food is also typically a healthier option. Try not to eat late at night — especially anything particularly heavy or rich.
If dietary issues may be contributing to your fatigue, your doctor may refer you to a licensed dietitian. This specialist can create a diet plan with the right nutrients for your needs.
Your doctor may recommend taking dietary supplements, such as vitamin D, B vitamins, minerals, or multivitamins, to help manage fatigue. Some people with psoriatic disease have said that omega-3 fish oil supplements have helped them with severe fatigue. Never try a supplement without asking your doctor about it first, as they may know about the benefits or side effects of these supplements that you’re unaware of.
Fatigue and PsA symptoms may make physical activity seem impossible, but getting regular exercise can actually boost your energy levels. The U.K.’s NHS notes that a 15-minute walk can have a positive impact on your energy levels. Rather than aiming for intense workouts, start slowly and work toward building a consistent exercise routine.
One MyPsoriasisTeam member offered the following advice: “Just keep moving. You are doing your best. Look at your diet. See if you can add any natural inflammation cessation to your daily routine.”
Allow yourself to rest and take breaks when you are feeling fatigued. It may be helpful to spread out your daily chores and activities with planned rests in between.
One member shared how they handle life when fatigue hits: “When I’m fatigued, I try to keep my daily routine but just go through the motions and get the basics done. I still go to Pilates but put very little effort in.”
Keeping a fatigue diary can help you identify what factors or situations may be contributing to your fatigue. In this journal, you can record the days and times when you’re fatigued and how long the fatigue lasts. You could also record:
This information can help you and your doctor uncover patterns in your fatigue and identify how to help prevent fatigue.
MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis as well as their loved ones. More than 111,000 members come together to ask questions, give advice, and share their experiences with others who understand life with psoriasis or PsA.
Have you experienced fatigue with psoriatic arthritis? How have you managed it? Share your experiences and tips in the comments below or by posting on MyPsoriasisTeam.