Article on fatigue

[MirkeshCat]

Hi guys,

I?ve found an article about fatigue in a German rheumatology magazine. Maybe you guys are interested. So I tried my best to translate it and post it here:

Many rheumatic diseases come with fatigue. The reasons for this continuing, chronic fatigue are not claryfied yet.

Weariness is common in all humans: Not just on late evenings as an early signal of hopefully refreshing sleep, but also during non-fitting times. Everyone of us has cycles in life where he feels unusally tired and ?destroyed?. The reasons can be plentyful and do not neccesarily always hint on a hidden chronic illness. Emotional stress for example often goes hand in hand with sleep disturbances. Stress on the job or an imminent viral infection may also lead to unusual tiredness. This type of tiredness has a non-chronic character. Different is fatigue common in inflammatory and rheumatic diseases: The ?tiredness? is one of the main results, that is felt always or most of the time by the patient and can not be properly influenced by rest.

What exactly defines the weariness, or ?fatigue? (the international name) of the rheumatic patient? Fatigue is not clearly defined. This may lead to five different answers if five different patients are asked the same question. Aside from tiredness the patients often mention exhaustion, weakness and lack of energy. But aside from this indistictness: Tiredness and weakness are part of all cases of fatigue. The following text will therefore use the term ?tiredness?, even if this is just a part of fatigue.

Tired or depressive?

Tiredness as a symptom is often connected to pain and depression. Many patients experience two or all of these symptoms at the same time and they can also intensify each other. For one thing this means that when the symptom of tiredness is present the doctors will also have to find of if depression is there. On the other hand this also means that when all three of these symptoms are present the successful treatment of depression and pain may well improve the fatigue.

The specific reasons for this tiredness are not clear yet. Earlier scientists suggested that a viral infection may have triggered this central nervous reaction. Such a reaction is still being discussed as a trigger for primary fatigue syndrom (CFS) without any connection to rheumatic diseases. The search for a trigger, a culprit, has been unsuccessful so far. A possible reason that includes the central nervous system in rheumatic patients remains a mystery.

We gotta be aware of the fact that other illnesses are also connected to abnormal tiredness. A rheumatic patient for example my also suffer from hypothyroidism or anemia. Maybe the reason for their tiredness therefor can at least be partially found in these ?side-illnesses?. A possible sleep disturbance pattern also needs to be taken into consideration and if diagnosed, needs to be treated.

There are also diseases in which fatigue is a major player. Just like in fibromyalgia fatigue is one of the main symptoms of Primary Sjogren Syndrome. In patients with rheumatoid arthritis it is often present, too ? but not always. It affects between 40 to 80 percent of patients. This is the reason why I want to look deeper into the role of fatigue in patients with both Primary Sjogrens and RA. We also need to clarify that fatigue is also often present in other severe rheumatic diseases, like SLE or Sclerodermia.

Aside from pain fatigue often reduces life quality much more than joint swelling. Many rheumatologists often tend to overlook this meaning, though: They often don?t even ask for the degree of fatigue. Meanwhile there are good methods for measuring fatigue, for example via questionaire. It can only be hoped that more and more rheumatologists will use such questionaires in the future.

Tiredness in RA can have two reasons, just like pain: If it is triggered by high activity of the illness and inflammation then it can be positivly assumed that a good therapy that reduces acitivy and inflammation will also affect tiredness. Sadly, pain and tiredness start ?living their own life? after a long time of being sick (secondary pain syndrome and secondary fatigue syndrome). They persist despite low inflammatory levels and have to be treated separately.


The tiredness is present in almost all patients suffering from Primary Sjogrens Syndrome ? they tend to discribe it as feeling like ?lead?. Besides dry mouth and dry eyes this fatigue influences life quality in a dramatic way. It does almost never reacts to cortisone or immune-suppressive therapy. Only traditional treatment without use of drugs is promising here. An increase in physical activity is very important. But the patients must be careful to start training very slowly and carefully.

Written by Professer Klaus Kruger, Spokesman for the Commission of Drug Therapy of the German Association for Rheumatology.

[Suslew]

Thanks for translating this!  Very interesting.

[slccom]

Ditto on the appreciation of the translation!
SHaron

[Thea]

Thanks so much.

[Jasper]

Interesting article. Thanks.