Fatigue is an enigma: Everyone seems to know what it is, but a detailed definition is hard to provide. Like water, it slips away and cannot be grasped. There are no laboratory tests, no magnetic resonance image can quantify it objectively, and no specific treatment is available.
Fatigue is a common and often severe complaint. In the adult US population, 9.4% have fatigue during at least one month1, and as many as 22% of working adults were fatigued in The Netherlands2, as summarized in the article by Bergman, et al in this issue of The Journal3.
When a patient with rheumatoid arthritis (RA) starts talking about fatigue, the doctor will look for anemia, hypothyroidism, and other treatable explanations first. But when fatigue persists, the doctor does not know what to say: as a patient with RA recently told me, “Doctors do not seem able to understand or to handle fatigue, so despite the fact it is one of my main problems, I stopped talking about it in the clinic.” This fits in with the findings of a postal questionnaire among Dutch rheumatologists4, and with in-depth studies in UK patients, most of whom did not discuss fatigue with their clinicians, but when they did they felt it was dismissed5.
Fatigue is a significant problem for people with rheumatic diseases as it contributes to many aspects of life. Studies have found the prevalence of fatigue in RA patients to be 88%—98%6. Patients with osteoarthritis (OA) experience notable amounts of fatigue and indicate it has substantial impact on their lives7.
Fatigue can be both physical and cognitive, manifesting as inability to think clearly, concentrate, or be motivated to do anything5. Patients perceive their fatigue as unmanageable and unresolving, and professional support is rare8.
http://jrheum.org/content/36/12/2630.fullexcellent article.. I've not felt as validated about my fatigue as after reading this.WOW!!- Author Affiliations
Objective. To investigate whether fatigue is an inflammatory (rheumatoid arthritis; RA) variable, the contributions of RA variables to fatigue, and the levels of fatigue in RA compared with osteoarthritis (OA) and fibromyalgia (FM).
Methods. We studied 2096 RA patients, 1440 with OA, and 1073 with FM in a clinical setting, and 14,607 RA, 3173 OA, and 2487 patients with FM in survey research. We partitioned variables into inflammatory and noninflammatory factors and examined variable contribution to fatigue (0–10 visual analog scale).
Results. Factor analysis identified Disease Activity Score-28 (DAS28) and swollen (SJC) and tender joint count (TJC) as a physician-inflammation factor, and patient global assessment, pain, Health Assessment Questionnaire, and fatigue as patient components. Fatigue demonstrated weak correlations with erythrocyte sedimentation rate (ESR; r = 0.071) and SJC (r = 0.112), weak to fair correlations with TJC (r = 0.294), physician global assessment of RA activity (r = 0.384), and DAS28 (r = 0.399), but strong correlation with patient global assessment of severity (r = 0.567). In hierarchical regression analysis, patient global explained 43.1% of DAS28 fatigue variance; when SJC, TJC, and ESR were entered, the explained variance increased to 43.7%. In reverse order, SJC, TJC, and ESR explained 9.2% of the variance, but explained variance increased to 43.7% when patient global was added. The mean clinic fatigue scores were RA 4.9, OA 4.8, FM 7.6; mean survey scores were RA 4.5, OA 4.4, FM 6.3. Adjusted for age and sex, RA and OA fatigue scores were not significantly different.
Conclusion. Inflammatory components of the DAS28 contribute minimally to fatigue. RA and OA fatigue levels do not differ. Fatigue is not an inflammatory variable and has no unique association with RA or RA therapy.
It's pretty much my number one complaint. I'm learning to live with the stiffness and pain but the fatigue is killing me! My RD gave me Provigil that is supposed to keep you awake and help with sleep apnea related fatigue. I think it's also used for narcolepsy as well. It's not too effective so far. It's not the feeling tired that is the worst though, it's the inability to think clearly and to bring myself to do things. It's really getting old though.