Ankylosing spondylitis is a type of inflammatory arthritis that affects the joints, tendons, and ligaments of the spine. It is a chronic condition that causes inflammation at the point where the ligaments, tendons, and bones meet. Ankylosing spondylitis is known for causing various complications associated with inflammation of the spine, including severe to moderate pain and discomfort that can disrupt your daily routine and activities. The other problem, which is not talked about enough, is that ankylosing spondylitis causes another negative side effect – fatigue. Here are some tips to beat ankylosing spondylitis fatigue so that you can live a better quality of life even with this condition.
Causes of Fatigue in Ankylosing Spondylitis
As per the National Ankylosing Spondylitis Society, fatigue is one of the most common debilitating side effects caused by ankylosing spondylitis.(1) It is believed that the inflammatory process of ankylosing spondylitis causes fatigue.(2, 3, 4)
People who have ankylosing spondylitis very well know just how zapped of energy they feel. While any form of arthritis can cause fatigue because the pain keeps people up at night, but the fatigue associated with ankylosing spondylitis is different from normal fatigue because this is caused by the inflammation itself. Fatigue caused by the inflammation in ankylosing spondylitis feels like you have the flu. Apart from tiredness, you are going to ache all over. This happens because the inflammation from ankylosing spondylitis does not affect only one part. It affects the entire body, not just your joints.(5)
The problem of fatigue is very common in people who have ankylosing spondylitis. A study published in the Clinical Rheumatology Journal in March 2020 found that out of the 150 participants with the condition, 47.8 percent of them suffered from fatigue. The participants were asked to fill out a series of questionnaires. The results also showed that there were certain factors that increased the likelihood of experiencing fatigue, such as sleep disturbances and more severe disease activity. People who experience extreme fatigue related to ankylosing spondylitis tend to report a lower quality of life.(6)
However, it should be noted that not every person with ankylosing spondylitis experiences fatigue. There are many factors that fatigue is associated with, not just the disease activity or sleep problems and pain. Even psychological factors like anxiety and depression also have a role to play. Let us look at the various causes of fatigue due to ankylosing spondylitis.
Of course, the biggest cause of ankylosing spondylitis fatigue is inflammation. In people with this condition, there are inflamed tissues located within the spine that releases small, protein-based chemicals known as cytokines. Cytokines are believed to play a significant role in fatigue, psychological disturbances, and pain. Cytokines are produced by the cells in the immune system, and they react inside the body similarly to the cells produced when a person has the flu or a cold. This is why fatigue caused by ankylosing spondylitis makes you feel like you have the flu or viral infection when you really don’t have any such thing.(7, 8)
Treating inflammation with medications will help decrease extreme fatigue, but it is important to note that certain prescription drugs that contain codeine or opioids may actually increase your tiredness and not reduce the inflammation either.(9)
Tips to Beat Ankylosing Spondylitis Fatigue
Get A Good Night’s Sleep
In some cases of ankylosing spondylitis, it is possible that the fatigue is not being caused by inflammation. Discomfort and pain caused by ankylosing spondylitis make it difficult for a person to fall asleep and stay asleep during the night, further increasing exhaustion. Pain also makes you wake up multiple times in the night, again making you feel tired.(10, 11)
Here are some ways that can help you get a good night’s sleep with ankylosing spondylitis.
- Try to have a consistent bedtime. Go to bed at the same time every night, even on the weekends.
- Keep a comfortable temperature in the bedroom.
- Avoid sleeping in on vacation days or the weekends.
- Take some breaks throughout the day, but avoid napping.
- Consider taking a warm bath before going to bed.
Maintain Your Weight
One of the big reasons behind the lack of energy in people with ankylosing spondylitis is the weight that happens in many people with the condition due to their reduced level of physical activity. Being overweight can obviously present many other long-term health issues and can also worsen the symptoms of ankylosing spondylitis.(12)
When there is extra fat, it puts more strain on the spine, worsening the inflammation of ankylosing spondylitis. Being overweight or obese also makes it much more challenging to complete everyday tasks. So if you notice that you are putting on weight despite eating a nutritious and healthy diet, and you are even exercising properly, you should let your doctor know so that they may prescribe any other tests as required, such as thyroid function tests, to find out the underlying cause of the weight gain.
Check Whether You Have Anemia
Inflammation caused by ankylosing spondylitis is known to increase the risk for anemia, a condition that causes a lack of a healthy number of red blood cells. Red blood cells are needed by the body for transporting oxygen to all organs.(13, 14)
Fatigue is known to be one of the first signs of anemia. Some of the other common symptoms of anemia include:
If your doctor suspects anemia, they will prescribe a blood test. If you are diagnosed with anemia, your doctor is most likely to prescribe an iron supplement that will help restore the levels of red blood cells. Your doctor will also want to ensure that there is no bleeding or ulcers caused by the usage of non-steroidal anti-inflammatory medications or, in some cases, from heavy menstrual periods.
If you are finding yourself feeling wiped out, exercising is probably going to be the last thing you want to think about. However, regular exercises can help boost your energy levels and also improve your flexibility over a period of time. This will help you if the severity of your symptoms increases.
Exercise is also necessary for ensuring your bones remain strong to fight against osteoporosis, which is a common condition that people with ankylosing spondylitis are at a greater risk of later in life. This does not mean that you need to indulge in strenuous exercise. You can begin by taking short walks and slowly build up to doing longer or higher-intensity exercises. Swimming is especially a great exercise for people with ankylosing spondylitis.(15, 16)
At the same time, you will find it easier to fall asleep at night and get a good night’s sleep. Just keep in mind that you should not exercise too late in the evening as this may actually prevent you from falling asleep.
Watch Your Diet
If you have gained weight, you need to change your diet. However, at the same time, if you want to address fatigue caused by ankylosing spondylitis, your dietary changes have to be much more than just restricting your calorie intake. In such a case, it is important that you eat food that is nutrient-dense to keep your energy levels high throughout the day.
You should include more carbohydrates and whole grains instead of foods made from refined flour and containing sugar. Switch from caffeinated beverages to drinking more water. While your cup of coffee can give you an energy boost at that moment, but it will eventually make you feel run down.(17)
Since there is no cure for ankylosing spondylitis, you need to work hard to manage the symptoms of the illness. If you find yourself regularly feeling zapped of energy, you should let your doctor know so that they can review your current treatment plan. Remember that there are some different tips also you can follow to have enough energy throughout the day and keep fatigue at bay. Remain positive and calm, and remember that stress will only add to your fatigue.
- Anon, 2022. Your fatigue. National Axial Spondyloarthritis Society. Available at: https://nass.co.uk/about-as/what-is-as/fatigue/ [Accessed September 1, 2022].
- Braun, J. and Sieper, J., 2007. Ankylosing spondylitis. The Lancet, 369(9570), pp.1379-1390.
- Sieper, J., Braun, J., Rudwaleit, M., Boonen, A. and Zink, A., 2002. Ankylosing spondylitis: an overview. Annals of the rheumatic diseases, 61(suppl 3), pp.iii8-iii18.
- Haywood, K.L., Packham, J.C. and Jordan, K.P., 2014. Assessing fatigue in ankylosing spondylitis: the importance of frequency and severity. Rheumatology, 53(3), pp.552-556.
- Turan, Y., Duruöz, M.T., Bal, S., Guvenc, A., Cerrahoglu, L. and Gurgan, A., 2007. Assessment of fatigue in patients with ankylosing spondylitis. Rheumatology international, 27(9), pp.847-852.
- Zhou, W., Guo, J., He, M., Li, J., Chen, Y., Liu, J., Zhao, R., Wang, Y., Ge, X., Yang, J. and Gu, Z., 2020. Fatigue and contributing factors in Chinese patients with ankylosing spondylitis. Clinical Rheumatology, 39(8), pp.2337-2344.
- Günaydin, R., Göksel Karatepe, A., Çeşmeli, N. and Kaya, T., 2009. Fatigue in patients with ankylosing spondylitis: relationships with disease-specific variables, depression, and sleep disturbance. Clinical rheumatology, 28(9), pp.1045-1051.
- Calin, A., Edmunds, L. and Kennedy, L.G., 1993. Fatigue in ankylosing spondylitis–why is it ignored?. The Journal of rheumatology, 20(6), pp.991-995.
- Missaoui, B. and Revel, M., 2006, July. Fatigue in ankylosing spondylitis. In Annales de réadaptation et de médecine physique (Vol. 49, No. 6, pp. 389-391). Elsevier Masson.
- Hultgren, S., Broman, J.E., GudbjoÈrnsson, B., Hetta, J. and Lindqvist, U., 2000. Sleep disturbances in outpatients with ankylosing spondylitis-a questionnaire study with gender implications. Scandinavian journal of rheumatology, 29(6), pp.365-369.
- Aissaoui, N., Rostom, S., Hakkou, J., Berrada Ghziouel, K., Bahiri, R., Abouqal, R. and Hajjaj-Hassouni, N., 2012. Fatigue in patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status, and sleep disturbance. Rheumatology international, 32(7), pp.2117-2124.
- Chen, C.H., Chen, H.A., Liu, C.H., Liao, H.T., Chou, C.T. and Chen, C.H., 2020. Association of obesity with inflammation, disease severity and cardiovascular risk factors among patients with ankylosing spondylitis. International Journal of Rheumatic Diseases, 23(9), pp.1165-1174.
- Zviahina, O.V., Shevchuk, S.V., Kuvikova, I.P., Segeda, I.S., Zviahina, O.V., Shevchuk, S.V., Kuvikova, I.P. and Segeda, I.P., 2020. Anemia in patients with ankylosing spondylitis, association with the activity of the inflammatory process and the severity of the disease.
- Niccoli, L., Nannini, C., Cassara, E., Kaloudi, O. and Cantini, F., 2012. Frequency of anemia of inflammation in patients with ankylosing spondylitis requiring anti‐TNFα drugs and therapy‐induced changes. International journal of rheumatic diseases, 15(1), pp.56-61.
- Millner, J.R., Barron, J.S., Beinke, K.M., Butterworth, R.H., Chasle, B.E., Dutton, L.J., Lewington, M.A., Lim, E.G., Morley, T.B., O’Reilly, J.E. and Pickering, K.A., 2016, February.
- Exercise for ankylosing spondylitis: An evidence-based consensus statement. In Seminars in arthritis and rheumatism (Vol. 45, No. 4, pp. 411-427). WB Saunders.
- Regnaux, J.P., Davergne, T., Palazzo, C., Roren, A., Rannou, F., Boutron, I. and Lefevre‐Colau, M.M., 2019. Exercise programmes for ankylosing spondylitis. Cochrane Database of Systematic Reviews, (10).
- Macfarlane, T.V., Abbood, H.M., Pathan, E., Gordon, K., Hinz, J. and Macfarlane, G.J., 2018. Relationship between diet and ankylosing spondylitis: A systematic review. European journal of rheumatology, 5(1), p.45.
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