The drugs methotrexate and prednisone were effective in a 2-year study in reducing the fatigue that plagues many people with rheumatoid arthritis. Getty Images
  • Researchers say a new combination therapy involving two drugs may help ease the fatigue associated with rheumatoid arthritis.
  • In a 2-year study, the drugs methotrexate and prednisone were effective in reducing the fatigue of participants who took them.
  • Experts say relieving the unrelenting fatigue allows people with rheumatoid arthritis to live more pain-free and productive lives.

Fatigue: It’s a symptom that many people with rheumatoid arthritis are literally tired of experiencing.

Many of them describe their fatigue as being “bone-tired,” “frustrating,” or “unrelenting.”

It is an invisible mystery that persists alongside many chronic conditions, especially rheumatoid arthritis and other autoimmune diseases.

This fatigue affects up to 80 percent of people with rheumatoid arthritis (RA). It can contribute to things such as brain fog, a lack of motivation, an unwillingness to exercise, and job performance.

While some people in RA community forums and the new RA Healthline app say that supplements such as B12 and iron can help with fatigue, most medical professionals are hard-pressed to find a treatment or cure that works.

Research provides hope

However, a new study shows that, when started early, intensive treatment with the drugs methotrexate and prednisone can ease fatigue in people with rheumatoid arthritis.

The research was presented at the 2020 conference of the European E-Congress of Rheumatology last month. The findings have not yet been peer-reviewed or published in a scientific journal.

The 2-year study looked at 80 participants with RA who started the drug regimen immediately after their rheumatoid arthritis diagnosis.

The participants received either 15 milligrams (mg) of methotrexate a week or a combination therapy that consisted of 15 mg of methotrexate alongside 30 mg of prednisone on a weekly basis. This amount was eventually reduced to 5 mg a week over time.

Why this particular drug combo?

Researchers say methotrexate can suppress RA-related inflammation. Prednisone can help ease both joint pain and inflammation.

Researchers say the drugs’ ability to quell disease activity subsequently helped to stave off severe fatigue.

The study’s findings indicated that the participants who had the more intensive treatment with the drug combo over 2 years were less tired than those in the other group.

Researchers added that both groups had similar disease activity over time, but the participants in the combo group had less fatigue.

They added these differences in fatigue levels between the two groups appeared to noticeably increase over time.

Reaction to the research

“My fatigue is by far the most annoying everyday part of life with RA,” Shirley Hanover, 58, a resident of Connecticut who has lived with rheumatoid arthritis for 10 years, told Healthline.

She and Norma Harvey, 46, a resident of Ontario, Canada, who has had RA since her 20s, both would like to see a treatment for their tiredness.

“In my mind, a miracle cure for rheumatoid disease involves not just the reduction of pain but also the management of fatigue. I’m always so tired,” Harvey told Healthline.

So is there hope for people like Hanover and Harvey?

Diederik De Cock, PhD, a researcher at KU Leuven in Belgium and an author of the study, thinks so.

“The early course of the disease could provide an opportunity to manage fatigue,” he said in a press release.

Experts say such a treatment is needed.

“In addition to pain, profound fatigue reduces the quality of life for many people, even more than the swelling of the joints,” Dr. Iain Mcinnes, president-elect of the European League Against Rheumatism, said in a press release. “But, doctors often don’t pay enough attention to patients’ fatigue.”

“This study provides further evidence that an early aggressive approach to rheumatoid arthritis treatment can improve outcomes of rheumatoid arthritis and its complications,” Dr. Joseph R. Martinez, a specialist in internal medicine and rheumatology at Texas Orthopedics in Austin, told Healthline. “Our patients with RA may be able to achieve a higher quality of life as suggested by this study’s findings.”

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