Joint pain you expect. Stiffness and swelling, too. But with rheumatoid, psoriatic, and other kinds of inflammatory arthritis, there’s another symptom that’s just as common, but much less tangible: chronic fatigue.

Fatigue in inflammatory arthritis is different than just being tired or a little worn out. Fatigue is a more overwhelming feeling, a deeper sense of slowing down that can be tough to define.

“Some patients describe it as ‘not feeling like doing much,’” says Elena Schiopu, MD, a rheumatologist at the Michigan Medicine Rheumatology Clinic in Ann Arbor, Michigan. “Others say it’s falling asleep all day long, at the drop of a hat.”

Research shows as many as 80 percent of people with RA report chronic fatigue. Experts believe inflammatory arthritis activates inflammatory proteins in the body, which not only cause pain but also fatigue.

“Much like influenza, when the body is fighting the viral burden with increased inflammation, deep muscle aches and fatigue are present,” explains Dr. Schiopu, who also serves as associate professor of rheumatology and internal medicine at the University of Michigan.

Fatigue can come and go in bouts — one day you feel fantastic and ready to do it all; the next day you can’t get yourself out of bed. That unpredictability can make arthritis fatigue a tough symptom to manage. And it’s not a symptom that others who haven’t experienced it can easily understand or empathize with.

What’s more, in many cases, treating arthritis and reducing systemic inflammation doesn’t necessarily resolve the fatigue, says Dr. Schiopu. In fact, one study published in Arthritis Care & Research found that fatigue in RA patients doesn’t stem solely from the disease itself, but also from other factors including inactivity, obesity, depression, and poor sleep.

Constantly feeling exhausted can take a toll on your body and mind. Though you can’t always control or predict when fatigue hits, there are things you can do to help you manage your fatigue naturally and live better:

Science-Backed Tips for Fighting Fatigue Naturally

1. Take a brisk walk

Exercising is likely last on your list when exhaustion sets in. But that walk is a natural fatigue fighter, and it may be just the thing you need to boost your energy. A review of research found that physical activity helped people with RA manage fatigue. Aim for a 30-minute walk in the morning, and another in the afternoon, around 2 or 3 PM, suggests Dr. Schiopu.

Start slow, then gradually increase your distance and pace. Regular exercise — including aerobic and strengthening moves — can help reduce pain and improve function; it also generates endorphins, which are brain chemicals that trigger a positive feeling in the body. Bicycling and swimming, as well as yoga and tai chi, are also good activities for people with arthrtis. Talk to your doctor before starting any new exercise program.

2. Load up on plant foods

Fruits and veggies, whole grains, legumes — these are the kinds of foods that help to naturally fight inflammation, boost energy, and help you maintain a healthy weight. Carrying extra pounds can make you feel even more sluggish and make arthritis symptoms worse.

Spinach and tomatoes are good choices to fight inflammation; so are dark berries, which contain natural “energy bullets,” says Dr. Schiopu. Include lean protein and a little healthy fat in every plate, and eat regularly for a steady stream of energy throughout the day. Also: Drink lots of water. Dehydration can contribute to fatigue.

3. Skip caffeine after 2 PM

That’s because it can take up to eight hours for half of the caffeine you consume to be metabolized by your body. Drink coffee too close to bedtime and it can mess with how well you rest. Poor sleep quality has been linked to more fatigue, as well as higher levels of depression in people with RA.

Taking your last coffee break by 2 PM can help ensure you’re able to fall asleep by 10 PM or so, say experts. Other healthy habits to help you rest better: Avoid heavy meals and alcohol before bed; wind down with a warm bath or soothing music; and keep your bedroom quiet, dark, and comfortable. Going to bed and waking up at the same time every day can also help.

4. Rearrange your kitchen counter

A simple natural way to prevent fatigue: Put everything you use often within easy reach. (Here are more ways to make it easier to cook while living with arthritis.) Then do the same in your bathroom and bedroom. Set up your home to make life a little easier on you, particularly on the more difficult days, say experts.

And use specialized assistive tools throughout the day — zipper pulls, gripping tools, electric can openers, and long shoe horns can all help conserve energy and ease pain.

5. Take five

Or 10, or more if you need it. Don’t perform any one task for an extended period of time; instead, spread activities throughout the day and take frequent breaks. Rest allows your body to naturally refuel and improve so you can get back to the things you want or need to do. And if you don’t have the energy to do it all, ask for help. Acknowledging that fatigue exists, and adapting to its limitations, is essential to coping with it.

6. Get help for depression

Mood disorders like depression take a toll on energy levels, and they commonly occur in people with chronic pain conditions. In fact, research has shown that nearly three-quarters of those with RA were depressed.

Left untreated, depression may lead to more severe arthritis symptoms, including greater arthritis pain and fatigue. Other conditions, such as obesity, obstructive sleep apnea and anemia (a consequence of inflammation) may also contribute to fatigue, adds Dr. Schiopu.

While depression, sleep disorders, and other factors could be linked to inflammatory arthritis, they may also be independent conditions that patients have, she says. Your doctor may screen for these and other conditions to find the root cause, and then determine the best treatment.

7. Consider your meds

Uncontrolled arthritis inflammation and pain can contribute to fatigue, so it’s important to follow your doctor’s prescribed regimen to keep your arthritis in check. However, some medications you take, such as prednisone or other corticosteroids to treat arthritis, can cause side effects including fatigue. Talk to your doctor about how to balance medication benefits and potential side effects.

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