Check out Fight Back Against Fatigue: A Psoriatic Arthritis Patient’s Guide for more information on this topic.
Most people understand what you mean when you say you’re tired; we’ve all been there. When you’re tired, you feel as if your body is dragging. You might crave a bit more sugar and caffeine than usual for energy. Perhaps you can sneak in a short nap and wake up feeling a little perkier. You can’t wait to crawl under the covers and get a good night’s rest so you can wake up and feel better the next day.
But what if you wake up after seven to eight hours of sleep and feel as though you can barely get out of bed? What if you feel like you can’t mount the energy to do much of anything — and the persistent, nagging exhaustion keeps preventing you from participating in your usual activities?
This is fatigue, which is much different than feeling tired.
“Fatigue is a major symptom for roughly 30 to 40 percent of patients with psoriatic arthritis,” says rheumatologist 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.
Unfortunately, fatigue is one of the most misunderstood and underestimated parts of managing psoriatic arthritis (PsA). Family members, friends, colleagues, or even health care professionals may mistake it for being tired and tell you to “take a nap” or “go to bed earlier.” But as anyone living with PsA can tell you, fending off fatigue is not that simple.
“Fatigue is not quenched by sleep alone,” says Dr. Ogdie. “You have to break the cycle at multiple points and address different aspects of fatigue for it to lift.” Sleep is part of it, but you also have to address inflammation, pain, itchy or irritated skin, exercise, depression and anxiety, stress, other contributing health issues, and more.
We talked with experts and patients who live with psoriatic arthritis to learn more about the difference between fatigue and being tired. Understanding the distinction can help you better cope with the physical and emotional burden of this often unpredictable, overwhelming, can’t-shake feeling of exhaustion when you have psoriatic arthritis.
Defining Fatigue vs. Being Tired in Psoriatic Arthritis
Being tired means that your mind and body need sleep or rest — and that you are weary. It happens to all of us. Usually some short-term rest, a shot of espresso, a brisk walk around the block, or a cat nap can help us power through feeling tired.
In contrast, fatigue is a medical term that describes “a perception or feeling of how much energy a person has,” says Susan Bartlett, PhD, a Professor of Medicine at McGill University in Canada. Fatigue is not only exhaustion, but also reduced physical and mental capacity.
As MedLine Plus puts it, “fatigue is different from drowsiness. Drowsiness is feeling the need to sleep. Fatigue is a lack of energy and motivation. Drowsiness and apathy — a feeling of not caring about what happens — can be symptoms that go along with fatigue.”
Fatigue can differ from patient to patient and be hard to imagine or describe if you’ve never experienced it.
“Patients who have fatigue will immediately recognize it,” says Dr. Bartlett. “The tiredness is well beyond normal tiredness.”
The words “fatigue” and “tired” are not synonyms, but they do overlap, with fatigue being more toward the “extreme end of being tired spectrum,” says Saakshi Khattri, MD, a board-certified dermatologist, rheumatologist, and internist at Mount Sinai in New York City. “Fatigue is a feeling of tiredness with sometimes minimal exertion, even upon waking up in the morning.”
For CreakyJoints member Eddie A., who has been living with psoriatic arthritis for 18 years, the biggest difference is that “fatigue is from deep within. It is not circumstantial. You didn’t earn your fatigue; it was placed upon you.”
Exploring the Causes of Fatigue in Psoriatic Arthritis
Another key difference between fatigue and being tired is that the cause may be tougher to pinpoint. If you’re feeling sleepy, you may be able to quickly identify why. For example, maybe you were up late on a Netflix binge, woke up in the middle of the night to care for your child, or you got up earlier than usual to exercise or meet a work deadline.
With fatigue, the cause is often due to many factors. Chronic pain and inflammation from psoriatic arthritis can contribute to fatigue.
Not only is fatigue a red flag that your PsA is active and/or not well-controlled, but fatigue can also be a sign of other co-occurring health conditions, including:
- Low thyroid disease
- Sleep issues (often due to joint pain or itchy skin from PsA)
Understanding the cause of your fatigue is the first step toward feeling better, so making it part of the conversation with your rheumatologist, dermatologist, or primary care provider is a must. Be as detailed as possible about how fatigue is affecting your daily life.
Read more here about how to talk to your doctor about PsA fatigue.
“Patients are their own best advocates, so they should bring up fatigue if their doctors do not ask them,” says Dr. Khattri. “They should state how they feel, ask if the fatigue might be related to their disease or medications, or affected by co-occurring issues like depression or fibromyalgia, and discuss whether more effective treatment of their disease can help improve fatigue.”
Read more here about the different causes of PsA fatigue.
How PsA Fatigue Differs from Being Tired: What Patients Say
We asked several of members of our CreakyJoints Psoriatic Arthritis Patient Council to describe how fatigue differs from being tired. If any of these descriptors resonate for you, try sharing them with your health care provider or others who mistake the two.
- “With fatigue, I’m exhausted, but not necessarily tired. I need to rest and may or may not sleep well. I’m certainly not going to wake up refreshed.” — Ashley K.
- “When it comes to being tired, naps or a few hours of rest can solve your problem; on a good day, maybe even a cup of coffee. Fatigue takes it to another level. It’s a constant state of being tired in which the simplest tasks can cause me to lie in bed for 90 percent of the day.” — Diane T.
- “The ability to fall asleep is how I determine whether it’s fatigue or just being tired. When I am fatigued and I need rest, I’m not sleeping. I am just lying there; nothing in my brain is shutting off, everything is going full force except my body. If I am tired, I’m able to completely shut down and go to sleep.” — Jaime H.
- “I can’t push through fatigue like I can when I’m tired. Fatigue affects my whole body.” — Frances D.
Read more here about what fatigue feels like for people with psoriatic arthritis.
Managing Fatigue with Psoriatic Arthritis
Unlike feeling tired, a good night’s sleep isn’t a simple fix for fatigue, but it can help. In fact, developing good sleep habits (having a set bedtime and wake-up time, avoiding alcohol or caffeine close to bedtime, avoiding electronics close to bedtime, and using your bed for sleep and sex only) is an important part of dealing with fatigue. Depending on the underlying cause of your fatigue, your rheumatologist may also recommend the following:
- 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
Fatigue is complicated and feeling better is a gradual process, says Dr. Ogdie. “It may take time, but it is possible to get back on track and feel better.”
Read about some daily routine tweaks that can help with PsA 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.
Fatigue. MedLine Plus. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/003088.htm.
Haugeberg G, et al. Psoriatic Arthritis: Exploring the Occurrence of Sleep Disturbances, Fatigue, and Depression and their Correlates. Arthritis Research & Therapy. August 2020. doi: https://doi.org/10.1186/s13075-020-02294-w.
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 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
Krajewska-Włodarczyk K, et al. Fatigue – an underestimated symptom in psoriatic arthritis. Reumatologia.March 2017. doi: https://doi.org/10.5114/reum.2017.68911.
Pilgaard T, et al. Severity of Fatigue in People with Rheumatoid Arthritis, Psoriatic Arthritis and Spondyloarthritis – Results of a Cross-Sectional Study. Navarini L, ed. PLoS ONE. June 2019. doi: https://doi.org/10.1371/journal.pone.0218831.
Skougaard M, et al. Relationship Between Fatigue and Inflammation, Disease Duration, and Chronic Pain in Psoriatic Arthritis: An Observational DANBIO Registry Study. The Journal of Rheumatology. April 2020. doi: https://doi.org/10.3899/jrheum.181412.
What Is Sleep Hygiene? The National Sleep Foundation. https://www.sleepfoundation.org/sleep-hygiene.