A pattern of people with battery icons on their chests. All have full batteries except for the patient in the middle with a red exclamation point and one tick mark of energy left.

Why Are People With Lupus So Tired?

Nearly every person with lupus experiences fatigue at some point during the course of their disease. Fatigue can feel like crushing exhaustion, low-level tiredness, or even being too wiped out to get out of bed. For many people living with lupus, fatigue is a daily symptom. For others, fatigue mostly occurs after exertion.

Lupus fatigue causes

Inflammation

There are many suspected causes of lupus fatigue, but no one definitive answer. In "The Lupus Book," renowned rheumatologist Daniel Wallace explains that active inflammation can cause fatigue. Inflammation in lupus is caused by our immune system attacking either invading germs or, in the case of lupus, our own body’s organs. To understand immune system dysfunction in lupus, imagine the body’s immune system as an army. A healthy immune system is made up of cells, or soldiers, who recognize enemy germs and then fight them in order to protect the body. In lupus, however, imagine that the soldiers in the army are confused. They incorrectly identify organs such as the joints, skin, kidneys, or central nervous system as foreign invaders. Then the immune system ruthlessly attacks, causing inflammation. The same inflammatory response that makes us tired when our bodies fight off the flu or cold becomes a frequent occurrence in lupus because our immune system is overactive.1

Cytokine dysfunction

Cytokine dysfunction may also play a role in lupus fatigue. Cytokines, a part of our body’s immune system, are hormone-like substances that are spurred into action by our body’s immune response. A phenomenon called cytokine storm occurs when excess cytokines flood the body. Cytokine storm is the result of an overactive immune response and is currently being studied in COVID-19 patients.2

Other medical conditions

Another cause of fatigue in lupus patients may not be lupus at all. Some lupus patients develop additional medical conditions after they’ve already been diagnosed with lupus.

  • Anemia – One condition commonly found in lupus patients is anemia. Anemia, or a lack of iron in the blood, prevents red blood cells from doing their job of carrying oxygen throughout the body. Unlike lupus, anemia can be easily diagnosed with a simple blood test. Taking a multivitamin with iron can help with anemia. Adding foods rich in iron into a patient’s diet can also increase the amount of iron in the blood. Patients with anemia can benefit from eating foods like red meat (like beef or lamb), chicken, or fatty fish like mackerel or salmon. Tofu, beans and lentils, and dark leafy vegetables are also good sources of iron.3
  • Thyroid disease – Like anemia, thyroid disorder is another common condition that can appear in people with lupus. In an autoimmune disease like lupus, thyroid disease occurs when a dysfunctional immune system confuses the thyroid for a foreign invader and attacks it. This can cause the thyroid to produce too much of a hormone called TSH, resulting in hyperthyroidism, also known as Graves Disease.4More commonly, thyroid disease causes the thyroid to underproduce TSH, resulting in hypothyroidism, or Hashimoto’s.5

    Thyroid disease is more common in women, although it can affect people of any gender. Hashimoto’s or Grave’s can be diagnosed with a blood test, although sometimes an ultrasound is needed also.6 A doctor may also physically feel a patient’s neck to examine their thyroid. Thyroid disease is monitored with frequent blood tests and treated with a pill that patients swallow each morning before eating.

Conclusion

Whatever the cause of fatigue people experience as part of their lupus, it’s important for people with lupus to respect the new limitations of their bodies. Pushing through fatigue will only increase your exhaustion, and might even induce a flare. While it might be tempting to finish everything on your to-do list, what is truly most important is your health and well-being.

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