Study Suggests Disconnect Between Doctors and Patients Over Psoriatic Arthritis Fatigue

Everyone knows what it feels like to be tired, but most people down a cup of coffee or take a power nap and get on with their day. True fatigue, however, doesn’t respond to quick fixes. It can sap your energy so much that even basic tasks like cooking dinner or checking the mail might feel insurmountable. As patient advocate Eileen Davidson wrote in a recent article, “your body feels like it’s powering off like a dying battery.” 

Fatigue is incredibly common among people with inflammatory arthritis. Yet too often those around them — including the doctors who treat them — tend to focus mostly on their joints.

A new study, published in the Journal of Rheumatology, highlighted a concerning disconnect: It determined that 78 percent of people with psoriatic arthritis (PsA) experienced significant fatigue, yet providers only thought that a fraction of their patients (25 percent) had this problem. The researchers concluded that “prevalence of patient-reported fatigue was high among patients with PsA and underrecognized by physicians.” 

PsA is an inflammatory condition that’s characterized by skin and/or nail psoriasis as well as joint inflammation. People who have it are also at higher risk of developing diabetes, cardiovascular disease, and other immune diseases including inflammatory bowel disease. While fatigue might seem relatively unimportant compared to these other issues, ignoring it is a mistake, because it often makes other aspects of living with PSA far worse.  

In this recent study, PsA patents who had the highest levels of fatigue also had the highest levels of PsA disease activity and pain. They had more mental health problems (primarily anxiety and depression), struggled with work productivity, and had an overall lower quality of life as well.  

These findings were based on surveys completed by 831 patients who took part in the Adelphi Disease Specific Programme, a survey of American and Europeans with spondyloarthritis, which includes PsA. As part of this earlier research, patients were asked to rate their level of fatigue, and providers were asked to mark “yes” or “no” to indicate whether a given patient had fatigue.  

It’s not clear why physician and patient reports about fatigue were so often contradictory. There were some differences in the way each group was surveyed, so that might have been part of the problem. It’s more likely that some doctors were clueless because they neglected to ask patients about their energy levels — and the patients themselves never brought it up. Learn more about how to talk about your fatigue with your doctor when you have psoriatic arthritis so you can start feeling better. 

It’s also worth noting that fatigue is subjective and not easy to measure. Some clinicians use a formal assessment tool, such as the Fatigue Numeric Rating Scale (NRS) or Fatigue Severity Scale (FSS), but others simply assume that patients will bring up the topic if it’s a symptom that’s bothering them. 

Clearly, patients and doctors both need to do a better job of communicating that fatigue is a problem so they can work together on finding ways to address it. “These findings highlight the importance of prioritizing fatigue in the research and management of PsA. Additional research that evaluates the causes and potential interventions to improve fatigue in PsA are needed,” the authors concluded. 

What This Means for You

For roughly 30 to 40 percent of people with psoriatic arthritis (PsA), debilitating fatigue is one of the most difficult symptoms to live with. That said, you don’t have to just accept fatigue as part of your disease. Together with your doctor, you can take steps to determine the underlying cause and how to best get your energy up.

Fight Back Against Fatigue: A Psoriatic Arthritis Patient’s Guide 

CreakyJoints launched this guide to help people living with PsA understand how fatigue is different from being tired, what causes it, how to treat fatigue, and how to talk to your doctor so you can start feeling better. Learn more.