Fatigue in Ankylosing Spondylitis Warrants Greater Focus, Study Says

Worse sleep quality, higher disease activity, and a greater waist-to-hip ratio (WHR) predict fatigue among patients with ankylosing spondylitis (AS), a study in China found.

Medical personnel should be more alert and use more effective approaches to ease fatigue symptoms in AS patients, the researchers said.

The study, “Fatigue and contributing factors in Chinese patients with ankylosing spondylitis,” was published in the journal Clinical Rheumatology.

AS is a type of arthritis that particularly affects joints of the spine, causing chronic, inflammatory back pain. Reports have indicated fatigue in AS patients affects daily functions, mental health, disease activity, and quality of life. Yet factors that predict fatigue in those with AS remain controversial.

Aiming to address this gap, as well as the lack of studies on fatigue in AS patients in China, researchers from Affiliated Hospital of Nantong University looked at 150 adults with AS with a mean age of 32, having them complete a series of questionnaires related to their experiences with AS and with fatigue. Their median disease duration was five years.

Factors such as disease activity (according to the Bath Ankylosing Spondylitis Disease Activity Index, BASDAI), anxiety, depression, sleep disturbance, pain, functional status, and levels of inflammation biomarkers were also assessed.

Roughly half the participants (48.7%) suffered from fatigue. Those who reported fatigue were more likely to have more severe pain, higher anxiety and disease activity, greater functional disability, and worse sleep quality.

The more severely fatigued had higher disease activity and greater functional impairment, anxiety, sleep disturbance, and sexual dysfunction.

Sleep disturbance, higher disease activity, and greater WHR all independently predicted fatigue. The investigators found that fatigue significantly lowered both physical and mental quality of life.

The results will need to be confirmed in larger settings involving greater numbers of patients from more than one medical facility, and researchers will need to examine other factors, such as medications, the team said.

Despite its limitations, the study points to fatigue as a major limiting factor in quality of life, and a disease symptom that must be addressed, they said.

“These findings suggested that medical personnel should pay more attention to AS patients with fatigue and take effective measures to relieve fatigue,” the scientists wrote.