When Alisha Alvarez, 31, was diagnosed with psoriatic arthritis in 2018, she and her doctors were focused mainly on the joint pain in her knees that made it difficult for her to move around and walk. But within a year, she had another troubling symptom to contend with: fatigue.
“I was so wiped, there were days when between my joint pain and my fatigue, I could barely get out of bed,” recalls Alvarez, a public relations executive in Los Angeles. “I was exhausted. It felt like I was coming down with the flu much of the time. I was already depressed about my psoriatic arthritis diagnosis, and these feelings of fatigue just made everything seem so much worse.”
Unfortunately, fatigue is a very real and problematic symptom of psoriatic arthritis. A recent study published in the Journal of Rheumatology found that almost 80% of people with psoriatic arthritis experience it. People with more severe fatigue also reported more severe PsA symptoms, and, not surprisingly, worse physical functioning.
“The fatigue patients report with psoriatic arthritis is very real,” says Teja Mahadeshwar Kapoor, MD, a rheumatologist at the Columbia University Irving Medical Center in New York. “It impacts tremendously their ability to go about day-to-day life. But since fatigue is an invisible symptom, it can be hard for other people to understand.” That includes doctors; in the Journal of Rheumatology study, only about a third of them acknowledged that their patients had reported to them their fatigue.
The Fatigue-Psoriatic Arthritis Link
When you have psoriatic arthritis, your body makes proteins called cytokines, explains Kapoor. These cytokines cause inflammation that makes your joints swollen and painful. They also appear to cause fatigue. “We see it in many different autoimmune diseases, including psoriatic arthritis,” she says.
It’s also important to understand psoriatic arthritis fatigue itself, versus just being tired. “Normally, when someone is tired, they’ll take a nap, or get a good night’s sleep, and feel better,” says Kapoor. “But this is a whole other level of fatigue. It’s the exhaustion you feel when, say, you’ve got a viral illness such as the flu. It really knocks you out.”
Alvarez agrees. “It’s a tiredness that you feel in your bones,” she says. “The idea of even taking a shower is hard to think about. And on top of that, there are times where I am also coping with throbbing pain, which is also exhausting.”
People with psoriatic arthritis often may have trouble getting restful sleep, which can worsen fatigue, adds Kapoor. Almost 70% of people with PsA, for example, report poor sleep quality. “We know poor sleep is linked to increased pain and inflammation, which in turn then worsens fatigue,” says Kapoor. “It becomes a vicious cycle.” Patients with PsA are also more likely to have underlying sleep disorders such as sleep apnea or restless legs syndrome, notes Kapoor. This in turn worsens their sleep and makes them even more fatigued.
When Alvarez doesn’t have a flare up, she’s able to get a good night’s rest. But when she is in the midst of one, all bets are off. “I’ll be up until 1 or 2 in the morning, dealing with throbbing pain that prevents me from falling asleep,” she says. To compound this, Alvarez has restless legs syndrome, a condition that causes an uncontrollable urge to move the legs. “When I wake up, my joints not only hurt, but they feel too tired to do what they need to do,” she says.
Finding Relief
Alvarez has refused to let her psoriatic arthritis take over her day-to-day life. “For a while, my psoriatic arthritis stopped me from doing anything I loved, including physical activity,” she says. “But I realized that if I revamped my lifestyle, it would help to get my symptoms under control.”
One way she has done that is to stay as active as she can. She plays tennis twice a week and goes to Pilates three times a week. On days where she doesn’t have an actual workout planned, she and her wife go for walks. “When I move around, I often do feel better,” she says. “When I get my blood flowing, it energizes me. I feel more alert.” Research also shows that there are clear benefits to staying active with psoriatic arthritis, including decreased fatigue. “One theory is that physical activity can help to reduce some of the inflammation associated with psoriatic arthritis,” explains Kapoor.
Alvarez has also focused on an anti-inflammatory diet. She eats a plant-based diet that’s also rich in healthy fats, such as olive oil. “I focus a lot on fruits and vegetables and avoid processed foods as much as possible, although I still am a sucker for candy,” she says. “Since we incorporated this healthy eating style into our diets a couple of years ago, I’ve noticed fatigue has really improved. It makes sense: I’m fueling my body with good, high-quality stuff.”
While there’s not good data yet on whether specific foods themselves can help with PsA-related fatigue, there is research to suggest the Mediterranean diet, which is rich in fruits, veggies, whole grains, nuts, seeds, fatty fish, and healthy fats like olive oil, can help, says Kapoor. She also recommends that her patients try to stay at a healthy weight. “If you’ve overweight or obese, it’s not only more stress on joints: it increases inflammation, which can worsen fatigue,” she points out.
Alvarez has also made some work modifications to help her cope with fatigue. She usually works from home to conserve energy. She also paces herself. “I plan often a week in advance what I’m going to do,” she says. “I ask myself, ‘is it worth it to go out on Thursday night with friends, if I’m going to be exhausted on Friday?’ Usually, the answer is no. If I do travel for work, then I make sure that the first few days after I return, I can rest quietly at home to let my body recover.”
She also takes time to focus on things she enjoys, whether it’s cooking with her wife, reading, or watching a funny movie. One study published in the journal Arthritis Care & Research found that patients who engaged in these sorts of valued activities were better able to cope with their fatigue.
All of these tweaks have allowed Alvarez to continue to lead a life she loves. While she still experiences bouts of fatigue, she’s been able to take a break from medications and focus on these lifestyle changes to manage her psoriatic arthritis day to day.
Most importantly, she listens to her body. “It can be hard living with fatigue from psoriatic arthritis because people look at me and see a healthy, vibrant, 31-year-old woman,” she says. “They don’t realize that I’m exhausted from a poor night of sleep and that I have heating pads on my legs to relieve joint pain. But when I’m extremely tired, I take some time for myself, whether it’s to go for a short walk or spend time with my wife. That way, I’m reinvigorated enough to return to my everyday tasks again.”
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Alisha Alvarez, 31, public relations executive and psoriatic arthritis advocate, Los Angeles.
Teja Mahadeshwar Kapoor, MD, rheumatologist, Columbia University Irving Medical Center, New York.
Journal of Rheumatology: “Effect of Fatigue on Health-Related Quality of Life and Work Productivity in Psoriatic Arthritis: Findings from a Real-World Survey.”
Reumatologia: “Sleep Disorders in Patients with Psoriatic Arthritis and Psoriasis.”
Clinical Rheumatology: “Psoriatic Arthritis and Physical Activity: A Systematic Review.”
Rheumatology International: “Mediterranean Diet and Psoriatic Arthritis Activity: A Multicenter Cross-Sectional Study.”
