Check out Fight Back Against Fatigue: A Psoriatic Arthritis Patient’s Guide for more information on this topic.
If you have psoriatic arthritis and find that fatigue is preventing you from participating in your usual activities, know that you’re not alone.
In fact, you’re among the nearly half of people with PsA who say fatigue has a greater impact on everyday life than skin issues (though joint pain still ranks as most problematic), according to a 2016 study published in the journal Joint Bone Spine.
Fatigue in a chronic condition like psoriatic arthritis is more than feeling tired.
Psoriatic arthritis fatigue is usually due to a combination of many different causes, which means that treating fatigue requires addressing each of those causes. Fatigue can be due to:
- Chronic pain
- Itchy or irritated skin
- Certain medications
- Co-occurring medical conditions
Depending on the underlying cause of your fatigue, different treatments may be needed, such as:
- Lifestyle changes (diet, exercise, weight loss, practicing self-care, knowing your limits)
- Medication adjustments (changing the dose, timing, or class of medication)
- Therapy and mental/emotional help through support groups
The good news is that there are a lot of steps you can take — both with your doctor and on your own — to help manage and reduce fatigue related to psoriatic arthritis.
To get you started, we asked health experts and CreakyJoints members for effective daily routine changes to try when you feel “exhausted by exhaustion.”
Improve sleep hygiene
“As obvious as this sounds, good sleep and good sleep habits are important in controlling pain and fatigue,” says Rebecca Haberman, MD, Clinical Instructor of Rheumatology at NYU Langone Health in New York City. Make one change today to improve your sleep hygiene. This can include any of the following:
- Perform a relaxing bedtime routine, like listening to calming music or soaking in a warm bath
- Skip large, heavy, high-fat meals, as well as alcohol or caffeine, close to bedtime
- Stop using your phone, tablet, and other electronic devices close to bedtime
- Set your home’s temperature to 60 to 67 degrees Fahrenheit (the ideal sleep temp, according to the National Sleep Foundation)
Move for five minutes
It may sound counterintuitive to get physical activity when your energy levels are low, but a little movement can go a long way. Research shows that exercise can help fight fatigue in a number of different ways, including by reducing inflammation, increasing endorphins, preventing deconditioning, and improving sleep.
“Get up and walk up and down the stairs a few times or around your home,” says Alexis Ogdie, MD, Director of the Penn Psoriatic Arthritis Clinic in Philadelphia and Associate Professor of Medicine at the Hospital of the University of Pennsylvania.
Agrees Dr. Haberman: “Even a short, brisk walk is helpful in helping to manage fatigue. Make it something manageable.”
Track your steps
Activity trackers (like a pedometer, Fitbit, or Apple Watch) can help you move more throughout the day. One study published in the journal Arthritis Care & Research found that people with rheumatic and musculoskeletal diseases who used activity trackers took an average of 1,520 more steps per day than those who didn’t use the wearable devices.
“Maybe you got 2,000 steps yesterday, and you can get a few more today,” says Dr. Ogdie, who encourages patients with psoriatic to invest in an activity tracker, which can be motivating to move more.
Switch it up
“The day you feel least like getting off the couch is the day it’s most important to get off the couch,” says Susan Bartlett, PhD, a Professor of Medicine at McGill University in Canada. While you don’t want to push yourself too far, you do want to try something different if resting isn’t working. “Even if it’s a 15-minute walk outside in the sun,” she says.
Try some tai chi
Incorporating low-impact activities like swimming or tai chi in your day can help ease fatigue, recommends Saakshi Khattri, MD, a board-certified dermatologist, rheumatologist, and internist at Mount Sinai in New York City. A study published in the journal BMJ found that tai chi eased symptoms of fibromyalgia (which is a common cause of fatigue in PsA patients) more than aerobic exercise or physical activity that benefits the cardiovascular system.
Stand up and take a tech time-out
“When we spend too much consecutive time in front of the screen, on the couch, sitting in a chair, the consequences of that can be tiredness,” says Dr. Bartlett.
Take methotrexate close to the weekend
Methotrexate is a common cause of fatigue in patients with PsA, but adjusting your medication can help, says Dr. Ogdie, who recommends taking the medication, which is often given weekly, on Friday or Saturday so you can rest and recover over the weekend. On the other hand, if you’re someone who wants more energy for the weekend, consider taking your methotrexate on Sunday nights or early in the week.
Try teletherapy for mental health support
Virtual mental health can be very beneficial for those coping with overwhelming fatigue. One big plus: It eliminates the exhaustion of getting ready to leave the house and traveling from point A to point B. “Some therapists can help you identify coping strategies to manage fatigue in day-to-day life and overcome the roadblocks in your way,” says Dr. Ogdie.
Do something you love
When you stay in the present moment and focus on doing something you love — whether cooking, drawing, reading a good book, or watching a funny movie — you’re better able to cope with your fatigue, according to a 2020 study published in the journal Arthritis Care & Research. Researchers say this is because mindfulness helps increase psychological flexibility, or the ability to stay in contact with the present moment regardless of unpleasant thoughts, feelings, and bodily sensations (including fatigue).
Decide what’s really a priority
When you’re feeling fatigue, it’s important to learn how to procrastinate wisely. Prioritize what needs to be done over what may be less essential. “Ask yourself what’s reasonable,” says Dr. Bartlett. “Maybe the floor can go another week without being washed.”
Zoom with a friend or family member
Social connections can help fight fatigue because we can get energy from being around other people. This is challenging during the COVID-19 pandemic, especially when you have underlying health issues and are trying to stay home as much as possible. Use virtual platforms like Zoom and FaceTime to make sure you’re connecting with loved ones, suggests Dr. Bartlett.
Use a meditation app
Dr. Ogdie, who recommends the app Calm, suggests meditation before bed to set the stage for a good night’s sleep, which is crucial for fighting fatigue. Other popular apps to consider: Insight Timer, Headspace, Buddhify, Unplug, Simple Habit.
Members of the CreakyJoints Psoriatic Arthritis Patient Council shared their own strategies for coping with fatigue, based on years of managing their chronic conditions.
Know your limitations
“Never be afraid to know your limitations,” says Diane T. “Pushing yourself will only do more damage in the long run.”
“If you know you aren’t feeling up to things, it’s okay to say no. Better to say no and save yourself instead of pushing yourself and causing harm,” says Eddie A.
Go for a quick walk
“It doesn’t matter if it’s in the house or outside; movement helps,” says Jaime H.
Take a bath
“Soaking in the tub cures many things,” says Eddie A.
Schedule self-care in your routine
“Having a routine helps tremendously with fatigue,” says Ashley K., who says her routine includes self-care and some work, “to keep things moving and keep from completely succumbing to the fatigue.”
Sip a cold decaf drink
Jaime H. says a cold drink helps her feel awake, especially on hot and humid days in Florida, where she lives. “I don’t rely on caffeine because it can backfire and make it harder to sleep later,” she says.
“Break daily tasks up into smaller pieces to give yourself time to rest while completing your goal,” says Diane T.
If you work, taking quick breaks throughout the day can help you collect yourself and re-energize. If you work in an office, get a change of scenery for a 10- to 15-minute break in a conference room or head to your car for a quick rest, says Jaime H. “When that wasn’t an option, I was not above sitting in a bathroom stall to close my eyes for a few minutes,” she admits.
“Fatigue episodes make me anxious and I spiral down into depression because I don’t know how long it is going to last, can’t plan social activities, and get concerned about being able to work,” says Frances D. “Support from other PsA patients has helped me not feel alone and full of despair.”
You can start by following CreakyJoints on Facebook, Twitter, Instagram, or TikTok to connect with other chronic illness patients who are going through similar issues as you.
Communicate, communicate, communicate
Communication means asking for help from others in your household, sharing how you feel with friends and family, and talking to others going through something similar to “help your mental energy,” says Ashley K., who adds, “I owe my fellow autoimmune warriors a debt of gratitude for their support.”
Communication also means talking to your health care providers about your fatigue symptoms and working together to find solutions to help you feel better.
Both patients and health care providers agree that managing fatigue requires a well-rounded approach that may include adjusting and/or supplementing your medication regimen, managing your mental health, and making other healthy lifestyle changes.
Perhaps the first (and most important) step is to speak up. “If fatigue is a major problem, make sure you tell your doctor, even they don’t explicitly ask,” says Dr. Haberman.
Read about how to talk to your health care provider about fatigue.
This article is part of Fight Back Against Fatigue: A Psoriatic Arthritis Patient’s Guide and was made possible with support from Janssen Pharmaceuticals, Inc.
10 Tips for a Better Night’s Sleep. National Sleep Foundation. https://www.thensf.org/sleep-tips.
Gudu T, et al. Fatigue in psoriatic arthritis – a cross-sectional study of 246 patients from 13 countries. Joint Bone Spine. July 2016. doi: https://doi.org/10.1016/j.jbspin.2015.07.017.
Hegarty R, et al. Understanding fatigue‐related disability in rheumatoid arthritis and ankylosing spondylitis: The importance of daily correlates. Arthritis Care & Research. April 2020. doi: https://doi.org/10.1002/acr.24224.
Interview with Alexis Ogdie, MD, Director of the Penn Psoriatic Arthritis Clinic in Philadelphia and Associate Professor of Medicine at the Hospital of the University of Pennsylvania
Interview with Rebecca Haberman, MD, Clinical Instructor of Rheumatology at NYU Langone Health in New York City
Interview with Saakshi Khattri, MD, a board-certified dermatologist, rheumatologist, and internist at Mount Sinai in New York City
Interview with Susan Bartlett, PhD, a Professor of Medicine at McGill University in Canada
Katz P, et al. Physical Activity to Reduce Fatigue in Rheumatoid Arthritis: A Randomized Controlled Trial. Arthritis Care & Research. January 2018. doi: https://doi.org/10.1002/acr.23230.
Wang C, et al. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ. March 2018. doi: https://doi.org/10.1136/bmj.k851.