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 a desire to take rest or sleep. Fatigue leads to a sedentary lifestyle, impairs function, and reduces the quality of life in these patients. Ordinary day-to-day activities such as brushing teeth and eating food become difficult. Later, a feeling of helplessness creeps in, leading to anxiety and depression. Work capacity and accuracy decrease due to fatigue. Almost all patients with rheumatoid arthritis have fatigue, and the absence of fatigue indicates remission of the disease. Fatigue is also seen in a very high number of cases of fibromyalgia, ankylosing spondylitis, osteoarthritis, systemic lupus erythematosus, polymyositis, and Sjögren's syndrome. Drugs used to treat these diseases, such as methotrexate and leflunomide, can aggravate fatigue in a few cases. Various other conditions can also cause fatigue (see Table for common causes). It is essential to realize and treat these conditions for optimal management of rheumatic diseases.
| Anaemia | Malnutrition | Vitamin deficiencies |
| Old age | Infections | Cancer |
| Pregnancy | Thyroid diseases | Diabetes |
| Menopause | Insufficient sleep | Hypertension |
12.1% of about 2500 women surveyed in Goa reported fatigue. Fatigue in these cases was associated with many other somatic symptoms such as generalized pain, limb pains, back pain, headache, abdominal pain, bloating, burning sensation, tingling numbness, and palpitations. Women with more than three 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 to better understand and manage individuals' health status. Various instruments are available for the measurement of fatigue. They 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 themselves of the situation. Any associated factor such as anemia must be appropriately treated. Control of underlying rheumatic disease eases fatigue to a significant extent. Physical activity, aerobic exercises, endurance training, easing psychological stress (with yoga and other relaxation techniques), proper sleep, and adequate pain control are critical in fatigue management. A nutritious diet and a healthy lifestyle are equally essential. Outdoor activities, hobbies, strong interpersonal relationships, job satisfaction, avoidance of smoking, and limiting alcohol are helpful in the management of fatigue.