Arthritis and fatigue: An extreme exhaustion

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Arthritis and fatigue: An extreme exhaustion

Arthritis, also known as rheumatic arthritis, is an autoimmune diagnosis which, among other things, involves chronic joint inflammation. Usually there are several active joint inflammations in the body at the same time. This fight against inflammation in the body can lead to feelings of general weakness, drowsiness and exhaustion.

This extreme exhaustion is also known as "fatigue". Many people with the autoimmune and rheumatic diagnosis, arthritis, report that this is the worst symptom. Fatigue also occurs in it chronic pain syndrome fibromyalgia and other types of rheumatism. Researchers therefore believe that it is the eternal struggle inside the body that leads to the extreme exhaustion.¹ Other characteristic symptoms of arthritis are swelling and pain in the joints - in addition to stiffness. Many also experience extensive muscle aches and pains.

Fatigue is not the same as being tired

Chronic headache and neck pain

Fatigue is different from ordinary tiredness and being tired. People affected by fatigue describe it as overwhelming and uncontrollable. Furthermore, it is described as being totally exhausted and completely drained of energy. In addition, several report that they become almost apathetic and lose interest in almost everything around them. The need for sleep and rest becomes significantly greater and concentrating can be difficult. Naturally, this feeling of being constantly exhausted will also make it difficult to be active - which in turn can affect mood and state of mind (often in the form of depression and anxiety).

Tips: Fatigue can lead to a less active lifestyle - which in turn can contribute to tension in the neck. Towards the end of the article shows chiropractor Alexander Andorff, from the Vondtklinikkene dept. Lambertseter Chiropractic Center and Physiotherapy in Oslo, presented a training video with gentle neck exercises that you can easily do at home.

Symptoms of fatigue

We must remember that symptoms of fatigue can be physical, mental or emotional - and may include:

  • Chronic fatigue
  • Lack of energy and sleepiness
  • Headache
  • Dizziness
  • Sore and aching muscles
  • Muscle weakness
  • Impaired reflexes and responses
  • Impaired decision-making and judgement
  • Mood changes (for example, irritability)
  • Impaired hand-eye coordination
  • Lack of appetite
  • Reduced function of the immune system
  • Visual disturbances (difficulty focusing)
  • Memory impairment
  • Difficulty concentrating
  • Hallucinations (in case of extreme exhaustion)
  • Apathy and reduced motivation

Not everyone with fatigue will experience all of these symptoms. This is a general list of symptoms associated with fatigue, but often the experience will vary from person to person.

Our clinic departments at Vondtklinikkene (click here  for a complete overview of our clinics), including in Oslo (Lambert seats) and Viken (Eidsvoll Sound og Raw wood), has a distinctively high professional competence in the investigation, treatment and rehabilitation of pain in muscles, tendons, nerves and joints. Toe contact us if you want the help of therapists with expertise in these fields.

9 good tips for dealing with fatigue

Many people affected by arthritis and fatigue gradually learn to recognize the body's signals - and how they should then best adapt the day based on this. It is important to learn to control energy use in a better way and, not least, to accept that this (unfortunately) is a part of this rheumatic diagnosis. In addition to this, arthritis is characterized by periods when the symptoms and pain are worse (flare-ups), which must be taken into account.

- You have to accept that fatigue is part of arthritis

It can be difficult to accept, but unfortunately one has to accept that fatigue is felt with rheumatic arthritis - and then deal with this in the best possible way. Arthritis often goes up and down a lot, but with the right adaptations and preventive measures it is entirely possible to live a good and fairly normal life. Set yourself new goals that you can achieve despite the rheumatic diagnosis.

9 pieces of advice from people with arthritis

sleeping problems

In interviews with people with rheumatoid arthritis, practical ways of dealing with fatigue are often mentioned. This may include to:

  1. Learn to say no sometimes
  2. Don't plan too much at once
  3. Customize your goals
  4. Plan carefully and take your time
  5. Remember to take breaks
  6. Go to bed early, take rest breaks and use relaxation techniques
  7. Don't go out at the busiest times of the day
  8. Talk to family and friends about rheumatoid arthritis - so that they understand the disease better
  9. Meet others with arthritis to learn from their experience and experiences

A key message that repeats itself in these nine pieces of advice is that you must learn to become better at thinking about yourself. Many people burn too much energy in periods where they don't really have a surplus - and the consequence can be that you end up in a longer flare-up period with worsening symptoms and pain. Daily use of relaxation techniques can therefore be very useful for patients with arthritis.

Good relaxation tip: 10-20 minutes daily in neck hammock (link opens in a new browser window)

Many people with fibromyalgia suffer a lot from tension in the upper back and neck. A neck hammock is a well-known relaxation technique that stretches the muscles and joints of the neck - and can therefore provide relief. In the case of significant tension and stiffness, you can expect to feel the stretch extra well the first few times. Thus, it may be wise to only take short sessions at the start (around 5 minutes). Press the image or here to read more about how it works.

Comprehensive treatment and rehabilitation therapy against fatigue

Research has shown that massage can reduce pain and alleviate fatigue in MS patients.² It is reasonable to believe that the results can also be transferred to arthritic patients. In addition to this, meta-analyses, the strongest form of research, have shown that intramuscular acupuncture (dry needling) can reduce both fatigue and pain in people with fibromyalgia.³ It has also been seen that yoga, relaxation and mindfulness can have a positive effect. Other examples of measures that can help arthritis patients include:

  • Medicinal treatment (supervised by a rheumatologist and GP)
  • Anti-inflammatory diet
  • Physical treatment
  • Physiotherapy
  • Cognitive therapy
  • Training in a warm water pool
  • Cryotherapy for swollen joints (reusable cryopack)

As we understand, it is important to combine several elements within treatment and rehabilitation therapy to achieve the best possible effect. An approach that addresses both physical and psychological aspects is important. Thinking about several factors within movement, circulation, diet and self-measures can make everyday life better. Remember that even cooling down swollen joints with reusable ice pack can contribute to less inflammation - and thus less stress on the body.

- Pain clinics: We can help you with pain in muscles and joints

Our publicly authorized clinicians at our affiliated clinics The pain clinics has a distinctive professional interest and expertise in the investigation, treatment and rehabilitation of muscle, tendon, nerve and joint ailments. We work purposefully to help you find the cause of your pain and symptoms - and then help you get rid of them.

See clinic overview

The pain clinics: A holistic treatment approach is essential

With us, you can always be sure that you are in the best hands. Feel free to contact one of our clinic departments belonging to Vondtklinikkene if you would like more information about how we use combinations of treatment techniques – including massage, dry needling, rehabilitation exercises and therapeutic laser therapy, to achieve the best possible results. Collaborating with a rheumatologist and GP, in relation to drug treatment, is also an important part of the overall treatment plan.

VIDEO: 9 adapted neck exercises

In the video above shows chiropractor Alexander Andorff at the Vondtklinikkene ward Lambertseter in Oslo presented nine adapted exercises against neck tension and stiffness. The exercises can help you stimulate movement and dissolve sore muscles and stiff joints.

«Summary: Fatigue is no joke. And one of the first things you have to do as arthritis patients is to recognize just that. By mapping and adopting measures that save energy, you avoid flare-up periods and the worst episodes of fatigue. It is therefore very important that you find the things that work for you."

Join our rheumatism support group

Feel free to join the Facebook group «Rheumatism and Chronic Pain - Norway: Research and news» (Press here) for the latest updates on research and media articles on rheumatic and chronic disorders. Here, members can also get help and support - at all times of the day - through the exchange of their own experiences and advice. Otherwise, we would greatly appreciate it if you would follow us on the Facebook page and Our Youtube channel (the link opens in a new window).

Please share to support those with rheumatism and chronic pain

Hello! Can we ask you a favor? We kindly ask you to like the post on our FB page and to share this article on social media or via your blog (please link directly to the article). We are also happy to exchange links with relevant websites (contact us on Facebook if you want to exchange links with your website). Understanding, general knowledge and increased focus is the first step towards a better everyday life for those with rheumatism and chronic pain diagnoses. So we hope that you will help us with this battle of knowledge!

The pain clinics: Your choice for modern interdisciplinary health

Our clinicians and clinic departments always aim to be among the top elite in the field of investigation, treatment and rehabilitation of pain and injuries in muscles, tendons, nerves and joints. By pressing the button below, you can see an overview of our clinics - including in Oslo (incl Lambert seats) and Viken (Raw wood og Eidsvoll Sound).

See clinic overview

Sources and Research

1. Institute for Quality and Efficiency in Health Care (IQWiG). Rheumatoid arthritis: Living and dealing with fatigue. May, 2020. [PubMed – Books]

2. Salarvand et al, 2021. Effectiveness of massage therapy on fatigue and pain in patients with multiple sclerosis: A systematic review and meta-analysis. Mult Scler J Exp Transl Clin. 2021 Jun.

3. Valera-Calero et al, 2022. Efficacy of Dry Needling and Acupuncture in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Aug.

Article: Arthritis and fatigue: An extreme exhaustion

Written by: Our publicly authorized chiropractors and physiotherapists at Vondtklinikkene

Fact check: Our articles are always based on serious sources, research studies and research journals - such as PubMed and the Cochrane Library. Please contact us if you spot any errors or have comments.

FAQ: Frequently asked questions about arthritis and fatigue

1. Are arthritis and rheumatism the same?

No, it is not. Arthritis is the same as rheumatic arthritis (often abbreviated to RA) - i.e. a rheumatic diagnosis. Rheumatism is the umbrella term for over 200 different rheumatic diagnoses, which include Psoriasis arthritis and ankylosing spondylitis (Ankylosing spondylitis). It is important to point out that rheumatoid arthritis is an autoimmune condition - where the body's own immune system attacks its own cells in the joints.

Ankylosing spondylitis: When the joints heal together

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Ankylosing spondylitis: When the joints heal together

Ankylosing spondylitis, also known as ankylosing spondylitis, is a chronic rheumatic autoimmune diagnosis that affects the vertebrae, pelvic joints, larger joints (including knees and hips) and tendon attachments. Unfortunately, there is no cure for Bekhterev's.

Ankylosing spondylitis is thus a form of arthritis that causes inflammation in the joints and ligaments of the spine and pelvis (sacroilitis).¹ In addition to this, more peripheral joints such as knees, ankles and hips can also be affected. But it is more rare. Normal joint function means good range of motion and being able to move freely. The chronic inflammation in the joints and ligaments of the spine leads to stiffness and reduced mobility. In severe cases, this can cause the vertebrae to fuse together - in such cases you are left with a completely stiff back. But such cases are fortunately very rare these days.

Chronic inflammation of the joints can lead to fused joints

Ankylosing illustration image

(Figure 1: Illustration of how Ankylosing spondylitis can lead to fused vertebrae)

In the example above (figure 1) you see an illustration of how inflammation in the end plates of the vertebrae and ligaments can lead to gradual calcification and bone formation. We would like to emphasize that the majority of people with Bekhterev's have mild to moderate symptoms. Early diagnosis and more modern treatment methods make it possible to slow down the negative development. The majority of people with Bekhterev's have positive results for HLA-B27 in blood tests.

Tips: Exercise with pilates band (elastic band) can be an excellent form of exercise for people with Bekhterev's. Towards the end of the article shows chiropractor Alexander Andorff also produced a video with recommended back exercises for this patient group.

- There is no cure, but the diagnosis can be kept in check

There is thus no cure, but there are a number of treatment modalities that help control and alleviate the symptoms. Recommended treatment may include mobility exercises, strength training, physical therapy for muscles and joints to improve mobility and posture, as well as drug therapy to reduce inflammation and slow progression. The vast majority of people with Bekhterev's can live good and fulfilling lives.

Our clinic departments at Vondtklinikkene (click here  for a complete overview of our clinics), including in Oslo (Lambert seats) and Viken (Eidsvoll Sound og Raw wood), has a distinctively high professional competence in the investigation, treatment and rehabilitation of pain in muscles, tendons, nerves and joints. Toe contact us if you want the help of therapists with expertise in these fields.

Symptoms of Ankylosing Spondylitis (Ankylosing Spondylitis)

Rigid back about the morning in bed

Many people with ankylosing spondylitis experience mild to moderate episodes of back pain and stiffness. Others may experience more significant pain with associated stiffness in the spine and pelvis. It is also important to mention that the diagnosis can lead to the development of eye disease (uveitis), skin disease (psoriasis) or intestinal disease (irritable bowel syndrome).

Joint pain and stiffness

The most common symptom of ankylosing spondylitis is pain and stiffness in the lower back and pelvis. As the rheumatic diagnosis develops, the symptoms will affect larger parts of the spine and body. Characteristically speaking, the pain and stiffness are worst after longer periods of rest and inactivity – for example in the morning and after prolonged sitting. Movement and exercise usually provide pain relief and functional improvement.

May vary from person to person

It is important to state that there are both mild and severe versions of ankylosing spondylitis. Some people have mild periods of pain versus others who have significant, constant pain. Regardless of this, people with the diagnosis may experience worsening in so-called "flare-up periods". So, for example, periods when the inflammation is more active.

Other symptoms

In addition to the stiffness and pain in the back, pelvis and hips - are there more symptoms that you should be aware of. These include:

  • Pain, stiffness and inflammation in the ribs, shoulders, knees or feet
  • Pelvic joint pain
  • Sacroilitis (pelvic arthritis)
  • Night pain (due to lack of movement)
  • Difficulty taking a full breath in (if the joints of the ribs are affected)
  • Vision problems and eye pain (uveitis)
  • Fatigue and exhaustion (due to chronic inflammation)
  • Lack of appetite and associated weight loss
  • Skin rash (possible psoriasis)
  • Abdominal pain and irritable bowel

In the next part of the article, we take a closer look at the cause of Bekhterev's disease - we warn in advance that it will be technical (but interesting).

Theory: The cause of Bekhterev's disease

(Figure 2: Possible pathophysiological cause of Bekhterev's | Source: Creative Commons / PubMed)

Before, and until recently, it has long been said that scientists know nothing about the cause of Bekhterev's disease. Well, that's not entirely true. Firstly, we know that research has found concrete evidence that Bekhterev's is an autoimmune diagnosis - meaning that the body's own immune system is behind the chronic inflammation. As seen by increased amounts of T cells.²

The pathophysiology behind Bekhterev's (Ankylosing spondylitis)

Figure 2 above is a demonstration of the possible pathological role of HLA-B27 in ankylosing spondylitis. On the far left you see a cell and the lines indicate which cell structures we are talking about. But you don't have to be 100% committed to that. Briefly, the following happens:

- HLA-B27 plays a central role 

HLA-B27 provides arthritogenic peptides to CD8+ T lymphocyte cells, which in turn initiate the autoimmune process - and thus trigger ankylosing spondylitis. In addition to this, a number of abnormal reactions occur in the cell membrane which result in significant stress reactions on what we call the endoplasmic reticulum (ER). In other words, a cell organelle that consists of membranes - and where the majority of the cell's biochemical processes take place.¹ If you wish, you can also read even more details about this complicated process via the link to the research study.

- Pain clinics: We can help you with pain in muscles and joints

Our publicly authorized clinicians at our affiliated clinics The pain clinics has a distinctive professional interest and expertise in the investigation, treatment and rehabilitation of muscle, tendon, nerve and joint ailments. We work purposefully to help you find the cause of your pain and symptoms - and then help you get rid of them.

See clinic overview

Modern and holistic treatment of Ankylosing spondylitis

We can divide modern treatment and rehabilitation of Bekhterev's into three key points:

  1. Stimulate mobility and function
  2. Strengthen joints and muscles
  3. Reduce inflammation

For patients with Bekhterev's, movement is one of the most important things. We know that inactivity and prolonged sitting lead to increased stiffness, more pain and inflammatory reactions. This is precisely why it is so important that people with this diagnosis have good discipline when it comes to daily mobility exercises and follow-up with a physical therapist (such as a physiotherapist or chiropractor). We also recommend fixed intervals with follow-up for joint mobilization and traction treatment (pulling the joints apart) - to maintain joint mobility in a good way. Meta-analyses, the strongest form of research, have also shown that follow-up with a therapist is more effective than doing everything on your own.³ An anti-inflammatory diet can also play a central role.

Good tip: Back stretching board (link opens in a new browser window)

For patients with Bekhterev's, where the main problem is actually extensive stiffness in the back, we cannot escape a recommendation for the use of back stretch board.  This is therefore an in-house measure that stretches and stretches the vertebrae - and pulls them apart. For many people with a very stiff back, many will feel a fairly clear stretching sensation in the first few weeks of using the back stretcher. But eventually it will work out - and the stretching will no longer feel as intense, which will also be a clear sign that it is working. Press the image or here to read more about how it works.

VIDEO: Exercises against Ankylosing spondylitis

In the video above, chiropractor Alexander Andorff v/ Vondtklinikkene avd Lambertseter shows four recommended exercises for patients with Bekhterev's. These are exercises that can be done daily to stretch and maintain better movement in the lower back and pelvis.

«Summary: As with all diagnoses and illnesses, one of the most important things is to take it all seriously. Contact a physical therapist and make sure that you have a good rehabilitation program with the right exercises to deal with, and that you also occasionally get help with joint mobilization and muscular work."

Join our rheumatism support group

Feel free to join the Facebook group «Rheumatism and Chronic Pain - Norway: Research and news» (Press here) for the latest updates on research and media articles on rheumatic and chronic disorders. Here, members can also get help and support - at all times of the day - through the exchange of their own experiences and advice. Otherwise, we would greatly appreciate it if you would follow us on the Facebook page and Our Youtube channel (the link opens in a new window).

Please share to support those with rheumatism and chronic pain

Hello! Can we ask you a favor? We kindly ask you to like the post on our FB page and to share this article on social media or via your blog (please link directly to the article). We are also happy to exchange links with relevant websites (contact us on Facebook if you want to exchange links with your website). Understanding, general knowledge and increased focus is the first step towards a better everyday life for those with rheumatism and chronic pain diagnoses. So we hope that you will help us with this battle of knowledge!

The pain clinics: Your choice for modern interdisciplinary health

Our clinicians and clinic departments always aim to be among the top elite in the field of investigation, treatment and rehabilitation of pain and injuries in muscles, tendons, nerves and joints. By pressing the button below, you can see an overview of our clinics - including in Oslo (incl Lambert seats) and Viken (Raw wood og Eidsvoll Sound).

See clinic overview

Sources and research

1. Zhu et al, 2019. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Res. 2019 Aug 5;7:22. [PubMed]

2. Mauro et al, 2021. Ankylosing spondylitis: an autoimmune or autoinflammatory disease? Nat Rev Rheumatol. 2021 Jul;17(7):387-404.

3. Gravaldi et al, 2022. Effectiveness of Physiotherapy in Patients with Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Healthcare (Basel). 2022 Jan 10;10(1):132.

Article: Ankylosing spondylitis – when the joints heal together

Written by: Our publicly authorized chiropractors and physiotherapists at Vondtklinikkene

Fact check: Our articles are always based on serious sources, research studies and research journals - such as PubMed and the Cochrane Library. Please contact us if you spot any errors or have comments.

FAQ: Frequently asked questions about Ankylosing spondylitis

1. How can one get a better quality of life with Bekhterev's?

One of the most important things is an early examination to assess function and make a diagnosis. In the case of proven Bekhterev's, regular movement, rehabilitation exercises and physical treatment (for both muscles and joints) will play central roles in maintaining good mobility and functionality. Studies have shown that going regularly to a physical therapist for follow-up in relation to training and rehabilitation has the best effect.³