Psoriatric arthritis (PsA) is an autoimmune disease that can cause swollen, painful joints and inflamed, itchy patches on the skin. Fatigue often accompanies these symptoms. In fact, fatigue may be the first symptom many people develop with psoriatic arthritis.
The fatigue from PsA may overwhelm some people with the condition, but there are many ways to manage this symptom.
How does psoriatic arthritis lead to fatigue?
Fatigue, also described as being tired or exhausted, refers to a physical or mental state of feeling run down or lacking in energy. People with PsA are prone to fatigue for a number of reasons.
People with PsA may experience fatigue for a number of reasons, including the release of cytokines in the body.
PsA is an inflammatory condition. Inflammation often causes fatigue. When inflammation is present in the body, proteins called cytokines are released as a byproduct of the inflammatory process.
These proteins are the same proteins released by the body when it is fighting a cold or flu. They are linked to fatigue and conditions like anemia, obesity, and depression. These conditions are more common in people with PsA and may also contribute to fatigue on their own.
Additionally, people with PsA and other chronic pain conditions may find themselves fatigued for other reasons.
Pain from PsA may disrupt sleep cycles, causing people with the condition to wake feeling unrefreshed and fatigued even after a full night's sleep. PsA pain may also make it difficult to go to sleep at night, even when tired.
Dealing with the chronic pain of PsA may cause fatigue. Having chronic pain requires a lot of mental energy as the the pain must be dealt with every day. This can create a vicious cycle. The fatigue can make the pain seem worse and the worsening pain may cause more fatigue.
Living with a long-term, painful condition like PsA can put a person at increased risk of depression and anxiety. Both depression and anxiety can contribute to increased levels of fatigue in turn.
Finally, medications for pain and managing PsA may cause side effects that include fatigue. Some medications prescribed for PsA may not cause fatigue directly but instead may disrupt nighttime sleep cycles, leading to increased daytime drowsiness.
Knowing the cause of fatigue
People with PsA often experience periods of flare-ups, when symptoms such as fatigue may be worse. If fatigue is associated with a period of increased PsA symptoms, the fatigue is likely to be caused by the PsA itself.
However, persistent fatigue may be related to a condition that exists alongside PsA. People with PsA are at a higher risk for many conditions that cause fatigue, including the following:
Chronic pain and fatigue can put people with PsA at risk for developing anxiety or depression.
It can be difficult to work out whether the PsA is causing fatigue or if it is due to another condition. A doctor should evaluate any person with PsA who experiences new or worsened fatigue.
When to see a doctor
Someone with PsA should see a doctor if their fatigue worsens or starts interfering with their life.
Someone who hasn't been diagnosed with PsA should see a doctor if they have a family history of psoriasis and begin developing symptoms of PsA themselves. These symptoms include:
- joint pain
- patches of inflamed red skin with silvery, white scales
A doctor can recommend a combination of lifestyle changes and medications that can make the fatigue associated with PsA more manageable. A doctor can also assess whether or not there are any other conditions that are contributing to greater levels of fatigue.
Lifestyle changes for managing fatigue
Though fatigue is a real problem for people with PsA, there are many ways to lessen its effects. Methods for managing PsA fatigue include the following:
Maintaining a healthy weight is important for people with PsA, as obesity may cause extra pain and fatigue.
- Getting exercise. Light exercise like walking or yoga can help energize people and may help loosen joints, easing pain. Exercise releases chemicals called endorphins that fight depression and boost mood and energy levels.
- Maintaining a healthy weight. Obesity contributes to fatigue and increased psoriatic arthritis pain. Keeping a healthy weight can lead to better energy levels.
- Building in time to rest. People with PsA should not try doing too much. Planning periods of rest or less physical activities can help the body have time to recover during the day.
- Asking for help. People with PsA should ask for help doing tasks they can't do on days when the fatigue is particularly bad.
- Getting enough sleep. This should be a top priority. The average sleep recommendations may not be enough to ease the fatigue, so people should figure out how much sleep they need to feel their best.
- Eating a healthful diet. Eating a sensible diet of whole grains, fruits, vegetables, and lean protein keeps the body energized without causing energy crashes.
People should avoid eating refined carbohydrates and simple sugars that may boost energy but lead to energy levels falling shortly after consumption.
These methods may not end fatigue permanently for people with PsA, but they can lessen it greatly.
If lifestyle adjustments do not make enough of a difference in a person's level of fatigue, they may need to alter medications or consider other treatment options.
Treatment options may include:
- Activating medications. These increase energy and may include some antidepressants and psychostimulants.
- Iron treatments. Excessive fatigue can be caused by underlying anemia, a condition where there aren't enough red blood cells in the body. Iron treatments can relieve fatigue by treating the anemia.
- Sleep aids. For people who have pain or anxiety-related sleep disturbances, prescription sleep aids may help increase the amount of restorative sleep each night. Getting more restorative sleep helps reduce fatigue.
- Therapy. Behavioral therapy can help fight fatigue related to anxiety, depression, or the burden of dealing with chronic pain.
A doctor should advise anyone with PsA on what course of treatment would best help with their PsA-related fatigue.