“I feel exhausted during the day, especially after work, and take a nap. Then, I can’t sleep at night. When I do, I never feel refreshed. Ugh! When does it end?” These words from a MyPsoriasisTeam member capture what many people experience with psoriatic arthritis (PsA).

While joint pain is a better-known symptom of PsA, 30 percent to 40 percent of people with the condition experience fatigue — an extreme feeling of exhaustion or tiredness that doesn’t improve with rest.

Fatigue might not get as much attention as other PsA symptoms, but it can be severe. Fatigue affects both cognitive (mental) and physical functioning, making everyday tasks harder. When combined with other symptoms of psoriatic arthritis, fatigue can really impact your overall wellbeing and quality of life.

Understanding PsA fatigue better can help you manage it. Keep reading to find out what you need to know about fatigue in PsA, including what causes it and how to manage it.

What Does Fatigue in Psoriatic Arthritis Feel Like?

Many MyPsoriasisTeam members have shared how fatigue from PsA affects their daily lives. One member said that it takes them “ages to fall asleep.” They added, “Then I wake up hours early and lay awake again. When it’s time to get up, I finally want to sleep. I go on like this until the fatigue hits, and I’m so tired I can hardly put one foot in front of the other. Then I sleep during the day. By night, it all starts again.”

Another member lives with several conditions that contribute to their fatigue. They explained: “On top of my arthritis, I have thyroid problems, which add to the fatigue — it’s sort of a double whammy.” They added, “When the arthritis is really painful, it’s so tiring, but I still cannot get to sleep. Then, when I do eventually snooze, it’s for very short spells at a time throughout the night. I find myself wanting to sleep during the day, when I need to be alert and refreshed to go out to work, but it is something I have just had to put up with over the years. Now it’s a way of life that I am used to.”

What Causes Fatigue in Psoriatic Arthritis?

PsA is an autoimmune disease that affects how the immune system works and leads to inflammation. This inflammation itself can trigger fatigue. Other factors like PsA medications and disease complications can also contribute to tiredness.

1. Pain

The chronic (long-term) joint pain commonly experienced by people with PsA is a major contributor to fatigue. Joint pain makes it harder to stay physically active, and this lack of movement can worsen fatigue over time.

2. Sleep Problems and Insomnia

Sleep disturbances are common in PsA. In fact, nearly 90 percent of people with psoriatic disease have trouble sleeping. Many experience “painsomnia” — insomnia (difficulty sleeping) caused by chronic pain and discomfort from PsA symptoms like joint pain and swelling.

Losing sleep contributes to fatigue and can even make PsA symptoms worse. In this cycle, poor sleep causes the brain to become fatigued. A tired brain becomes less effective at regulating pain signals. This makes your pain start to feel even worse, which can make getting to sleep even harder.

3. Depression

Depression and other mental health conditions are common in people with chronic inflammatory diseases like psoriasis, and can make fatigue much worse.

The relationship goes both ways: PsA symptoms can lead to depression and depression can make PsA symptoms feel worse.

Depression can also be a side effect of some PsA medications such as corticosteroids, which are used as long-term treatment. It can be hard to tell whether your depression is due to disease itself or its treatment.

4. Anemia

People with PsA are more likely to develop anemia (low red blood cells), which can lead to fatigue. Two types of anemia can appear with PsA: iron-deficiency anemia and anemia due to chronic disease (caused by inflammation).

Iron-Deficiency Anemia

People with psoriatic disease are more likely to develop iron deficiency. Since the body can’t produce iron on its own, we rely on iron-rich foods (both plant and animal sources) for this essential mineral. Iron-deficiency anemia — the most common type — occurs when there aren’t enough healthy red blood cells. Red blood cells play a key role in the production of iron. Some common symptoms of iron deficiency are extreme fatigue, weakness, and lightheadedness.

Anemia of Chronic Disease

Anemia of chronic disease develops when chronic inflammation (like in PsA) interferes with the body’s ability to use stored iron to make red blood cells. Inflammatory conditions such as PsA may also affect the production of erythropoietin, a hormone that regulates red blood cell creation. People with inflammatory arthritis such as PsA seem to be more likely to develop this type of anemia.

5. Medication Side Effects

Certain PsA treatments can cause fatigue, including types of methotrexate and cyclosporine. Other medications, including antidepressants and those for anxiety and pain, may cause fatigue in people with PsA. Biologic treatments can also cause extreme fatigue.

One MyPsoriasisTeam member shared the following about being on their third day of a new treatment: “Doctor said it could take three to four months before I feel any relief from my psoriatic arthritis. I feel extremely fatigued. Can’t decide if it is my PsA or the [treatment].”

6. Comorbidities

Living with comorbidities (other health conditions) — such as psoriasis, fibromyalgia, or depression — may affect your sleep quality and contribute to fatigue.

6 Tips for Managing Fatigue With Psoriatic Arthritis

If fatigue is interfering with your daily activities, talk to your rheumatologist or healthcare provider. Your doctor may need to run tests to see if there’s another issue that could be causing your fatigue.

Once your doctor identifies what’s causing your fatigue, they may suggest different approaches to help you feel better. These could include adjusting your PsA treatment or making lifestyle changes to help control your fatigue. Be sure to speak with your doctor before trying any new therapies.

1. Adjust Your Medications

Since inflammation often causes fatigue, the right PsA treatment is crucial to control your symptoms and prevent flare-ups. Talk to your doctor about which therapies might work best for you and choose the most suitable treatment together.

If your doctor thinks your fatigue might be caused by the PsA medication you’re taking, they may recommend changing your treatment. Always let your doctor know if you notice any changes in your levels of fatigue after starting, changing, or adjusting medications for PsA. You can work together to find a plan to manage both your psoriatic arthritis and fatigue.

2. Eat a Nutritious Diet

Eating a nutritious diet may help keep fatigue at bay. A healthy diet can also help you maintain a healthy weight. Focus on eating lean proteins, whole grains, and plenty of fresh fruits and vegetables. Try to avoid fatty, processed foods. Cooking fresh meals at home is better than eating prepackaged foods. Try not to eat late at night — especially anything heavy or rich.

If you need help with your diet, your doctor may refer you to a licensed dietitian. This specialist can create an eating plan with the right nutrients for your needs.

3. Try Dietary Supplements

Some people with psoriatic disease find that supplements help with severe fatigue. Your doctor might suggest vitamin D, B vitamins, minerals, multivitamins, or omega-3 fish oil. Never start a supplement without asking your doctor first. Some can interact with medications or cause side effects. Your doctor knows which supplements are safe and helpful for your situation.

4. Exercise Regularly

Exercise might seem hard when you have fatigue and PsA symptoms, but getting regular exercise can actually give you more energy. The NHS notes that a 15-minute walk can boost your energy levels. Start slowly — the key is to move regularly, not intensely.

One MyPsoriasisTeam member offered the following advice: “Just keep moving. You are doing your best. Look at your diet. See if you can add any natural inflammation cessation to your daily routine.”

5. Let Yourself Rest

Listen to your body and allow yourself to rest when needed. Schedule breaks during your day.

One member described their approach: “When I’m fatigued, I try to keep my daily routine but just go through the motions and get the basics done. I still go to Pilates but put very little effort in.”

6. Keep a Fatigue Diary

Keeping a fatigue diary can help you identify what may be contributing to your fatigue. Record the days and times when your fatigue starts and stops. You can also record:

• Your activities at those times
• Sleep quality and duration
• Work or exercise sessions
• What you ate and drank
• PsA flare-ups

This information can help you and your doctor spot patterns in your fatigue and find solutions.

Find Your Team

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis as well as their loved ones. More than 194,000 members come together to ask questions, give advice, and share their experiences with others who understand life with psoriasis or PsA.

Have you experienced fatigue with psoriatic arthritis? How have you managed it? Share your experiences and tips in the comments below or by posting on your Activities page.