Exhausted? Here’s What You Should Know About Psoriatic Arthritis Fatigue

Psoriatic arthritis fatigue is more than feeling tired. It doesn’t go away even if you take a nap or drink a cup of coffee. Research is still in the early stages, but here’s what we know and what you can do about it.

About half of people with psoriatic arthritis (PsA) report they have moderate fatigue, and about a third say they experience severe fatigue.

Even though fatigue is very common in people with PsA, until very recently, it’s been under-appreciated and under-studied, says Arthur M. Mandelin, MD, PhD, associate professor of medicine (rheumatology) with the Feinberg School of Medicine at Northwestern University.

Fatigue can, understandably, lead to a lack of motivation — which can lead to job loss, decreased quality of life, and social isolation.

“Fatigue affects patients differently. Many patients describe feeling tired, run-down, sluggish, or having just enough energy to work and maybe meet some home demands, but not enough energy to go out and do recreational things beyond their daily requirements,” Mandelin says.

“For some [people], the fatigue can be disabling. At times literally keeping them in bed for all but the most basic self-care activities,” he adds.

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What causes psoriatic arthritis fatigue?

The simple answer is that experts don’t fully know what causes PsA fatigue, says Mandelin.

“Some patients note that when their psoriatic disease is more active, the fatigue is worse as well. But this is not universally true for everyone,” he says. “Unfortunately, even for those whose fatigue does seem to be tied to arthritis or skin flares, it is frequently true that even after the flare starts to ease up, the fatigue is often the last thing to get better.”

If you’re feeling fatigued, your doctor may also request tests for a nutrient deficiency or thyroid problem. These can occasionally explain the fatigue, and they’re directly treatable, says Mandelin.

Fatigue is a complex phenomenon that’s linked to physiological, social, and psychological factors — and it’s highly subjective. In other words, what makes you feel fatigued may not affect someone else.

Some people with PsA may feel fatigued when they wake up with more pain and stiffness than usual. In others, it can happen with unpleasant environmental stimuli, like noise, high temperature, or humidity.

It can be hard to point to a single factor.

Disease-related factors may include:

• skin psoriasis
• tender joints
• enthesitis (inflammation of the bone around the joint, which can cause joint pain)

Other factors that may contribute include:

• being female
• having low levels of iron or another nutrient
• thyroid issues

Traditional medications for PsA, including methotrexate and leflunomide, may also be associated with fatigue in some people.

A 2020 study found that sleep disturbances, pain, and anxiety or depression were all related to fatigue in people with PsA. But researchers weren’t sure how those factors were connected.

The role of inflammation

In psoriatic arthritis, your body experiences chronic inflammation. When your body is in this state, there are higher levels of inflammation-inducing compounds in your blood. These can have an effect on the brain as well as on your joints.

“Psoriatic disease is an inflammatory state, and we know that many of the same pro-inflammatory chemical messengers (called cytokines) are present during a psoriatic arthritis flare as are present when a person has other inflammatory states,” says Mandelin.

“It is believed that this is why psoriatic fatigue feels so much like having the flu; because many of the same pro-inflammatory cytokines are running loose in the system,” he adds.

These inflammatory molecules can affect nerves throughout your body and influence your brain function.

Research in 2017 has shown inflammatory compounds caused reduced social behavior and increased drowsiness in rats. The research in people has found that those with increased inflammatory molecules in their blood also tended to have increased levels of fatigue.

What does psoriatic arthritis fatigue feel like?

Fatigue in PsA can be intense. It’s much more than “tired.” People describe it in different ways — including comparing it to having the flu.

Researchers in a 2020 study asked 19 people with PsA to describe what fatigue felt like. Participants used descriptors including:

• “lack of energy”
• “exhausted”
• “brain fog”
• “life/energy steam out”
• “drained”
• “like a hangover”
• “wiped out”

People with psoriatic arthritis tend to describe their fatigue as an overwhelming feeling of exhaustion that doesn’t go away and decreases their capacity to do physical and mental work.

How to manage PsA fatigue

The first thing to focus on is getting the right treatment for your condition.

“While fatigue is important, we wouldn’t want to focus solely on fatigue and lose sight of skin and joint disease,” says Mandelin. “We still have to make our treatment decisions based on those things first and foremost. Working to get the psoriatic disease under the best possible control can help.”

How you manage your fatigue should be highly personal. Consider what factors normally come up before or while you’re feeling this way.

Here’s how to deal with some causes of fatigue if you’re experiencing them:

• Treat depression if you have it: Depression itself may be causing your fatigue. Talk therapy, medication, or both can help.
• Get regular exercise: Daily physical activity can increase your energy levels.
• Learn and practice stress-coping techniques: Stress can increase chronic inflammation, especially if you experience chronic stress.
• Keep good sleep hygiene: Go to bed at the same time every night, drink caffeine only in the mornings, and make sure to go to sleep at around the same time every night.
• Take steps to reduce inflammation with daily habits: Your every day habits can help reduce systemic inflammation that may be contributing to your fatigue. For example, eating a diet packed with fruits and vegetables and avoiding highly processed foods. The tips above, like reducing stress, can decrease inflammation, too.

Medications may also help.

Recently, drug manufacturers have found that some medications for PsA may reduce fatigue associated with the condition, although the research is still emerging.

A 2018 review of research in 2,341 people with PsA found that participants had reduced fatigue compared with the placebo group after they took the medication Otezla (apremilast) or biological disease-modifying antirheumatic drugs — either Humira (adalimumab), Cimzia (certolizumab pegol), Cosentyx (secukinumab), or Stelara (ustekinumab) — for 24 weeks.

The researchers found that these medications did reduce fatigue, but not by a lot. And they were better at reducing pain.

If you’re curious about whether medications might work for your fatigue, speak with your doctor.

The takeaway

Fatigue can be a vicious cycle. Exhaustion can make it hard to do many things you need to.

If fatigue is getting you down, make sure to tell your doctor. They can recommend a way forward that works for you. They’ll likely also want to rule out a thyroid problem or nutrient deficiency as a cause for the fatigue.

Solutions that can help with fatigue include medications, treatments for depression, and following lifestyle habits that help reduce chronic inflammation naturally.

And consider connecting with the Bezzy PsA community in the symptoms forum for support. Other people have been there and can share what has worked for them.