Fatigue

Fatigue is a common problem in patients with rheumatic diseases. It is a complex phenomenon resulting from various physical, psychological and environmental factors. Fatigue, a feeling of decreased mental and physical capacity, is variously described as tiredness, exhaustion or lethargy and is usually associated with desire to take rest or sleep. Fatigue leads to a sedentary life style, impairs function and reduces quality of life in these patients. Ordinary day-to-day activities such as brushing teeth and eating food become difficult. This is followed by feeling of helplessness leading to anxiety and depression. Work capacity and accuracy decrease due to fatigue. Almost all patients of rheumatoid arthritis have fatigue and absence of fatigue indicates remission of disease. Fatigue is also seen in a very high number of cases of fibromyalgia, ankylosing spondylitis, osteoarthritis, Systemic Lupus Erythematosus, polymyositis and Sjogren’s syndrome. Drugs used in treatment of these diseases, such as methotrexate and leflunamide, can aggravate fatigue in a few cases. Fatigue can also be caused by various other conditions (See Table for common causes). It is important to realize and treat these conditions for optimal management of rheumatic diseases.

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AnaemiaMalnutritionVitamin deficiencies
Old ageInfectionsCancer
PregnancyThyroid diseasesDiabetes
MenopauseInsufficient sleepHypertension
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12.1% of about 2500 women surveyed in Goa reported fatigue. Fatigue in these cases was associated with many other somatic symptoms such as generalised pain, limb pains, back pain, headache, abdominal pain, bloating, burning sensation, tingling numbness and palpitations. Women with more than 3 children, less education, poor housing conditions and financial difficulties are more likely to develop fatigue. Gender disadvantage (violence, alcohol abuse and extramarital relations of spouse) is another risk factor. Fatigue must be measured in all cases of rheumatic diseases for better understanding and management of the health status of individuals. Various instruments are available which ask a few questions and the answers are recorded on a numerical scale. Functional Assessment of Chronic Illness Therapy (FACIT) -Fatigue is one such scale widely used in clinical practice. All patients must understand fatigue and apprise oneself of the situation. Any associated factor such as anaemia must be appropriately treated. Control of underlying rheumatic disease eases fatigue to a significant extent. Increasing physical activity, aerobic exercises, endurance training, easing of psychological stress (with Yoga and other relaxation techniques), proper sleep and adequate pain control are all important in fatigue management. Nutritious diet and healthy lifestyle are equally essential. Outdoor activities, hobbies, strong interpersonal relationships, job satisfaction, avoidance of smoking and limiting alcohol are useful in management of fatigue.