Despite having issues with low energy for most of her high school and college years, Julie Cerrone enjoyed a go-go-go lifestyle in her 20s, staying active and traveling frequently for work as an IT developer.
By 2012, however, when she was in her late 20s, serious knee pain and other issues were slowing her down. That year, she was hit with a triple-whammy diagnosis: severe psoriatic arthritis affecting her right wrist and left knee; a chronic pain condition called complex regional pain syndrome; and avascular necrosis, bone tissue death caused by a lack of blood supply, which affected the same knee joint impaired by PsA. These diagnoses — and the fatigue and other symptoms that came with them — changed her life.
“I had to go on disability,” said Cerrone, who is now 30 and living in Pittsburgh. “I spent six months in bed, immobile. It was hard for my friends and family to understand, because the fatigue was something they couldn’t relate to. When I was tired, people would say, ‘Oh, push through it,’ but when you have fatigue from an arthritic condition, it’s a whole different state.”
Fatigue from PsA and other types of inflammatory arthritis, which patients have described in research study interviews as “wipeout,” “overwhelming” and “like having stones on my back,” is often ranked among the most troublesome symptoms of PsA, along with pain, skin problems and physical disability.
Some studies show that as many as 50 percent of patients with PsA have moderate-to-severe fatigue, while 29 percent have severe fatigue, said Dr. Souyma Reddy, co-director of the Psoriasis and Psoriatic Arthritis Center at NYU Langone Medical Center in New York City. There’s rarely just one factor causing fatigue in PsA, she said.
“The inflammation that’s part of the disease process can play a role,” Reddy said. “Proteins called cytokines that are released during inflammatory reactions can cause fatigue, but also contributing can be conditions that are common among people with psoriatic arthritis, including anemia, obesity, diabetes, depression and sleep problems.”
The key to managing fatigue so that it interferes as little as possible with daily life, said Reddy, is “finding what’s contributing to your fatigue and addressing those issues.”
As noted, those with PsA can be affected by active PsA inflammation and other coexisting conditions that independently contribute to fatigue. A 2014 Rheumatology International study, for example, found that about one in five people with PsA also have fibromyalgia, which causes fatigue in almost everyone affected. According to the American Academy of Rheumatology, the cause of fibromyalgia is not fully understood.
However, it appears to be linked to both emotional and physical triggers, both of which are common in patients with psoriatic arthritis. “Depression and anxiety are also common in psoriatic arthritis and have a clear connection with fatigue,” said Reddy. A 2014 Journal of Rheumatology study found that 36.6 percent of people with PsA had depression and anxiety, which in turn were linked to disability, pain and fatigue.
“Some medications, particularly methotrexate, can cause fatigue,” Reddy said. “If active disease, medications or other conditions are the root cause of fatigue, then people can work with their doctors to adjust their medications or treat these issues.” Sometimes, however, fatigue continues to be a problem, even when PsA is well-controlled and medications aren’t a factor. In these cases, relief may mean making lifestyle changes.
Pain and exercise
Chronic pain is a major contributor to fatigue. “Exercise can play a role here,” said Reddy. “Many studies show exercise reduces pain in arthritis. Keeping muscles strong helps protect joints, decreasing the amount of work they have to do and reducing pain.”
People with active inflammation or joint deformities should check with their doctor to make sure specific activities are safe for them. Cerrone still uses a crutch to walk but is close to completing her yoga teacher certification.
“Once I begin moving, I feel better immediately and have so much more energy,” she said. “It has also helped me cope with depression and stress.”
Cerrone, who in the years since her PsA diagnosis has trained and now works part-time as a holistic health coach, has made radical changes to her diet, eliminating gluten, sugar and dairy.
“For me, these things were triggers for fatigue, and I noticed that making even small changes made a big difference in the way I felt,” she said.
Reddy recommends a nutritious, balanced diet to her patients to improve overall health and energy but said there’s no evidence that eliminating any specific food improves PsA symptoms, including fatigue. Maintaining a healthy diet, getting proper sleep and getting more exercise will also help treat or prevent other comorbid diseases, such as diabetes, that are associated with psoriasis.
A 2014 study published in the International Journal of Rheumatic Disease found that people with PsA who had low sleep quality had more pain, anxiety and fatigue, as well as higher levels of inflammation. Sleep specialists can treat specific disorders, such as sleep apnea, and a 2014 study in the journal Sleep found tai chi and talk therapy both improved insomnia and reduced inflammation.
Once you understand the factors contributing to fatigue, it’s easier to plan your life so fatigue doesn’t sideline you when you need to be active.
“Planning, prioritizing and pacing yourself throughout the day or workweek can help you cope better with fatigue,” Reddy said.
Cerrone, who hopes to return to full-time work this year, subscribes to the “spoon theory” of chronic illness. “Every activity costs a certain number of spoonfuls of energy. When you run out, you need to rest,” she said.
Driving discovery, creating community
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