Psoriatic Arthritis and Fatigue

Reviewed by: HU Medical Review Board | Last reviewed: October 2016. | Last updated: May 2022

Fatigue, or extreme tiredness, is a common symptom in many people with chronic inflammatory diseases such as psoriatic arthritis. For some patients, fatigue is the most troublesome symptom of their disease, as it disrupts both physical and social functioning. Fatigue can contribute to social withdrawal, long durations of >sick leave, and disability.1,2

What is fatigue?

Fatigue may be characterized by unrelenting exhaustion that is not relieved by rest. Fatigue is a disabling and difficult to manage symptom of psoriatic arthritis. It has been estimated that as many as 50% of patients with psoriatic arthritis have moderate-to-severe fatigue, and 29% have severe fatigue.2,3

Although the pathology of fatigue is largely unknown, the fatigue experienced by patients with psoriatic arthritis is in part due to the inflammatory process of the disease. The cytokines, or chemical messengers, that cause the inflammation in psoriatic arthritis can cause fatigue. In addition, other conditions that are common among patients with psoriatic arthritis, such as obesity, diabetes, and depression, can also contribute to fatigue.4,5 Fatigue is more common in patients with severe psoriatic arthritis that includes more joint involvement, more dactylitis (swollen, sausage-like digits), and more enthesitis (inflammation at the attachment points of ligaments and tendons).2 Some medications used to treat psoriatic arthritis, particularly methotrexate, can also cause fatigue.5

Diagnosing fatigue from psoriatic arthritis

A physician diagnoses fatigue during a physical examination. Physicians will ask a variety of questions to assess the patient’s activities and quality of life that may be impacted by fatigue.3

Treating fatigue from psoriatic arthritis

The key to treating or managing fatigue is identifying the contributing conditions and addressing each of those. Fatigue can be linked to both physical and emotional triggers, and the conditions that may be contributing to fatigue must each be treated.5

As with all symptoms of psoriatic arthritis, treating fatigue begins with treating the underlying disease. Recommended treatments include disease-modifying anti-rheumatic drugs (known as DMARDs). The first step for treatments is usually DMARDs such as methotrexate, leflunomide, or sulfasalazine. Other treatments include medicines that target tumor necrosis factor (TNF), a chemical that produces a wide range of inflammation in PsA. Examples of TNF blockers include etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), golimumab (Simponi), and certolizumab pegol (Cimzia). Other DMARDs that have proven effective in clinical trials include ustekinumab (Stelara), brodalumab (which is awaiting FDA approval), and secukinumab (Cosentyx). 6 The FDA has also recently approved Inflectra (infliximab-dyyb), a biosimilar to infliximab, for the treatment of psoriatic arthritis.7

Lifestyle changes can also improve the symptom of fatigue. Exercise can reduce pain and improve well-being, both of which have an impact on fatigue. Some patients also find anti-inflammatory diets improve their energy levels and reduce fatigue.5

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