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Fatigue and Ankylosing Spondylitis

Fatigue is a common symptom of people with axial spondylitis (axial SpA), including those with ankylosing spondylitis (AS). Fatigue is an extreme sense of tiredness that is not relieved by sleep, so even after a full night’s sleep, an individual with fatigue can feel drained. Fatigue can also be described as malaise, exhaustion, or lack of energy, and it can feel like physical, mental, and/or emotional exhaustion. Fatigue negatively impacts a person’s daily life, and like other symptoms of AS, it’s a symptom that should be discussed with and evaluated by a healthcare professional.1,2

How does ankylosing spondylitis cause fatigue?

There are several ways AS can cause fatigue. The chronic inflammation caused by AS not only affects the joints but also affects the whole body. Inflammation causes a release of cytokines (a type of protein), and cytokines may cause fatigue. In addition, the body uses energy to deal with the inflammation, leaving less available energy overall.1,3

Dealing with the chronic pain of AS can make it difficult to sleep comfortably, adding to a sense of fatigue, and living with a chronic condition like AS increases a person’s risk for depression, which also causes fatigue as a symptom. Chronic diseases like AS also increase the risk of developing anemia of chronic disease (ACD), which can lead to fatigue.1,3

Some medications used to treat AS (or other medications used for different conditions) may cause fatigue as a side effect and worsen the symptom of fatigue experienced by people with AS.

How is fatigue assessed?

Fatigue is assessed by a doctor during a physical exam and symptom history. Doctors may use a tool, such as the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), which measures well-being and how someone’s life is impacted by AS.2 Patients who are experiencing fatigue should tell their doctors how often they experience fatigue and what effect it has on their daily functioning and activities.

What are ways to manage fatigue?

Chronic fatigue can be a daily occurrence for those with AS, and can be an incredible challenge, at times even surpassing the primary symptoms of the condition such as joint pain or stiffness. Everyone’s experience with fatigue can be completely unique. However, there are some potential tips that may help manage some of these feelings, including1:

  • Treating any underlying causes of fatigue. Treating AS can help reduce fatigue. As the inflammation in the body is reduced, it can have a positive effect on an individual’s energy levels. Any additional conditions like depression or anemia should also be assessed and treated.
  • Engaging in regular exercise. While increasing physical activity has been shown to decrease fatigue, it’s a good idea to discuss any new exercises with your doctor before you begin. Regular exercise has also been shown to help with AS symptoms overall.
  • Eating a well-balanced, nutritious diet. Proper nutrition is important to maintaining energy levels. Consider a consult with a nutritionist or registered dietician to get personalized advice and support.
  • Getting enough sleep. Sleep and downtime are important to help the body heal, and resting is also important for stress relief.
  • Pacing yourself. Managing activities and planning them for when energy is at its highest, while taking down time when energy wanes, can help someone with fatigue feel more control and organize their time to handle priorities.
Written by: Emily Downward | Last reviewed: February 2019
  1. Your fatigue. National Ankylosing Spondylitis Society. Available at https://nass.co.uk/about-as/what-is-as/fatigue/. Accessed 1/29/19.
  2. Missaoui B, Revel M. Fatigue in ankylosing spondylitis. Ann Readapt Med Phys. 2006 Jul;49(6):305-8, 389-91. Epub 2006 Apr 19. Abstract.
  3. Fatigue in spondylitis. Spondylitis Association of America. Available at https://www.spondylitis.org/Fatigue. Accessed 1/29/19.