Rheumatoid Arthritis and Fatigue, Exhaustion, Listlessness: It Actually is in Your Head

Lana Sandon, a dietician who has Rheumatoid Arthritis, told Health Talk about the effects of living with chronic pain: "Just taking a shower, something that should revive you and make you feel well, becomes exhausting." Sandon's experience is all too common. According to Joint Health, "[f]or many people living with arthritis, 'I'm so tired' is an often spoken phrase. Fatigue is their constant, very unpleasant companion."

The blood-brain barrier

The "blood-brain barrier" is the name for the idea that certain cells in brain capillaries function to protect the brain from surges of various chemicals and molecules. This function is likened to erecting a "barrier."

Scientists long believed that the blood-brain barrier isolated the brain from a person's immune system responses to "distant" events, such as inflammation in the knees or liver. Recently, researchers at the University of Calgary found that when mice developed inflamed livers---similar to inflammation caused by Lupus, for example---two things occurred:

First, the mice's brains produced chemicals that actually attracted immune cells, called monocytes, into the brain. Second, the mice's blood produced a chemical that directed those immune cells to go to the brain.

When the immune cells reached the brain, the mice began exhibiting "sickness" behaviors. Those behaviors demonstrated fatigue, listlessness, loss of social interest and malaise.

Mark D. Swain, Professor of Medicine at the University of Calgary and one of the researchers on this study, stated this is the first time studies have shown a biochemical pathway from distant inflammation (inflammation occurring away from the brain) to the brain itself.

Distant inflammation activates the brain

Nancy Rothwell, an expert on brain inflammation at the University of Manchester, says this new study helps explain how different problems occurring in the body also activate the brain. In this situation, the brain is activated in ways that result in sickness behaviors. These behaviors can be experienced and exhibited as overwhelming exhaustion, decreased social participation, malaise and "brain fog."

It makes sense that inflammatory events in the body provoke a brain response that affects behavior and sense of well-being. Rothwell observes that "[t]he brain is the master coordinator of many of our bodies' defense responses, so it must be able to sense injury and inflammation in distant body organs."

As the Calgary study shows, the brain's ability "to sense injury and inflammation in distant body organs" leads to brain action. According to Science Daily, the research suggests that "certain behavioral changes [such as fatigue and consequent social withdrawal] suffered by those with chronic inflammatory diseases are caused by the infiltration of immune cells into the brain."

Coping with overwhelming fatigue and other brain symptoms of chronic disease

Persons with chronic inflammatory disease, such as rheumatoid or other arthritis, psoriasis, lupus or Chron's, may suffer stark and even crippling effects on their mood, emotional outlook, and physical and social energy levels. No doubt many of those who suffer these effects have been told variations on "try to snap out of it" and "it's all in your head."

The Calgary study, demonstrating a direct link between inflammatory events in the body, brain reaction to those events, and resultant sickness behaviors, gives new meaning to "it's all in your head."

Based on this study, sickness behaviors in fact do start in the head: during inflammatory events, immune cells infiltrate the brain. Researchers think this is the reason the number one question asked by rheumatoid arthritis and other inflammatory disease patients is "Why am I so tired?"

For some people, just knowing about the biochemical process behind their fatigue, malaise and brain fog is helpful. This knowledge does not necessarily change the ways in which patients have to take care of themselves. Nor does it change the frequently debilitating impact of fatigue and related effects. Nevertheless, sometimes it seems easier to cope with a behavior when patients know it is a physical part of their disease, not an emotional reaction to it.

Sources:

"Blood Brain Barrier," University of Manchester (U.K.)

HealthTalk Staff (Ed Zimney, M.D., Medical Reviewer), "Rheumatoid Arthritis and Fatigue: Why Does RA Make Me So Tired?," Everyday Health.

"I'm so tired: Arthritis and Fatigue," Joint Health.

"How Inflammatory Disease Causes Fatigue," Science Daily.