February 15, 2013
Dear Mayo Clinic:
One year ago, at the age of 33, I was diagnosed with lupus. I am taking medications to help with flares, which are reasonably controlled, but I am exhausted all of the time. Is this just a part of the disease, or is there something that can help with fatigue?
Fatigue is a major problem in 50 to 80 percent of lupus patients and can be quite disabling. The specific cause, however, varies from person to person, with many potentially treatable conditions. Identifying what's causing you to feel run down much of the time is a good starting point.
Lupus is an autoimmune disease, meaning the immune system attacks the body's own tissues and organs, causing inflammation and damage. Lupus can affect any system in the body, but the skin, joints, lungs, kidneys and blood are most often affected. Because lupus can affect so much of the body, it's important that you work with a rheumatologist — a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions — and/or a specialized care team familiar with lupus.
A number of factors can contribute to your feeling tired on a daily basis. Factors that are related to lupus include anemia, fever, and lung and heart disease. Decreased exercise capacity from reduced blood flow or inflammation in the muscles can also cause fatigue. In some cases, iron deficiency anemia, low thyroid function, infection and certain medications are responsible. Blood tests are very useful in pinpointing and differentiating between causes.
It is also important to recognize that poor quality sleep, fibromyalgia and depression are common causes of fatigue in patients. Living with the unknowns and emotional stress of a chronic disease such as lupus can cause a person to become clinically depressed. If you have feelings of hopelessness or general sadness, or if you have a loss of interest in daily activities, let your rheumatologist know.
Treatment should be tailored to the cause of fatigue. Ask your doctor if he or she thinks an underlying condition may be contributing to your fatigue. For patients with mild lupus, medications like corticosteroids and hydroxychloroquine can help. Some benefit has also been shown for a supplement called DHEA (dehydroepiandrosterone), but DHEA has significant side effects and should be taken only if prescribed by your doctor. In many patients though, a clear cause is not discernible. If that is the case, making lifestyle changes will help you cope and lead a productive life.
There are things you can do daily to ensure that you aren't always feeling exhausted. Try to pace yourself in your daily activities. Taking frequent planned breaks or a nap during the day — even if you don't feel tired — can help you slow down and give your body the additional rest it may require to get through the day. Plan your day and eliminate unnecessary tasks or chores that can be delegated. Avoid total bed rest, as it can lead to deconditioning of muscles and worsen fatigue.
Be sure to exercise regularly, which can actually increase your energy level. Taking part in any kind of exercise — especially one that includes both an aerobic and strength training component — is good for your overall well-being. Activities like walking, swimming and low impact aerobics are good choices. Use of moist heat (e.g., hot tubs, whirlpool bathtubs or a hot shower) may help patients who commonly experience sore muscles following exercise. Before embarking on an exercise program, check with your rheumatologist to see if it is safe to do so. Pay attention to your sleep habits and consult with your doctor if you experience sleep difficulties.
Eat a healthy diet that consists of fruits, vegetables and whole grains. If you have dietary restrictions or concerns, ask your doctor what foods will be beneficial for your situation.
Finally, don't be afraid to ask for help. Eliminating fatigue altogether may not be realistic for people who have lupus. But by working with your health care team, you should be able to determine the cause and hopefully lessen the amount of fatigue you are currently experiencing.
— Vaidehi Chowdhary, M.D., Rheumatology, Mayo Clinic, Rochester, Minn.