6 Ways to Address Rheumatoid Arthritis Fatigue Naturally

• Does Rheumatoid Arthritis Cause Fatigue?|
• 6 Ways to Manage RA Fatigue|
• Addressing Fatigue During a Flare-Up|

Fatigue is one of the most common—and most overlooked—symptoms of rheumatoid arthritis (RA). Up to 80% of people with RA report ongoing exhaustion, yet it’s often treated as an afterthought compared to joint pain or mobility issues. Too often, people with RA  are told to simply “push through it,” even though 50% describe their fatigue as severe 1. 

From a clinical perspective, that approach misses the mark. RA fatigue is real, measurable, and multifactorial. RA fatigue is driven by factors like chronic inflammation, poor sleep, mood changes, gut health imbalances, medications, and the body’s own stress response. But the good news is that each of these areas offers a path toward improvement.

If you’re feeling worn down, unmotivated, or mentally drained from RA, natural strategies may help restore your energy in a meaningful and sustainable way.

Does Rheumatoid Arthritis Cause Fatigue?  

Rheumatoid arthritis (RA) is an autoimmune condition that affects the joints and often causes pain, stiffness, and swelling. But beyond these physical symptoms, RA also affects the immune system, metabolism, sleep, and inflammation, all of which can influence energy levels.

This is why many people with RA experience a unique type of exhaustion known as RA fatigue. It’s more than feeling tired. It may feel like 1:

• Extremely low physical and mental energy
• Lack of motivation
• Feeling overwhelmed
• Difficulty recovering even with rest

Research suggests RA fatigue may be connected to: 

• Inflammation 1 2
• Impaired physical ability 2
• Obesity 2
• Low mood 3
• Pain 4
• Sleep disturbance 2
• Depression 2

A review of 29 studies found that low mood was the symptom most consistently linked to RA fatigue. Researchers suggest that treating mental health may help ease fatigue 3.

Medications for RA, such as biologic drugs, can help control joint inflammation, but their benefits for fatigue might be limited. Research suggests that many biologic therapies tend to produce only small to moderate improvements in RA fatigue. In other words, your joints may feel better, yet lingering exhaustion can remain, which helps explain why many people with RA are still tired despite being on the “right” medication 5.

Gut Health and Fatigue

The health of your gut plays a vital role in your well-being. Your gut microbiome not only supports digestion, but also helps regulate inflammation, immune activity, and even mood, which is why your gut bacteria have a strong influence on many systems throughout the body 6 7 8. We see the gut-fatigue connection in the clinic all the time—when the gut is functioning well, our clients tend to have steadier energy and fewer inflammatory symptoms. When it is out of balance, fatigue often follows.

Research shows that a diverse, balanced gut microbiome is linked with better mood and healthier energy levels 7 9. Although there isn’t much research yet that directly studies the microbiome and RA fatigue, we do know that people with RA may have different gut microbes than their healthy counterparts 10 11. All of these factors matter in RA fatigue because if the gut becomes irritated by diet, stress, or other triggers, it may trigger immune activity that worsens systemic inflammation. And when inflammation is high, fatigue can increase.

How to Manage RA Fatigue

RA fatigue can feel like it comes out of nowhere, but it usually has understandable roots. Inflammation, gut health, sleep, movement, and emotional stress all influence energy levels, and they often overlap. The encouraging part is that each of these areas offers a way forward. Small, steady changes can make a real difference, especially when you choose the strategies that fit where your body is right now.

Below are the approaches I most often recommend to clients seeking to improve their energy in a sustainable, practical way.

1. Lower Inflammation With an Anti-Inflammatory Diet

Nutrition is one of the most reliable ways to support the immune system, and when inflammation decreases, fatigue may ease as well. There is no singular Rheumatoid Arthritis diet that works for everyone, but certain dietary patterns can help the body feel steadier.

Research shows that the Mediterranean diet can improve pain and fatigue in RA 12 13. A Mediterranean type diet centers on vegetables, beans, whole grains, fruit, olive oil, fish, lean meats, and lower fat dairy, and limits processed meats, excess sugars, and ultra-processed foods The whole food style of a Mediterranean diet provides antioxidants, fiber, and healthy fats that may help support the immune system 14, improve mood 14, and boost energy 15.

Paleo or Autoimmune Protocol (AIP) diets can be useful for some individuals as well, especially when symptoms are stubborn. We often recommend these dietary options in the clinic to help remove common inflammatory triggers and provide the body with a clearer environment to heal. These diets can be more restrictive, so I usually recommend starting with the least restrictive option and adjusting only if you need more support.

Why this helps RA: Lowering inflammatory load can help support the immune system, which can ease both joint symptoms and fatigue.

How to use this: Start with one or two anti-inflammatory meals per day and build from there. You do not need perfection to see progress. You can use our Paleo Diet Guide as a starting point.

2. Support Gut Health With Probiotics

Your gut may have a much bigger influence on RA fatigue than you may realize. Gut health isn’t just about digestion; it’s one of the places your immune system listens most closely. Up to 80% of your immune system lives in your gut 6, and when the gut is irritated or out of balance, your immune system feels it.

Research suggests that many people with RA experience increased intestinal permeability—often called leaky gut—along with imbalances in the gut microbiome. When the gut barrier is compromised, inflammatory compounds can more easily enter the bloodstream and stimulate the immune system, which may worsen autoimmune activity and contribute to fatigue 16.

Gut imbalances can also disrupt energy regulation. A healthy microbiome produces compounds that support the gut lining, help control inflammation, and influence brain chemistry tied to energy and mood 17. When this system is off, people often feel more fatigued, foggy, and inflamed.

The good news is that gut health is a highly modifiable factor. Supporting the microbiome, especially with an anti-inflammatory diet and probiotics, can help strengthen the gut barrier and reduce inflammatory signaling 18.

Why this helps RA: Gut irritation and microbiome imbalance can keep the immune system overactive. Supporting the gut makes it easier for the body to regulate inflammation, which may lead to lighter, more manageable fatigue.

How to use this: Add a high-quality probiotic to your daily routine. Our clinical approach is Triple Therapy, which uses three complementary categories of probiotics together for broad gut and immune support. Most people start noticing better digestion and more stable energy within a few weeks.

3. Improve Sleep Quality for Better Energy

Sleep has a powerful impact on fatigue in rheumatoid arthritis. Even with good nutrition and supplements in place, inadequate or disrupted sleep can keep inflammation elevated and energy suppressed. Pain, stiffness, and conditions like sleep apnea are common in RA and often interfere with restorative sleep, making fatigue feel more persistent and difficult to overcome.

Research shows that poor sleep increases inflammatory signaling and pain, and increases depression in RA 19, making next-day fatigue much more intense 2. The good news is that sleep is a modifiable part of RA fatigue. Addressing sleep quality, not just sleep quantity, can make a meaningful difference in daily energy and mental clarity. If you wake unrefreshed, snore loudly, struggle with fragmented sleep, or suspect sleep apnea, a simple home sleep test is a helpful next step. Treating apnea, when present, can significantly improve fatigue, mood, and overall symptom stability. You can also support restful sleep with natural supplements. 

Why this helps RA: Quality sleep helps regulate inflammation and pain perception. When sleep improves, fatigue becomes easier to manage and day-to-day energy feels more predictable.

How to use this: If sleep is irregular or unrefreshing, start by assessing whether pain, inflammation, or possible sleep apnea is getting in the way. From there, use the strategies to improve your sleep efficiency to build a sleep routine that supports more stable energy.

4. Develop a Consistent Movement Routine

Movement is one of the most reliable ways to improve fatigue in rheumatoid arthritis, but it often feels counterintuitive when you’re already drained. The key is understanding why exercise helps and how to approach it in a way that works with your body, not against it.

Research shows that aerobic exercise meaningfully reduces fatigue in RA, even at low durations. In a large review of randomized controlled trials (the gold standard of human research), people with RA experienced improved energy, less inflammation, and better overall functioning when they incorporated regular movement into their week 20. Another meta-analysis found that short sessions of walking, cycling, or light circuit work several times per week made a measurable difference in fatigue and did not worsen symptoms, even for people who were deconditioned or new to exercise 21.

It’s also worth noting that these exercise interventions are relatively short and only need to be done a few times per week. There’s no need to risk burnout by pushing yourself to exercise for hours every day. Instead, a simple exercise routine can have powerful effects on improving health.

Why this helps RA: Movement helps regulate immune activity, supports joint function, and improves sleep and mood, all of which influence daily energy and the intensity of RA fatigue.

How to use this: Start with the type and amount of movement you can manage on an average day, not your best day. Build gradually, stay consistent, and pay attention to what feels supportive rather than depleting.

5. Reduce Mental Load With CBT

Living with a chronic illness places a real mental and emotional load on the body. Over time, this can amplify fatigue. Cognitive behavioral therapy (CBT) helps you work with that layer, not against it.

A large randomized controlled trial found that a short group CBT course significantly reduced fatigue in RA, and those benefits lasted for at least two years 22. That is remarkable for such a simple intervention.

CBT teaches you how to recognize thoughts that heighten stress, challenge or reframe them, and build emotional resilience 23. For many people, this reduces the daily strain of living with RA and helps them feel more grounded in their body.

Why this helps RA: Lower emotional stress supports lower physiological stress, which reduces fatigue.

How to use this: Look for a therapist trained in CBT or a health psychologist familiar with chronic illness.

6. Calm the Nervous System With Mindfulness 

Mindfulness can sound a little abstract, especially when you’re dealing with a condition as concrete and physical as rheumatoid arthritis. But what we’re really talking about here is your nervous system, and how much it influences inflammation, pain, and day-to-day energy.

People with RA often live in a cycle where symptoms trigger stress, stress heightens inflammatory signaling, and fatigue becomes more intense. Mindfulness helps interrupt that loop. Practices like guided breathing, visualization, or structured relaxation activate the parasympathetic nervous system, which is the part of your physiology that helps the body downshift out of “fight or flight.”

The research on this is reassuring. Studies show that mindfulness-based strategies can improve emotional fatigue, lower perceived stress, and help people with RA feel more capable of managing their symptoms 20. These benefits translate into real changes in how the body processes pain and inflammation, making daily energy feel steadier and less unpredictable.

Why this helps RA: Mindfulness helps regulate the nervous system, which in turn helps regulate inflammation and pain perception. When the body is under less physiological stress, fatigue becomes easier to manage.

How to use this: Choose one simple practice that feels approachable, like guided breathing or a short relaxation exercise. Aim for consistency over intensity. A few minutes a day is enough to make a meaningful difference over time.

Addressing Fatigue During an RA Flare-Up

Fatigue often hits hardest during a flare, when the immune system becomes more active, and inflammation rises. For many people with RA, this kind of fatigue feels different. Heavier, more sudden, and harder to predict. Flares can be triggered by stress, reactive foods, infections, or environmental triggers, and when they occur, the body shifts a large amount of energy toward managing inflammation. That’s why even simple tasks can feel overwhelming.

Understanding this can make flares feel a little less chaotic. A flare doesn’t mean you’re losing progress. It means your immune system is reacting to something, and your body is asking for support while it recalibrates. The goal during a flare is not to push harder. It’s to reduce the load on the immune system, so symptoms settle more quickly, and your energy has room to return.

During a flare, most people do better when they simplify. Focus on what helps your system feel calmer: gentle movement to keep joints loose, using heat or cold for comfort, choosing foods you know your body tolerates well, protecting your sleep, and leaning on any stress-management practices that help you feel more settled. If the flare is tied to emotional stress, talking it through with someone, whether a therapist or a trusted support, can also make the physical symptoms feel easier to navigate.

Quick Reference: RA Fatigue Triggers and Tools

Resolve RA Fatigue Naturally 

RA fatigue may be an underappreciated symptom of rheumatoid arthritis, but it doesn’t have to go untreated. Many options can help reduce fatigue, improve energy levels, and get you back to a fulfilling life. Along with a good diet and optimized sleep, a consistent aerobic exercise regimen is especially important for reducing fatigue and building strength over time. Mental health strategies such as cognitive-behavioral therapy, guided imagery, and coping strategies can also help build mental and emotional resilience. 

If you’re interested in collaborating with a healthcare professional to address rheumatoid arthritis symptoms naturally, reach out to us at the Ruscio Institute for Functional Medicine and set up a consultation. 

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