Other Possible Causes
Adjoa, whose lupus is in remission, says that it is hard for her to tell when it is her lupus causing the fatigue or something else entirely.
“It could just be me getting older,” she says with a laugh.
It could also be any number of other causes -- some lupus-related, others not.
“Is it associated with any manifestation of the disease, such as kidney failure or anemia?” Grader-Beck asks. “We treat those manifestations and hope the fatigue had to do with those manifestations. But frequently, that doesn’t work.”
Other conditions can also cause fatigue. In her practice, Dall’Era screens patients for hypo- and hyperthyroidism, anemia, and heart disease, all of which are possible explanations for a patient’s fatigue.
Lifestyle May Help
Dall’Era and Grader-Beck say that lifestyle changes have made an impact on their patients’ fatigue.
“I always counsel my patients on common-sense health patterns – healthy diet, sleeping well, and regular exercise,” Dall’Era says. “I can’t point to a study that proves it’s true. There’s no high-level data. But my clinical experience and intuition points to that they are very important.”
She advises her patients to walk, swim, and do whatever exercise they can do. “Exercise combats fatigue, though it may sound counter-intuitive,” Dall’Era says.
“I think if patients can be motivated to exercise it will make a difference,” says Grader-Beck, who recommends that patients start slowly and that they find an exercise partner or group to help keep them motivated.
Keeping a healthy diet also may help reduce fatigue. Grader-Beck says that many lupus patients have low levels of vitamin D, so he makes sure his patients get enough so that their levels are in the high end of the normal range.
Patients are not the only ones who are frustrated by lupus-related fatigue. Because there are no biomarkers for fatigue, there is no way for doctors to measure it. And, Grader-Beck says, as long as that is the case, there is no way to know how effective any intervention will be. But he’s hopeful that things will change in the not too distant future.