My friend Sarah Schafer, a Sjögrens patient and an MD, wrote a message on the Sjögrens List Serve that I thought should reach a wider audience. Her thoughts on autoimmune fatigue are valuable and her personal experience with fatigue echo the experiences of so many Sjögrens warriors!  I also have fatigue and mostly give up social activities in the evening so that I can work most of the day (not a quality-of-life choice I like). So I think I will look more closely at these tips from Sarah…

Sjögrens fatigue – and all autoimmune fatigue – is a clinical conundrum.  No one really knows the cause, although there is some interesting research being done by a neuroscientist in Alabama who may shed some light on the underlying cause soon.

Fatigue is unrelated to blood tests  (e.g.- sed rate, SS-A) etc, or even severe organ system involvement. The study I posted recently  (article titled, “Fatigue in Sjögrens: A Paradoxical Response. Decreased pro-inflammatory cytokine levels tied to higher levels of fatigue”, by researcher Wan-Fai Ng from the UK) showed a surprising inverse correlation with fatigue and some inflammatory chemical levels in the blood. This is  the opposite of what you would expect, which goes to show, we really don’t know. Fatigue is a prominent symptom in Sjögrens (70% disabling) and other autoimmune diseases.

Fatigue is my worst symptom. It is what most keeps me from having a better quality of life, despite many other serious symptoms.  

What can help Sjögrens Fatigue

Treat every medical issue that is a known contributor to fatigue:  

1. Medical problems (not necessarily directly due to Sjögrens) — such as anemia, thyroid disease, celiac.  You should be screened for all of these, if you have not been.

2.   Cardiovascular dysautonomias — especially POTS. Causes terrible fatigue, and there are treatments for this. I recently posted a description of this condition. 

3.  Medication issues — I was practically in a coma and never adapted to Neurontin, Lyrica and so on for neuropathic pain. Everyone is different.

4. Depression — I think much of Sjogren’s depression is due to feeling lousy and not being able to live a normal life. However, major depression needs to be treated.

5. Substance use — take an honest look at alcohol and drug intake.   Are you treating your body well? 

6.  Sleep disorders — including awakening due to dryness (a big one for Sjogren’s patients). Many possible disorders, some quite treatable.

7.  Migraines — many Sjögrens patients  have these, sometimes undiagnosed.  Treatment helps a lot.

New Sjogren’s Guidelines Recommendations:

These are painstakingly reviewed by Sjögrens experts.  If you have not read them, do! Available at, link is on home page.

Most important recommendation —   EXERCISE!  (More on this below.)

Plaquenil helps many, although studies are inadequate to prove this either way.  The studies are too small and too short. It takes months to kick in, and up to 2 years to get full benefit.  There are no large studies to look at this long term.  Most Sjögrens experts agree it helps many patients. If your rheum is not up to date, show him/ her the guidelines. 

Lifestyle:  my comments

1. Diet — many patients focus on diet, and go through all sorts of gyrations. It is one of the few things we can control. Unless you are celiac  or gluten sensitive  (a significant minority of Sjögrens patients), then the main thing is Michael Pollen’s advice: Eat Real Food. In other words, anything processed, packaged, chemical-ized etc. not good for you. Sugar and processed carbs bad for your health, and make you feel bad when you eat them. There is hidden sugar in most commercial breads, sauces, etc. 60 % of American diet is processed food (food-like substances). I find that I do best eating small amounts on a regular basis, with protein mixed in for most meals, and lots and lots of produce. If my gut is off, I cook my veggies and even my fruits.

2. Yoga or Qigong — Something gentle like restorative yoga can be helpful. I have hyper-mobile joints, and yoga has not worked out for me.  However, I have a medical Qigong practice that does help with my overall wellbeing and dryness. I tried a number of practices before I found one that worked for me. 

3. Planned rest —  My fatigue is severe enough that I require a nap/ meditation break in the early afternoons. My body does not negotiate this. My overall function and QOL is much better with this. I would like to be well enough to be functional all day, but this has not happened. Others do well with shorter breaks, or resting after work.

4.  Exercise —  This is a tough sell  but it is the # 1 recommendation. If you are not exercising, you need to figure out something. It needs to be customized (eg, hurts too much to walk- bike or get in pool), graded- start small and supported.  There is little support to help people with serious illness get exercise. It seems counterintuitive, and people start out, overdo, feel lousy and stop.     

I swim daily (after my nap) and it is an amazing help for both pain and fatigue. It buys me my evening function. I learned that I have to be vigorous with some of my laps to get the most benefit, but it took me a long time to build up to it.  

There are so many benefits to exercise, I could go on and on. We are at increased risk for cardiovascular disease and osteoporosis. Exercise is an essential part of managing these risks. Exercise is the # 1 thing you can do to prevent Alzheimers.  

 I could go on…. But will spare you.

 Sarah Schafer

I always receive such great value in what Sarah writes because I know she has assessed information with the mind of a doctor and the heart of a patient. She also is able to communicate to each audience with truth and authority— other doctors listen to her deeply because she can speak their language, and patients listen to her deeply because she translates medical terminology and research clearly while using her patient’s lens. Thank you Sarah for all the work you do advocating for us Sjögrens patients and educating doctors on the disease!

If you are looking for another way to manage your energy, consider following the schedule I have included in the post Tips to Move Through Autoimmune Stages. If you have any tips that help your fatigue, place them in the Comments section and I will post them for others. Janet

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