How to manage fatigue from psoriatic arthritis

Fatigue is a common symptom in psoriatic arthritis (PsA), which can be a major barrier to functioning well in daily life. While it can be disabling, it can also be managed and improved.

Click here to skip to our strategies for coping with fatigue from psoriatic arthritis.

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PsA is an immune-mediated inflammatory disease which can cause a variety of physical symptoms, such as pain, stiffness and swelling in the joints. However, it is also associated with social and emotional problems, such as depression and anxiety. All of these contribute to fatigue, which can be a major barrier to functioning well in multiple aspects of daily life, from socialising and exercising to work, self-care or even doing simple tasks around the house. Fatigue can be a problem in PsA for many different reasons - which means there are many ways it could be improved.

What is fatigue?

When we use the term fatigue in daily life it is often used to describe having low energy levels, however, in clinical terms, fatigue can be defined as ‘an overwhelming, sustained sense of exhaustion and decreased capacity for physical and mental work’.1 Fatigue can then lead to psychologica symptoms – such as frustration, depression, embarrassment and regret at missing out on things due to exhaustion.

If fatigue is a problem for you, make sure your healthcare professional is aware of this, as they may consider it when recommending different interventions and treatments. There are also many self-help strategies you could try which may improve your symptoms. But first, what does fatigue feel like?

What does fatigue from psoriatic arthritis feel like?

People with PsA and fatigue have described how it feels during a flare in various ways; click through the quotes on the left to find out more.2

There are many things that can be done to reduce feelings of fatigue, but it can be helpful to understand why it is you feel fatigued first; then you can use the strategies that work for your situation.

6 strategies for coping with
fatigue from psoriatic arthritis

Consult with your healthcare professional(s) to narrow down the causes of your fatigue and find appropriate help. As fatigue has so many possible causes, there may be specific ways to help each problem that is contributing to it. Dietary changes, regular exercise, medications to treat underlying illness and psychotherapy are a few interventions which may improve fatigue in some people - but whether they work or not would depend on why the fatigue is occurring and each person’s individual circumstances. It can be difficult to tease apart the different causes of fatigue – there may be more than one. It may require some self-reflection and experimentation with different strategies to figure it out.

Discuss your treatment plan with your healthcare professional(s). Your healthcare professional may be able to address any aspects of your treatment plan which could be worsening your fatigue. They may also be able to offer you medication or psychological or lifestyle interventions to optimise the treatment plan for whatever conditions and symptoms you have that are contributing to your fatigue.

It may seem counterintuitive to recommend exercise to improve fatigue if you feel too fatigued to exercise in the first place - but this is one of those catch-22 situations. Regular physical activity can improve energy and feelings of fatigue in various people with or without chronic diseases, including psoriatic arthritis. It can also improve problems which lead to fatigue in some people:

  • Quality of sleep
  • Chronic pain
  • Low mood in people with depression
  • Risk factors for heart and metabolic disorders
  • Obesity – losing weight is likely to be most effective when combining dietary changes and exercise, which may improve the severity of psoriasis symptoms if you are overweight or obese too

It may help to match your exercise to how severe your disease is and where it is. For example, if your PsA mostly affects the joints in your hands, walking or cycling may be appropriate. Low-impact exercise (e.g. tai chi, yoga, swimming) may be easier than high-impact exercise (e.g. running).

The most important thing is to do what you can manage when you can manage it, and try to forgive yourself if you can’t do it much or at all.

Currently, there is no strong research to suggest that specific foods or diets help to improve PsA or the accompanying fatigue. However, this doesn’t mean that changes to your diet won’t help; many people with psoriatic disease believe diet is relevant for improving their symptoms. However, it won’t work for everyone and each person may differ in which foods they do or do not respond well to. It could help to:

Choose foods that help fight inflammation.
Diets which potentially combat inflammation include those with high amounts of:

  • Monounsaturated fats (such as from avocado, nuts, olive oil, sunflower oil and peanut butter) and omega-3 fatty acids (found in fatty cold-water fish, like salmon, mackerel and tuna, nuts and plant oils)
  • Fruits, vegetables, raw nuts and whole grains
  • Soluble fibre (which gives stool bulk, found in oats, beans, bran, barley and citrus fruits) and insoluble fibre (helps speed up digestion, found in whole-wheat flour, nuts, beans, potatoes and green vegetables)
  • Polyphenols (antioxidants - contained in tea, cocoa, berries, fruits and more)

Avoid foods which could worsen inflammation.
Diets which potentially promote inflammation include those with:

  • High fat content (including ‘artificial’ trans fats, found in many fried and baked goods - ‘junk food’ - including fried chicken, chips, cakes - along with whole milk, margarine and other products)
  • High glycemic index (foods that release sugar very quickly)
  • High amounts of refined grains or minimally processed whole grains (such as white flour, white bread and white rice)
  • Sugar-sweetened carbonated and noncarbonated beverages

Discuss supplements which may fight inflammation with your healthcare professional.
It is important to discuss any supplements you are considering using with your healthcare professional, so they can advise you on whether it would be suitable to take them or not.

If the quality of your sleep is poor, there are various ways it could be improved, which should have a knock-on effect and improve your fatigue too. The first step would be trying to identify why you’re not sleeping well, then you can target those problems. In addition to improving issues such as stress, worry, painful joints and lack of exercise, it may help to try improving your sleep hygiene. This could involve:

  • Avoiding stimulants such as caffeine and nicotine close to bedtime.
  • Avoiding foods and drinks that can be disruptive right before sleep (like heavy, rich, fatty, spicy or acidic foods, or carbonated beverages).
  • Getting some sunlight during the day, keeping it dark at night, and avoiding screens before bedtime (or using a blue light filter if you need to use a screen.
  • Setting up a relaxing bedtime routine – taking a bath, reading, meditating or doing whatever relaxes you could help. It’s best to do it every night around the same time, so your brain associates those activities with sleep.
  • Ensuring a comfortable environment – your mattress and pillows, the temperature and noise are all things you could modify until you find a set-up that comforts you.

It can be easy to try to fit too much activity into one day, leading to feeling overwhelmed and exhausted before you’ve managed to finish what you wanted to do. Work out what you have to do during the day, and figure out over time what is realistic, so you’re not overburdened. If you do feel that way, see if anyone can support you to get things done. Make a list of your essential tasks, and non-essential tasks which you can postpone if you need to, and make sure to rest when you’re feeling exhausted.

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1. Husted JA et al. Ann Rheum Dis. 2009;68(10):1553-1558
2. Moverley AR et al. Rheumatology. 2015;54(8):1448-1453.