The boundless energy of youth, that spark that keeps kids on the go, is something that fatigue steals from many children with juvenile arthritis (JA). And though it may require a bit of detective work from you, your child and your physician to get to the cause of your child’s fatigue, there are many things that can be done to alleviate this symptom and return that twinkle to your child’s eyes.
Some children with arthritis are very affected by fatigue while others are not. But in general, those with active disease, especially during flares, are more likely to feel fatigued. Kids with pauciarticular and oligoarticular disease don’t seem to have as much of a problem with it.
What causes fatigue?
Fatigue is a complex beast. Several factors ranging from the way her body handles the disease to an inability to get good sleep may be responsible.
“When the disease is active, we think it has to do with the toll of chronic inflammation on the body,” says Carol Wallace, MD, associate professor of pediatrics at the University of Washington and Children’s Hospital & Regional Medical Center in Seattle.
Iron deficiency (anemia) can also produce fatigue. Keeping kids’ arthritis under control is important in this regard because chronic inflammation impairs how well the body utilizes iron and can worsen anemia. Jean Kotowski’s 12-year-old-son Danny from Naperville, Ill., was diagnosed with systemic juvenile rheumatoid arthritis (JRA) when he was 9 years old and he was very anemic.
“As a young boy he always seemed tired and when we took him in for his kindergarten they noticed he was anemic,” says Jean. “We didn’t realize it then, but that might have been the start of everything with Danny.”
Another likely cause of fatigue is pain. “I think pain makes you very tired,” says Marisa Klein-Gitelman, MD, associate professor of pediatrics and head of the division of rheumatology at Children’s Memorial Hospital in Chicago. Pain and inflammation often seem to be linked. However, Dr. Klein-Gitelman points to children whose arthritis isn't active but who have previous hip or knee damage and are in pain on a regular basis. Even without inflammation, they feel fatigued. In these cases it seems pain is the trigger.
Getting good Zzzs
Poor quality sleep can certainly cause fatigue in anyone, particularly tough kids with arthritis. Research shows that compared to healthy kids, children with arthritis often “have more difficulty falling asleep, they wake during the night and have difficulty falling back to sleep, and they wake up early in the morning and can’t go back to sleep,” says Sharron Docherty, PNP, assistant professor at the Duke University School of Nursing in Durham, N.C.
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