Psoriatic arthritis is a chronic inflammatory condition that involves pain, swelling, and stiffness in the joints. Fatigue is common and can be an early symptom. In some cases, fatigue can make it difficult for a person to manage their daily life.

The symptoms of psoriatic arthritis (PsA) tend to come and go. During a flare-up, symptoms will get worse, but during a period of remission, they will reduce and may disappear. Fatigue can be a problem during flares.

This article will look at why fatigue happens with PsA and how to manage it.

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Fatigue is a common symptom of PsA.

Fatigue is tiredness or exhaustion that leaves a person feeling that they do not have enough energy to function fully in their daily life.

In 2017, researchers described fatigue as "an important medical problem" for people with psoriatic disease. They pointed out that it can lead to problems at work, social isolation, and a lower quality of life.

PsA can lead to fatigue for a number of reasons.

PsA is an inflammatory condition. When inflammation is present, the body releases proteins called cytokines as a byproduct of the inflammatory process. These are the same proteins that the body releases when it is fighting a cold or flu. When this happens, it can lead to feelings of fatigue.

Anemia, obesity, and depression can also occur with PsA and can contribute to fatigue.

Pain and loss of sleep

In 2018, a study reported that 67.7% of people with PsA experienced poor sleep quality, compared with 14.6% of people in a control group.

Pain from PsA may disrupt sleep cycles, leading to:

  • difficulty falling asleep
  • frequently waking up
  • sleep that is not refreshing

Dealing with the chronic pain of PsA may cause fatigue. It adds to mental stress, as a person needs to take it into account when planning and carrying out daily tasks. Tiredness can also worsen the feeling of pain.

Medications

Some medications to manage pain and other aspects of PsA can cause drowsiness and fatigue.

Those drugs that do not cause fatigue directly might disrupt nighttime sleep cycles, leading to a person experiencing daytime drowsiness.

Other causes

Pain that worsens before or during a PsA flare is likely due to PsA, but other conditions can occur alongside PsA that also cause pain.

These conditions include:

What is the link between PsA and depression? Find out more.

When to see a doctor

A person should see a doctor if they experience new or worsening symptoms of fatigue or fatigue that affects their ability to function in daily life.

The doctor will investigate whether there is an underlying cause or condition that needs additional treatment.

A doctor will recommend treatments and strategies to help a person manage the fatigue that occurs with PsA.

Some lifestyle choices can help a person manage PsA.

Exercise

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Low-impact exercise can benefit people with PsA.

Exercise can boost overall well-being and may help reduce stiffness and pain. Exercise releases chemicals called endorphins that fight depression and boost mood and energy levels.

Current guidelines recommend low-impact exercise as a way of managing PsA, as long as it will not cause further damage. Activities that might help include yoga, swimming, and tai chi.

When necessary, a person might find it useful to use shoe inserts, wear a brace, or use a cane for support.

What is the link between weight gain and PsA? Learn more here.

Diet and weight management

As with psoriatic disease, obesity features inflammation, and it commonly occurs with PsA.

Weight gain can add to fatigue by making it harder to move around and by putting pressure on the body's organs, including the lungs. It can also worsen joint pain from the extra strain on the joints.

Keeping a healthy weight can lead to better energy levels.

Tips for maintaining a healthy weigh include:

  • eating plenty of whole grains, fruits, vegetables, and lean protein
  • avoiding excess fat and added sugar and salt
  • staying hydrated by drinking plenty of fluid, preferably water
  • limiting or avoiding alcohol

A healthful diet can help a person:

  • achieve and maintain a healthy weight
  • improve body functions, such as digestion
  • avoid other complications and comorbidities, such as diabetes and high blood pressure
  • maintain a stable source of energy by preventing blood sugar fluctuations

People should avoid eating refined carbohydrates and simple sugars that may boost energy but lead to a drop soon after consumption.

Rest and sleep

People with PsA should be ready to reduce their activity levels if they are experiencing or may be about to experience a flare. Fatigue is an early sign of a flare, but resting may help prevent symptoms from developing.

Tips include:

  • Planning periods of daytime rest or reducing physical activities to allow time to recover during the day.
  • Getting enough sleep, possibly more than people usually need. If a person needs to get up early in the morning, they should try to sleep earlier at night. Establishing a routine that includes cooling the bedroom and leaving any mobile devices outside the room may help.
  • Asking for help with childcare and chores when it is difficult to do them alone, and being ready to say "no" at this time to additional tasks and requests for help from others.
  • Using a mobility device, such as a scooter, might help a person with severe symptoms to move around without becoming exhausted.

These methods will not resolve the problem of fatigue, but they can help a person preserve their energy for necessary tasks.

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If lifestyle changes do not help, a doctor can suggest other treatment options.

If levels of fatigue remain high after trying various lifestyle remedies, a doctor may be able to suggest a treatment option that can help.

Examples include:

  • Activating medications: These can increase energy. Some antidepressants or psychostimulants may help.
  • Iron treatments: Excessive fatigue may be a sign of underlying anemia when there are not enough red blood cells in the body. Iron treatments can relieve fatigue by treating anemia.
  • Sleep aids: For people who have pain or anxiety-related sleep disturbances, prescription sleep aids may help increase the amount of restorative sleep each night. Better sleep may help reduce fatigue.
  • Therapy: If fatigue stems from anxiety, depression, or the burden of dealing with chronic pain, cognitive behavioral therapy (CBT) or other counseling may help.

A doctor can advise anyone with PsA on ways to manage the condition and the fatigue that can accompany it.

Current treatment options for PsA include long-term drugs, such as biologics. These drugs can target specific parts of the immune system and help reduce the risk of flares, as well as the severity of symptoms, should a flare develop.

People should work with their doctor to ensure they have the treatment option that suits them. Once their treatment plan is in place, they should follow the plan and any instructions from the doctor. This can help reduce the risk of flares and the fatigue that occurs with them.

Q:

My mother has psoriatic arthritis, and she is overweight, but she does not want to exercise or even leave her chair, as she says it is too hard to move, and she is too tired. Should I encourage her to move? She can walk with a walking device.

A:

Yes, you should encourage her to move. Start with brief periods of activity and gradually increase the activity time every couple of days.

Investigate if there is a water exercise program in your area. Movement in the water is less painful for people with arthritis, and it can improve the range of motion of joints and flexibility. There is also the social component of being in a class.

Working with a physical therapist may be an excellent way for her to get started.

Nancy Carteron, MD, FACR Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.