Managing Fatigue, Depression Can Reduce Risk of Job Loss for AS Patients, Study Suggests

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by Alice Melao |

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pain, psychological stress

Improved diagnosis and management of fatigue and depression among people with ankylosing spondylitis can help reduce the risk of job loss in this population, researchers suggest.

The study, “Association of work instability with fatigue and emotional status in patients with ankylosing spondylitis: comparison with healthy controls,” was published in the journal Clinical Rheumatology.

Ankylosing spondylitis is a chronic inflammatory disease that can severely affect a person’s quality of life. This disease is not only linked to numerous physical symptoms and limitations, but also to high economic burden arising from direct healthcare costs, as well as indirect costs due to loss of earnings and reduced productivity.

People with ankylosing spondylitis are at increased risk for psychological distress, and are more likely to suffer from depression and anxiety than the general population. This emotional imbalance can also contribute to work disability in this population, and higher risk of professional instability.

Few studies have addressed the impact of this disease and its symptoms with the ability of patients to fulfill the requirements of their jobs and related work instability. Turkish researchers explored the relation of work instability with fatigue, depression and anxiety in working ankylosing spondylitis patients compared to healthy controls.

The study enrolled 61 actively working ankylosing spondylitis patients ages 19-57 who were followed at a single clinical site, and 40 sex- and age-matched healthy volunteers. Work duration and type were also similar between both groups. None of the participants was receiving psychiatric treatment, including psychotherapy or antidepressants.

Ankylosing spondylitis patients had significantly higher scores for depression and fatigue when compared to the control group. They were also found to have 5.5 times higher work instability, as determined by the Ankylosing Spondylitis Work Instability Scale (ASWIS). This disease-specific 20-item questionnaire assesses work instability on patient self-perceived impact of disease on work (scored from 0 to 20; 0 = no risk, 20 = maximum risk of work instability).

Nine patients (14.8%) reported they had quit a job because of ankylosing spondylitis.

Although several patients reported that they had other conditions, such as hyperlipidemia (high blood levels of fatty molecules) and hypertension (high blood pressure), none of the comorbidities was found to be associated with fatigue and had any effect on work status. There were 57 patients (93.4%) receiving biologic agents.

When reviewing patients’ clinical parameters according to ASWIS scores, researchers found that, in general, the clinical manifestations of the disease, except spinal mobility, were higher in patients with high (18-20 score) or medium (11-17 score) risk of work instability than those with reduced (0-10 score) risk.

Further analysis revealed that pain, functional capacity, and fatigue were strongly correlated with higher work instability scores.

“If the factors affecting work status are well-defined, appropriate clinical or workplace intervention will maintain the work continuity and productivity in ankylosing spondylitis patients,” researchers stated. “The early recognition of fatigue and depressive symptoms may lead to reduced risk of job loss in these patients. It may be beneficial to design targeted interventions to improve fatigue and psychological health in working [ankylosing spondylitis] patients,” they said.