I have had terrible fatigue as well... my answe to everything:hand pain, fatigue, lupus symptoms... is sweating it out on my bike.... i can't believe how much it help me... i just got over my first real flare. It lasted 9 months. Looking back at my lufe i have had flares, but nothing as identifiable as my current condition. I didn't think I'd ever emerge from that flare... obviously I'm not symptom free, but not nearly as bad... im trying to manage so much... just over a week ago I realized the onset of gastropheresis - again, really complexes things but I'm working through it... my hands are a never ending battle that I seem to be mostly managing... i struggle with Dryness but am getting by...