Why does rheumatoid arthritis cause severe fatigue?

Question

Hello doctor,

I am 43, and I have been dealing with severe fatigue along with joint pain for a few months. My doctor recently diagnosed me with rheumatoid arthritis. The joint pain has been difficult, but what worries me even more is the overwhelming fatigue.

I never realized that rheumatoid arthritis could cause this kind of exhaustion. Why does RA at the age of 43 cause fatigue that feels so different from ordinary tiredness? I feel like I have been shut down from head to toe even when I have had eight hours of rest.

Everyone thinks that I am being lazy, but I am sure it goes far beyond laziness. Some days I find it very difficult to even take a shower. I have tried to beat it, but I am still not able to work like before.

So far, I have begun the medicine that the physician has prescribed for me, but my fatigue level has not gone up significantly. This makes me wonder whether it is not working or whether my disease is tougher than it should be.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

The fatigue that you are experiencing is most probably due to the ongoing inflammation caused by rheumatoid arthritis (RA). In some people, fatigue can actually be the most prominent symptom of autoimmune diseases.

Sometimes, it may also be related to secondary fibromyalgia occurring alongside rheumatoid arthritis. It is also important to rule out any other autoimmune conditions that may overlap with RA.

In my opinion, you should increase the Prednisolone dosage up to 20 mg per day for two weeks and Methotrexate up to 25 mg once per week. The administration of Tryptazole (Amitriptyline) at 10 mg at bedtime and Milnacipran at 12.5 mg per day, slowly increasing the dose each five days to 50 mg per day, may be helpful in case of fatigue, whether this condition is associated with active rheumatoid arthritis or secondary fibromyalgia.

The patient will be considered for biologic therapy if there is no significant improvement during one month.

Probable causes are:

Active rheumatoid arthritis (RA).
Secondary fibromyalgia.

Investigations to be done are:

Complete blood count (CBC).
Erythrocyte sedimentation rate (ESR).
C-reactive protein (CRP).
Antinuclear antibody by immunofluorescence (ANA by IF).

I would suggest the following treatment:

Prednisolone 20 mg per day.
Methotrexate 25 mg once per week.
Folic acid 10 mg once per week.
Tryptazole (Amitriptyline) 10 mg at bedtime.
Milnacipran 12.5 mg per day, slowly increasing the dose each five days to 50 mg per day.

One-month follow-up before making a decision on the addition of biologic therapy.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.