What is the relationship between lupus and fatigue?

Fatigue is commonly reported during most chronic diseases. It affects almost 9 out of 10 lupus patients.

Fatigue is a decrease in the performance of physical and mental activity. It can hinder everyday life, preventing the realisation of certain projects, and can hinder social relations. This is the symptom that is considered the most disabling by half of the patients. When lupus is active, fatigue is directly related to the disease, especially if it causes pain or strong inflammation.

On the other hand, when lupus seems to be under control, the cause of fatigue is not well known.

Several factors are involved: the level of muscle performance (muscle weakness induced by prolonged cortisone intake, loss of physical condition), the possible association with fibromyalgia and sleep disorders sometimes points to a depressive state.

Fatigue: a sign of lupus activity, but not only. Another cause of organic fatigue, such as anemia, or dysfunction of the thyroid gland must be eliminated.

Fatigue is often a reflection of the activity of the disease. Persistent joint or muscle pain and worry about disease activity, which causes sleep disturbances, are all possible causes of lupus-related fatigue. However, fatigue sometimes persists despite good disease control, suggesting the existence of other factors.

These may include:

An autoimmune disease associated with lupus, including dysthyroidism (hypo or hyperthyroidism), myasthenia gravis or Sjögren syndrome (which sometimes causes urinary loss of potassium or phosphorus). Fibromyalgia, which is also present in about 15 to 15% of lupus patients can also be a major part of the fatigue.

Anemia, whose causes are multiple.  Fatigue is then accompanied by shortness of breath.

Adrenal insufficiency after discontinuation of prolonged corticosteroid therapy.

Hormonal problems: fatigue often accompanies ovulation difficulties and then occurs rather in the second part of the cycle: many women feel exhausted on the eve of their period.

A disease unrelated to lupus, including an infection.


Psychosocial factors are often associated, as in many long-lasting illnesses:

Anxiety is often present and can persist, even outside of any flare of the disease.

Sometimes depressive states are present and can be expressed by a state of chronic fatigue, which is isolated. It is then necessary to look for hypothyroidism. In situations of so-called "nervous" fatigue, it is anxiety or nervous tension that allows you to hold on. Depression tires, but anxiety sometimes helps one to keep standing. In this case, the more tired you are, the more you fight against exhaustion, using your reserves and using stimulants such as coffee.

Fatigue can also be the consequence of excessive stress. It is then a result of adaptation.

The fatigue that persists after the lupus flare often has several causes:

Anxiety or depression can be a result of worrying about your illness.

The daily stress linked to modern society imposing an incessant race: work (schedules, professional stress, fear of dismissal), public transport, family constraints, hyperconnection to emails, texts...

Medications and the disease itself may also be at play.


Fatigue, which affects 9 out of 10 patients, often has no obvious cause when lupus seems well controlled. It is readily associated with non-specific psychosocial factors, such as anxiety, stress or depression.

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