Why so tired? Factors contributing to fatigue in rheumatoid arthritis patients

This study examined whether sleep disturbances, depression, obesity and low exercise are associated with fatigue in patients with rheumatoid arthritis.

Fatigue is common among patients with rheumatoid arthritis (RA). The cause of fatigue in RA patients is currently unknown. Identifying factors which can cause fatigue is important in order to be able to reduce fatigue in RA patients. Previous studies have shown that poor sleep and mood disturbances play a role in fatigue. However, the impact of other factors such as obesity and physical inactivity on fatigue has not been determined.

This study involved 158 RA patients. Patients reported their quality of sleep, whether they experienced depression and their level of physical activity. Muscle strength and body mass index (BMI – measure of body fat based on weight and height) was assessed in patients. Fatigue was measured as the average fatigue over 7 days.

27.2% of patients experienced poor sleep. 41.1% of patients experienced depression (moderate or severe). 52.5% of patients reported physical inactivity, while 52.5% of patients were also obese.

Poor sleep, depression and obesity were associated with fatigue in RA patients. Lower levels of physical activity play a role in fatigue, likely due to the impact of low physical activity on poor sleep, depression and obesity. 

This study concluded that fatigue in RA patients may not be due to the disease activity. Rather, fatigue may be due to numerous factors such as low physical activity, obesity, depression and sleep disturbances, rather than the severity of the disease itself. 

The number of patients experiencing poor sleep, depression and physical inactivity was based on patients self-reporting. The study would have benefited by having control groups. Groups for patients without depression, with good quality sleep, a low BMI and high physical activity should have been established. 

Consult your physician regarding the options available to reduce fatigue, including increasing physical activity, treating depression and treating obesity.