Extreme Fatigue - Need Advice.

Hi. I am 24F, and I have had ANA and RF positive RA since I was 15, when I lost complete movement in my arm to a 45-degree contracture overnight. After an arthrocentesis, biologics, and an insane amount of PT hours, I got some semblancy of normalcy back in my life.

I had been in medicated remission from age 16 to 23. Even now, my lab work presents as totally normal, but after having had some ultrasounds done, it has been confirmed I am in active disease. I have noticed for the past year, and incredible amount of fatigue I cannot shake off.

I am talking sleeping from 7pm to 7am, and having limited ability to keep my eyes during work despite drinking a coffee and 2 redbulls just today. No matter how much I sleep, I do not feel rested. My body feels heavy and tired. It has been about a month since I moved houses, and I am wondering if it may be the following.

1. I changed my mattress, and the new one I bought online is way too soft. I started getting joint pain upon waking up from sleeping on this, and although I have never have a complete nights sleep (sleeping the whole way through without waking), I find myself waking up due to pain more often.
2. I keep getting Oral HSV outbreaks. Usually, I get them from lack of sleep, so it makes sense that I keep getting them, but I am sleeping as much or more than I usually do. Due to this, I wonder if it is a vicious cycle of the HSV causing the fatigue, and so on and so forth.
3. It just my active inflammation even though all my blood markers were fine.

I am really concerned, as it it is affecting my life to the point of not being able to work well, cook dinner after work, or meet with any of my special people due to the tiredness.

Also, I am aware that this is not the same as going to the doctor, but I live abroad in a country where the RA care is severely behind and expensive, and although I just went to the DR 3 weeks ago, the only option they were able to give me was a medicine I flunked out of when I was 15. I am looking for opinions on how to combat fatigue, personal anecdotes, and opinions.

Please. I feel so defeated.

Thank you for taking the time to read.