Managing Fatigue and Energy with Psoriatic Arthritis

Psoriatic arthritis (PsA) is a chronic inflammatory condition that causes pain, swelling and stiffness of the joints. Fatigue is a very common symptom of PsA and often makes it difficult to do even the simplest activities of daily living. Fatigue can be caused by inflammation, PsA symptoms, or disease complications, such as anemia and depression.

Here is what you need to know about what causes PsA fatigue and what you can do to preserve and improve energy levels.

Fatigue-Psoriatic Arthritis Connection

Fatigue can be defined as tiredness or exhaustion that leaves a person feeling they do not have enough energy or motivation to function fully in daily life. One 2017 article reported in the journal Reumatologia described fatigue as an important medical problem for people living with PsA, affecting various aspects of life, including work, social life, and quality of life. The researchers further noted fatigue is present in about half of the people with PsA, with 30% suffering from severe fatigue. he presence and severity of fatigue seems to correlate with the degree of psoriasis, the inflammatory skin disease that gives PsA its name,

Fatigue is experienced by people with PsA mainly because it is an inflammatory condition. When inflammation is present, the body releases cytokines—proteins that promote the inflammatory process. These same proteins are released if you had the flu or cold in an effort to rid your body of foreign invaders, such as bacteria and viruses. The inflammatory process causes fatigue. In people with PsA, the inflammatory process is working overtime because the body is mistaking healthy tissue for diseased tissue.

Causes

Inflammation is just only one contributor to fatigue for people with PsA. In fact, PsA fatigue may be caused by multiple factors from loss of sleep to pain, and many others.

Loss of Sleep

One study reported in 2018 found that 67.7% of people living with PsA experienced poor sleep quality, compared to only 14.6% in the control group who did have not have PsA. Sleep disturbances are often related to joint pain and PsA skin symptoms, including itchy and inflamed skin. Pain causes difficulty falling asleep, frequent waking at night, and waking up not feeling refreshed from sleep.  

Pain

Dealing with PsA pain may also cause you fatigue. It adds to the mental and physical stress of planning and carrying out daily activities. One study reported in 2019 by The Journal of Rheumatology finds fatigue in psoriatic arthritis is driven by three main components: inflammation, disease duration, and chronic pain. Inflammation accounted for 31% of the fatigue effect, disease duration and intensity were 17% of the cause, and chronic pain contributed by 15%.

PsA Treatments

Some of the medications you take for treating PsA may also contribute to fatigue. For example, methotrexate, a common treatment for PsA, causes fatigue the first day or so after taking the weekly dose. For most people, side effects improve with time. For others, however, the fatigue is so bad they have to discontinue the medication.

Methotrexate is not the only medication that contributes to PsA fatigue. Biologic drugs—including Simponi (golimumab)—are known for causing extreme fatigue. Much like methotrexate, the fatigue associated with biologic drug treatment improves over time.

Flare-Ups

A flare-up of PsA is a time when symptoms of the disease get worse. You may not know when a flare will occur but avoiding potential triggers may help you to avoid a flare. Fatigue is one of the earliest indicators of an oncoming flare, and as a flare worsens, fatigue may become so severe it affects motivation, concentration, and energy levels.

Diet

The same foods that may be triggering your PsA symptoms may also cause fatigue. For example, saturated fats, sugar, alcohol, and simple carbohydrates found in processed and refined sugars might trigger PsA flare-ups. Further, these foods do not contain adequate nutrients, cause the digestive process to work harder, and could contribute to fatigue.

Stress

Both fatigue and decreased energy can be caused by stress. Stress is also associated with disrupted sleep. One 2014 study found having too many stressful events is significantly connected to increased risk for insomnia—persistent problems with falling and staying asleep. Stress can also trigger PsA symptoms and make them worse, which will further increase the fatigue you are experiencing.

Disease Complications

Conditions that are complications of PsA can also increase your fatigue. For example, depression and anemia are common complications of PsA, among others.

Depression: Fatigue is one of the most common symptoms of depression. One 2018 report in the journal CNS Drugs finds up to 90% of people living with major depressive disorder experience fatigue.

Major depressive disorder—also called clinical depression—is a common but serious mood disorder that causes symptoms severe enough to affect how a person thinks, feels, and handles daily activities, such as sleeping, working or eating.

PsA can have a significant effect on a person’s mental health and well-being and eventually cause depression. PsA depression can be related to the stress of living with PsA and its many symptoms, including pain.

Anemia: Fatigue is one of the most common symptoms of anemia, which is common in people with PsA. Anemia results when there is a lack of red blood cells to carry adequate oxygen to the body's tissues.

Numerous factors contribute to anemia caused by PsA. This may include the medications you take, chronic inflammation that prevents the body from using stored iron to create new blood cells, bleeding, and inadequate iron intake.

Other fatigue-causing conditions associated with PsA include diabetes, cardiovascular disease, metabolic syndrome, and fatty liver disease.

Solutions

Despite the notion that fatigue and PsA go together, you can still find ways to get more energy. It may also help to find out what is contributing and worsening fatigue and work towards addressing those issues.

Follow a Healthy Diet

Being mindful of what is on your plate is an effective way to keep your energy up. Avoiding processed and junk foods, saturated fats, sugar, and alcohol, will help keep your body fueled and your fatigue down.

Following a healthy and balanced diet primary involves eating lean proteins, whole grains, fresh produce, and healthy fats—a diet considered an anti-inflammatory diet. Your healthcare provider or a dietitian can be helpful in finding the right diet to reduce your fatigue and other PsA symptoms.

Balance Activity and Rest

Instead of trying to power through a heavy workload, try breaking tasks down into 10- to 20-minute parts, then resting or completing easier tasks in between. Resting time can include anything from taking a nap, lying down, reading, or planning an activity.

You should also stay physically active. Something as simple as a daily 20- to 30-minute walk can increase the body’s natural opiates (pain relievers) and improve energy levels and sleep quality.

Reduce Caffeine Intake

Caffeine is OK in moderation, but it does not actually provide the body with any real energy. While caffeine may offer a short-term boost, it is more important to provide your body with good nutrition and balanced meals and snacks to avoid rundown.

If you need an energy boost, opt for black coffee or unsweetened tea to avoid refined sugars and artificial ingredients that cause you to crash and further worsen PsA symptoms and fatigue.

Drink Plenty of Water

Drinking water is important for the body to optimally function. Sip on water throughout the day and try to swap out soda, coffee, and other drinks for water. This is a simple change that can make a big difference in reducing fatigue and PsA symptoms and help you to feel better overall.

Work on Your Sleep Hygiene 

The National Sleep Foundation defines sleep hygiene as “a variety of different practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness.” These practices include:

• Limiting daytime naps to less than 30 minutes
• Avoiding stimulants—such as, coffee and nicotine—close to bedtime
• Exercising during the day
• Staying away from foods that may disrupt sleep or heavy meals close to bedtime
• Getting enough exposure to natural light (sunlight) during the day
• Establishing a regular relaxing bedtime routine, which can include anything from a warm shower or bath, reading a book, or light stretching
• Ensuring a pleasant sleep environment, such as a cool bedroom, blackout curtains, eye shades, earplugs, and devices, such as a white noise machine or humidifier, that make your bedroom more relaxing for sleep. 

Have Your Vitamin D Tested

There has been plenty of research that shows a connection between vitamin D deficiency and psoriatic arthritis. For example, one 2015 study reported in Arthritis Research & Therapy finds up to 40.9% of the PsA study participants also had vitamin D deficiency, this compared to only 26.9% of the control participants.

Chronic fatigue is one of the most common symptoms of vitamin D deficiency. If you think you have a deficiency, talk to your healthcare provider about getting your blood levels tested. Vitamin D deficiency is easily treated by eating more vitamin D rich foods, and with vitamin D supplements.

A Word From Verywell

Your healthcare provider is in the best position to advise you on how to manage psoriatic arthritis and the fatigue that often comes with it. You should see a practitioner if you start experiencing new or worsening symptoms of fatigue or if the fatigue affects your ability to function in your daily life. Your healthcare provider will try to determine whether PsA or another problem is causing your fatigue. He or she will then determine what additional treatments or strategies might help you to manage fatigue to keep it from taking over your life.