Why does a 24-year-old with RA feel the urge to stay in bed?

Question

Hi doctor,

I am 24 years old, and I was diagnosed with RA some months back. I have noticed one aspect where everyone focuses on the joint pain, but there is little discussion about the extreme exhaustion that accompanies it.

There have been instances when, even after having had a proper night’s rest, I have felt that I could lie in bed the entire day. This has made me feel extremely lazy, even though I do everything in my power to give my best.

Any help in this regard will be appreciated.

Thank you very much.

Answer 1

Hi,

Welcome to icliniq.com.

Another feature that is typical of rheumatoid arthritis(RA) and many other autoimmune diseases is fatigue. This symptom may be especially pronounced in some patients.

In order to explain the presence of this symptom in people suffering from RA, there are several reasons. Firstly, inflammation is a source of constant tiredness in those individuals who experience it for a long time. Some other causes of fatigue in people with RA are anemia of chronic disease, lung involvement due to RA resulting in shortness of breath, low energy, and the presence of concomitant autoimmune disease such as hypothyroidism (Hashimoto's thyroiditis). The presence of secondary fibromyalgia accompanying RA and other autoimmune diseases is a source of chronic fatigue.

Thus, the first step to be done is to identify the cause using a comprehensive clinical examination supported by proper investigations. The list of recommended investigations includes complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine, thyroid-stimulating hormone (TSH), free T3 (FT3), free T4 (FT4), HRCT of the chest, and pulmonary function tests (PFTs).

This test will rule out some other possible reasons for fatigue, such as active RA, hypothyroidism, anemia, RA-induced interstitial lung disease (lung fibrosis), and secondary fibromyalgia.

Until the results of the tests are known, it will be proper to continue the present treatment program. But after the analysis, the treatment program can be modified in accordance with the identified reason for fatigue. Fatigue due to the active RA problem can be cured if the disease control improves. But if there is some secondary fibromyalgia or any other condition, then a new treatment plan may be needed.

An appointment will be fixed to discuss the results of the test and the plan for further treatment in conjunction with medical treatment. Physical therapy will be advised to maintain the joint movements and functions.

I hope this helps.

Do get back in case of any further queries.

Best wishes.