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Management of Fatigue in Rheumatoid Arthritis
  1. Janet E Pope
  1. Medicine, Division Rheumatology, Western University, Ontario, Canada
  1. Correspondence to Dr Janet E Pope; Janet.Pope{at}


Fatigue in rheumatoid arthritis is highly prevalent. It is correlated only weakly with disease activity but more so with pain, mood, personality features, poor sleep, obesity and comorbidities. Fatigue can be measured by many standardised questionnaires and more easily with a Visual Analogue Scale or numeric rating scale. Most patients with RA have some fatigue, and at least one in six have severe fatigue. Chronic pain and depressed mood are also common in RA patients with significant fatigue. It affects function and quality of life and is worse on average in women. Evidence-based treatment for fatigue includes treatment of underlying disease activity (with on average modest improvement of fatigue), exercise programmes and supervised self-management programmes with cognitive-behavioural therapy, mindfulness and reinforcement (such as reminders). The specific programmes for exercise and behavioural interventions are not standardised. Some medications cause fatigue such as methotrexate. More research is needed to understand fatigue and how to treat this common complex symptom in RA that can be the worst symptom for some patients.

  • Ant-CCP
  • Rheumatoid Arthritis
  • Systemic Lupus Erythematosus
  • Systemic Sclerosis

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  • Contributors JEP performed the literature search, writing of the paper and formed the opinions presented.

  • Competing interests AbbVie, Actelion, Amgen, Bayer, BMS, Emerald, Genzyme, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB; RCTs: Bayer, BMS, Merck, Roche, Seattle Genetics, UCB.

  • Patient consent for publication Not required.

  • Ethical approval There was no ethics approval as this is a review article.

  • Provenance and peer review Commissioned; externally peer reviewed.

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