Welcome Back Rheumatology Fans,

Fatigue! The overlooked, underappreciated, oft ignored symptom associated with Arthritis. In this video I go into some detail about why it occurs and why it is so hard to manage, then explain the parameters we can use to actually make improvements!

Ideally watch the video but I have put a summary for you below.

Fatigue: The Most Under-Appreciated Problem In Inflammatory Rheumatology

In this episode, Jack explores what he believes is one of the most under-recognised and poorly managed problems facing people with inflammatory rheumatological conditions: fatigue. While joint pain, stiffness, and function quite rightly receive clinical attention, fatigue is often sidelined—despite being one of the most debilitating symptoms patients report and one of the hardest to treat medically.

Jack focuses specifically on auto-inflammatory rheumatological conditions such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, Sjögren’s syndrome, and polymyalgia rheumatica, rather than osteoarthritis or gout. He argues that fatigue in these conditions sits firmly within the therapist’s remit—not just physiotherapists, but all MSK professionals—because medication alone often fails to meaningfully improve it.

The episode breaks fatigue down into several key contributing factors. First is a literal sleep deficit. Many inflammatory conditions disrupt sleep, often waking patients in the early hours of the morning due to pain and stiffness. Over years, this creates a chronic lack of restorative sleep, often in people who are still working, raising families, and unable to flex their schedules.

Second is immune-driven fatigue. An overactive immune system requires energy and actively promotes tiredness as a protective mechanism—much like the exhaustion felt during flu or infection. In inflammatory disease, this process is switched on constantly, leading to a persistent, unrefreshing fatigue that is largely resistant to disease-modifying drugs.

Finally, Jack highlights muscle loss and deconditioning. Chronic inflammation can reduce muscle bulk, activity levels often fall after diagnosis, and even when disease control improves, muscle mass rarely returns fully to baseline. This means everyday tasks require more effort, accelerating fatigue.

At around the nine-minute mark, Jack emphasises a key clinical reality: fatigue is multifactorial, chronic, and difficult to “fix.” Patients cannot consciously control their immune system, and pacing strategies—while useful for some—are often impractical, particularly for younger patients with busy lives.