Written by Eileen Davidson, Arthritis Patient Advisory Board member
There are days when living with arthritis feels like much more than painful joints. You wake up and something simply feels wrong.
Your body feels heavy. You may feel weak, mildly nauseous, chilled, achy or strangely uncomfortable in your own skin. Food may not sound appealing. Your brain feels foggy. You may feel exhausted even though you haven’t done anything particularly strenuous.
There is a word for that vague but very real feeling of being unwell: malaise.
Malaise is a general feeling of discomfort, being ill, or lack of well-being. It isn’t a disease itself and it isn’t specific to arthritis. Infections, autoimmune diseases, medications and many other health conditions can cause it.
For people living with inflammatory arthritis, however, malaise can be another reminder that diseases such as rheumatoid arthritis, lupus, psoriatic arthritis, and axial spondyloarthritis involve much more than pain in your joints.
“Malaise is one of those symptoms that can be difficult for patients to put into words. It is more than simply feeling tired,” says Dr. Raheem B. Kherani, a clinician investigator at Arthritis Research Canada. “People may describe it as feeling like they are coming down with the flu, feeling generally unwell, or sensing that something is just not right.”
What Does Malaise Actually Feel Like?
Malaise can be difficult to describe because it isn’t one specific sensation. You may not be able to point to one painful spot or tell your doctor exactly what feels wrong. Instead, it is an overall sense that your body doesn’t feel well. Not everyone experiences malaise in exactly the same way. That vagueness is part of what makes it such a frustrating symptom.
People may describe malaise as:
– feeling like the flu is coming on
-weakness or heaviness
-chills or body aches
-nausea or loss of appetite
-feeling shaky or drained
-difficulty concentrating
-wanting to lie down
-feeling unusually sensitive to noise, smells or activity
-feeling physically “off”
-fatigue accompanied by a sick feeling
Malaise and fatigue often occur together, but they are not the same thing. Fatigue is primarily a lack of energy or extreme tiredness, while malaise is a broader feeling of being unwell. You can experience one without the other, or both at the same time.
Why Can Arthritis Make You Feel Sick?
One of the biggest misconceptions about arthritis is that it is exclusively a disease of the joints. That isn’t true for many inflammatory forms of arthritis.
Rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis are inflammatory diseases involving immune-system activity that can affect the entire body. People may experience symptoms such as fatigue, poor appetite and weight changes in addition to joint pain and stiffness.
“The immune system is active throughout the body, and the inflammatory signals involved in conditions such as rheumatoid arthritis and psoriatic arthritis can affect how a person feels overall,” explains Dr. Kherani.
Malaise Can Be Part of an Arthritis Flare
For some people, malaise can be an early sign of an arthritis flare. It may appear alongside increasing joint pain, longer morning stiffness, worsening fatigue or a general sense that something is off.
Over time, you may begin to recognize your own pattern. Malaise might come before other flare symptoms, during increased disease activity, or rarely at all. There is no single way an arthritis flare feels. However, not every episode of malaise is caused by arthritis. Infections, medications and other health conditions can also you make you feel unwell.
One of the frustrations of inflammatory arthritis is that symptoms and bloodwork do not always match. Fatigue and malaise can persist even when inflammation markers improve, and worsening symptoms do not necessarily mean inflammation is increasing.
“If you continue to feel unwell or notice a change in your usual symptoms, it is important to tell your healthcare team. Your symptoms and experience are meaningful information too,” says Dr. Kherani.
How Can You Manage Malaise With Arthritis?
There is no single treatment for malaise, because the first step is understanding what is causing it. A few strategies may help:
Watch your disease activity: If malaise regularly appears with worsening pain, stiffness, swelling or fatigue, discuss the pattern with your healthcare
Track symptom patterns: Keep notes on when malaise starts, how long it lasts, your sleep, pain, medications, infections, stress and any new symptoms. Patterns provide useful clues for your healthcare provider.
Look beyond arthritis: Persistent or unusual malaise may be related to infection, anemia, thyroid problems, sleep disorders, medications or other
Balance movement and rest: Rest when you need it, but managing fatigue does not mean you have to stop all activity. Gentle, individualized movement, such as stretching, walking or gradually building strength may help when you can tolerate it.
Pace yourself: Break tasks into smaller pieces, use supports when needed, accept help, and adjust your plans based on how you feel.
When Malaise Needs Medical Attention
If malaise is new, persistent or significantly worse than usual, talk to a healthcare professional – especially if you take medications that affect the immune system. Seek prompt medical attention for signs of infection, such as fever, chills, breathing problems, burning or frequent urination.
Persistent or unusual malaise should not be ignored. “I don’t feel well” is meaningful health information, even when it is invisible.
