Why do I have joint pain and fatigue?
Several conditions cause both together. Rheumatoid arthritis, lupus, fibromyalgia and polymyalgia can all bring tiredness with the aches. One early clue is how long you stay stiff after waking.
On this page
What causes joint pain and fatigue together?
It can be one cause, not two. The NHS lists tiredness with joint or muscle pain for rheumatoid arthritis, lupus, fibromyalgia, polymyalgia rheumatica (PMR) and ME/CFS.
Each one has its own pattern. Where it aches and what comes with it are the clues.
| Condition | Where it aches | Other clues |
|---|---|---|
| Rheumatoid arthritis | Small joints of the hands and feet, often both sides | Worse in the morning. Joints can swell and feel hot. |
| Lupus | Joints and muscles | Tiredness that rest doesn’t fix. Often a rash over the nose and cheeks after sun. |
| Fibromyalgia | All over, often worse in the back or neck | Even a light touch can hurt. Waking tired after plenty of sleep. |
| PMR | Muscles around the shoulders, neck and hips | Stiff for over 45 minutes each morning. Very rare under 50. |
| ME/CFS | Muscles or joints | Extreme tiredness for at least 3 months, worse after activity. |
Sources: NHS: rheumatoid arthritis; NHS: lupus; NHS: fibromyalgia; NHS: PMR; NHS: ME/CFS; NHS: tiredness
Note the row that sounds most like you. Then tell your GP about the tiredness as well as the pain. The NHS says to mention all your symptoms, not just ones you think are important.
How long are your joints stiff in the morning?
That clue is your morning stiffness, timed in minutes. Check the clock when you get up.
Stiffness from osteoarthritis usually wears off within 30 minutes. In rheumatoid arthritis it often lasts longer. Osteoarthritis pain is usually worse when walking, mostly over the age of 45.
- 30 minutes or belowOsteoarthritis stiffness usually wears off by now.
- Above 30 up to 45 minutesNHS: see a GP. Rheumatoid arthritis stiffness often lasts over 30.
- Above 45 minutesNHS: see a GP. Fits rheumatoid arthritis, and over 45 in the muscles is the main PMR sign.
Sources: NHS: joint pain; NHS: rheumatoid arthritis; NHS: PMR
Fibromyalgia can also make you stiffest when you first wake up. So the minutes are a clue, not an answer.
Write your time down for a week and take it to your GP.
Muscle and joint pain with fatigue: what else can it be?
Low vitamin D can make adult bones weak and soft. This is called osteomalacia. The NHS lists swollen, painful wrists and pain in your back, shoulders, ribs, pelvis or legs.
Weak muscles and getting tired more easily when walking are on that list too. In the UK, we can’t make enough vitamin D from sunlight between September and March. Adults need 10 micrograms a day.
Low iron and an underactive thyroid can both leave you tired and low on energy. But the NHS doesn’t list joint pain for either one. So they may explain the tiredness, not the aches.
In perimenopause and menopause, lower oestrogen can cause aching joints. The menopause can also cause tiredness.
Ask your GP if vitamin D, iron or thyroid tests make sense for you.
What tests will my GP do?
What usually happens if your GP suspects rheumatoid arthritis
- 1
Joint check
Your GP looks for swelling and how easily your joints move.
- 2
Blood tests
ESR and CRP, which check for inflammation. A full blood count for anaemia.
- 3
Antibody tests
Rheumatoid factor if a joint looks inflamed. Maybe anti-CCP, another antibody test, if that’s negative.
- 4
Specialist
A joint specialist (rheumatologist) if rheumatoid arthritis is suspected.
Sources: NHS; NICE NG100
For tiredness, you may have blood tests for anaemia, diabetes or an overactive thyroid.
Normal bloods don’t close the case. No blood test can prove or rule out rheumatoid arthritis. About 1 in 20 people without it test positive for rheumatoid factor.
NICE says to refer urgently if a joint lining seems to stay swollen with no clear cause. That applies when the small joints of the hands or feet are affected. The same goes if more than one joint is, or you waited 3 months or more to seek help.
That holds even with normal blood tests. Fibromyalgia has no specific test, so tests check for other causes.
More on the CRP test, blood tests for joint pain and tests for fibromyalgia.
What helps aching joints and fatigue?
Six things to do while you wait to be seen
- Keep moving the sore joint gently. Don’t stop moving it completely.
- Rest it when you can, with an ice pack wrapped in a towel for up to 20 minutes every 2 to 3 hours.
- Ask a pharmacist or GP which painkiller to take.
- Keep the same sleep times and aim for 6 to 9 hours of sleep.
- Don’t smoke, and try to lose weight if you’re overweight.
- Write down your stiff minutes each morning, plus any rash, fever or weight loss.
Sources: NHS: joint pain; NHS: tiredness
Physio may help. In many areas you may be able to get it from NHS musculoskeletal (MSK) services without a GP referral.
Feel worse hours or days after doing something? Tell your GP. The NHS calls this post-exertional malaise, one of the 4 main signs of ME/CFS.
See tests for chronic fatigue and still tired after sleep.
Already on treatment? Never stop or change a prescribed medicine without your prescriber.
When to speak to a GP
Book an appointment if:
- Your joints are stiff for more than 30 minutes after waking up.
- Joint pain stops you doing normal activities or affects your sleep, is getting worse or keeps coming back, or hasn’t improved after 2 weeks of home treatment.
- You’ve felt tired for a few weeks and you’re not sure why, or it affects your daily life.
- You feel tired and have other symptoms, such as weight loss or mood changes.
- You often get symptoms of lupus, such as a rash over your nose and cheeks after sun.
Ask for an urgent GP appointment or call 111 if a painful joint is swollen and the skin feels hot. Do the same if you have joint pain and feel generally unwell, have a high temperature or feel hot, cold or shivery.
With PMR, contact a GP immediately or call 111 if you get a new or frequent headache that comes on suddenly, or a sore scalp. The same goes for jaw or tongue pain when eating or talking, or double vision or loss of sight.
Go to A&E or call 999 if a joint has moved out of place, or you can’t walk or put weight on it. The same goes for very bad joint pain, tingling or no feeling around a joint after a fall or injury.