Many people think of arthritis as nothing more than the minor aches and pains of old age. Actually, it is a very serious health problem and affects people of all ages.

One of the reasons for this misunderstanding is that many symptoms of arthritis have no outward signs. The person with arthritis knows that the pain, stiffness and fatigue are there, but friends and family may not.

How many times have you heard a friend of family member say, I know you have arthritis, but you look so good?" they don't understand why you can't do all the things you would like to, in part because they can't "see" anything wrong with you. Whether or not they actually say it, they seem to be implying that you are over reacting, perhaps even that your problems are more mental than physical. But as a person with arthritis, you know all too well how real the disease is in the physical sense - pain and limited range of motion are daily reminders of arthritis. Yet even you may not be fully aware of the important part fatigue plays in your disease. It is a symptom whose effects can be destructive and deceiving.

"Why am I so Tired"

• People with some forms of arthritis become tired more easily for several reasons:

• Sore or stiff joints require much more energy to move. Even small, simple movements may take a lot of effort when arthritis has reduced your flexibility and range of motion.

• Weakened joints put an extra workload on normal joints and muscles. The unaffected areas must "take up the slack", causing them to tire more rapidly.

• Arthritis is cyclical in nature, causing a person to have good days and bad days. This brings with it uncertainty and stress which may increase fatigue. many people with arthritis tend to overdo when they are feeling well, causing even more fatigue on the bad days.

• The depression and frustration which often accompany a chronic disease like arthritis can result in fatigue. The fatigue, in turn, may heighten feelings of depression when you find that you can't complete a favourite activity or keep up with friends as in the past. Thus, a vicious circle is created.

• People with arthritis experience normal body fatigue like anyone else, but because their energy is sapped by their disease, this normal fatigue is more common, may occur more quickly and is more noticeable.

Ways to Save Energy

Once you and those around you accept fatigue as a very real part of life with your disease, you can take steps to help yourself cope with it. One way to reduce your fatigue is to begin an exercise program to strengthen muscles and to increase the range of motion in the joints. Within a few months, you should be able to do more without getting as tired. Your doctor can show you the best exercises to help keep your muscles strong and your joints as flexible as possible. Begin your exercise program gradually and build up slowly. A little pain may occur from the exercises, but if the pain persists for more than two hours, cut back.

Another way to cope with fatigue is to carefully plan and organise your activities so you make the most of your energy. Do try to plan your day so that you can alternate periods of activity with periods of rest. When you know you have a large task to do, such as preparing a meal or cleaning a room, plan ahead and break the job into smaller tasks. Then work on completing the tasks one at a time, and follow each with a rest break.

Arrange your day's activities to conserve energy. For example, combine shopping trips, eliminate or minimise stair climbing and share family chores. There are many modifications you can make in your home to simplify your lifestyle and make daily chores easier for you.

It is wise to take advantage of good days when you are feeling better to accomplish things you may have been putting off. However, remember not to overdo on these days. By engaging in frenzied, energised activity on the pain-free days, you may cause yourself increased pain, decreased energy and limited activity for many days to come.

The best way to deal with the frustration and depression you may experience as a result of your arthritis is to come to terms with the disease and accept your limitations. Be realistic about the things you can do, and work to create interesting alternatives to those you cannot do. For example, if your arthritis prevents you from enjoying outdoors activities like hiking and camping, you might try nature photography as an alternative. Keep your doctor informed about how you are doing. Sometimes small changes in treatment can make major differences in how you feel and how you cope.

During times of depression, your most important allies can be your friends and family members. Enlist their help and understanding. Educate those close to you about fatigue being a part of your arthritis, and explain to them the "ups" and "downs" you experience.

Fatigue can be controlled, but it depends on you. With careful planning and organisation, plus the understanding of friends and family members, you can successfully overcome this "hidden disability" of arthritis.