Curbing fatigue is possible, by multidimensional approach (non-pharmacologic and pharmacologic) measures, like exercise, cognitive behavioral therapy ,timely and effective use of conventional and biological dmards especially IL-6 blocker (Tocizilumab) and newer medications called conventional synthetic dmards Janus kinase (JAK) inhibitors (tofacinitab, baricinitab),in active, early RA, methotrexate naive, methotrexate and biologics inadequate responders shown major improvements, also treatment of anemia, Vit D and Omega 3 fatty acids supplementation may help.19 This evidence concerns the gene IL6 and anemia (phenotype).