Of all symptoms that I have experienced related to AS, none disheartens me as much as generalized fatigue. When experiencing disease-related fatigue, I have been known to sleep 14 hours continuously, still feeling exhausted upon awakening. It makes activites of daily living, such as getting out of bed, talking on the phone, driving, and attending to work responsibilities extremely difficult. It's easy to be labelled as lazy, unmotivated, or a procrastinator by those who don't know about AS. After all, everyone gets tired; what makes those of us with AS so different? For those of us striken with this disease, we are too keenly aware of the difference: a feeling of complete body heaviness and general malaise, where even keeping our eyes open seems impossible at times. Coupled with pain, difficulty concentrating, and limited mobility, we struggle to maintain a daily routine in world that has difficulty understanding our personal experience.
Pain, stiffness, functional impairment, range of motion and quality of life are the main conventional domains used in studies evaluating ankylosing spondylitis (AS). However, fatigue continues to be one of the primary complaints among patients with inflammatory rheumatic diseases, according to Croatian researchers in a recent study.
Disease activity, functional disability, and worse mental health are proven to contribute to greater fatigue. The relationship between exercise duration and fatigue intensity is moderated by mental health status. For patients with poorer mental health, exercise does not appear to influence fatigue severity. Research consistently encourages patients with AS to integrate regular leisure physical activity into the comprehensive treatment of their arthritis because it appears useful for modulating fatigue (i). Personally, I have found that my symptoms decrease when I am engaged in regular physical activity (i.e. weight lifting, aerobic classes, running). Not all physical activity works for me, though. Mountain biking and spinning appear to aggravate my condition.
One study(ii) originating out of Norway investigated 1) levels of fatigue in patients with ankylosing spondylitis (AS) compared with the general population; 2) the relationships between fatigue and demographic, self-reported, and clinical measures; and 3) the performance of both a generic and a disease-specific measure of fatigue. CONCLUSION: Self-reported measures of disease activity and mental health contributed significantly to explain fatigue, whereas clinical measures of inflammation and joint mobility did not.
Fatigue may be caused by many things related to spondylitis such as loss of sleep because of physical discomfort. But it can also be a by-product of the disease itself. Spondylitis causes inflammation. When inflammation is present, your body must use energy to deal with it. The body releases cytokines during the process of inflammation. Cytokines are small protein released by cells that has a specific effect on the interactions between cells, on communications between cells or on the behavior of cells. The cytokines includes the interleukins, lymphokines and cell signal molecules, such as tumor necrosis factor and the interferons, which trigger inflammation and respond to infections. Cytokines can produce the sensation of fatigue as well as mild to moderate anemia. Anemia may also contribute to a feeling of tiredness. Treating the inflammation caused by ankylosing spondylitis can assist in decreasing fatigue and anemia.
Another study(iii) acknowledged that fatigue was a frequent complaint of patients with AS. Fatigue had a strong relation with the other symptoms of AS (i.e. stiffness and pain). It was negatively influenced by sleep disorders. Quality of life of study patients was considerably reduced. Anti-TNF therapy (i.e. Enbrel) seemed to ameliorate fatigue more than nonsteroidal anti-inflammatory drug therapy. Regular physical activity was recommended to help alleviate the fatigue. DISCUSSION: No valid, relevant composite tool of multidimensional and multifactorial characters exists to assess fatigue in AS. Treatment such as anti-TNF therapy may facilitate rehabilitation. Regular physical activity helps alleviate fatigue and improves quality of life.
A Turkish study (iv) which evaluated fatigue by using the multidimensional assessment of fatigue (MAF) index in 68 AS patients, suggested that fatigue was a significant symptom in AS and it seemed to occur in severe AS patients. The study recommended that fatigue should appropriately be measured with respect to its intensity with appropriate measures, such as MAF. Moreover, fatigue may increase functional disability, which is already present as a feature of the disease.
References:
i)Da Costa, D., Dritsa, M., Ring, A., and Fitzcharles, M.A. (2004, Dec 15). Mental health status and leisure-time physical activity contribute to fatigue intensity in patients with spondylarthropathy. Arthritis Rheum.;51(6):1004-8.
ii) Dagfinrud, H., Vollestad, N.K., Loge, J.H., Kvien, T.K., and Mengshoel, A.M. (2005, Feb 15). Fatigue in patients with ankylosing spondylitis: A comparison with the general population and associations with clinical and self-reported measures. Arthritis Rheum.;53(1):5-11.
(iii) Missaoui, B., and Revel, M. (2006, Apr 19). Fatigue in ankylosing spondylitis. Ann Readapt Med Phys.;49(6):305-8, 389-91.
(iv) Turan, Y., Duruoz, M.T., Bal, S., Guvenc, A., Cerrahoglu, L., and Gurgan, A. (2007, Jan 25). Assessment of fatigue in patients with ankylosing spondylitis. Rheumatol Int.; Department of Physical Medicine and Rehabilitation, Ataturk Research and Education Hospital, Izmir, Turkey.
Dernis-Labous, E., Messow, M., and Dougados, M. (2003, Dec). Assessment of fatigue in the management of patients with ankylosing spondylitis. Rheumatology (Oxford). 42(12):1523-8.
Frane GrubiĊĦic and Zrinka Jajic. (2006, Nov). Fatigue in Patients With Rheumatoid Arthritis and Ankylosing Spondylitis: Its Relationship to Disease Activity and Functional Ability. University Hospital Sestre Milosrdnice, Zagreb, Croatia. Presented at the American College of Rheumatology Annual Meeting.
Pain, stiffness, functional impairment, range of motion and quality of life are the main conventional domains used in studies evaluating ankylosing spondylitis (AS). However, fatigue continues to be one of the primary complaints among patients with inflammatory rheumatic diseases, according to Croatian researchers in a recent study.
Disease activity, functional disability, and worse mental health are proven to contribute to greater fatigue. The relationship between exercise duration and fatigue intensity is moderated by mental health status. For patients with poorer mental health, exercise does not appear to influence fatigue severity. Research consistently encourages patients with AS to integrate regular leisure physical activity into the comprehensive treatment of their arthritis because it appears useful for modulating fatigue (i). Personally, I have found that my symptoms decrease when I am engaged in regular physical activity (i.e. weight lifting, aerobic classes, running). Not all physical activity works for me, though. Mountain biking and spinning appear to aggravate my condition.
One study(ii) originating out of Norway investigated 1) levels of fatigue in patients with ankylosing spondylitis (AS) compared with the general population; 2) the relationships between fatigue and demographic, self-reported, and clinical measures; and 3) the performance of both a generic and a disease-specific measure of fatigue. CONCLUSION: Self-reported measures of disease activity and mental health contributed significantly to explain fatigue, whereas clinical measures of inflammation and joint mobility did not.
Fatigue may be caused by many things related to spondylitis such as loss of sleep because of physical discomfort. But it can also be a by-product of the disease itself. Spondylitis causes inflammation. When inflammation is present, your body must use energy to deal with it. The body releases cytokines during the process of inflammation. Cytokines are small protein released by cells that has a specific effect on the interactions between cells, on communications between cells or on the behavior of cells. The cytokines includes the interleukins, lymphokines and cell signal molecules, such as tumor necrosis factor and the interferons, which trigger inflammation and respond to infections. Cytokines can produce the sensation of fatigue as well as mild to moderate anemia. Anemia may also contribute to a feeling of tiredness. Treating the inflammation caused by ankylosing spondylitis can assist in decreasing fatigue and anemia.
Another study(iii) acknowledged that fatigue was a frequent complaint of patients with AS. Fatigue had a strong relation with the other symptoms of AS (i.e. stiffness and pain). It was negatively influenced by sleep disorders. Quality of life of study patients was considerably reduced. Anti-TNF therapy (i.e. Enbrel) seemed to ameliorate fatigue more than nonsteroidal anti-inflammatory drug therapy. Regular physical activity was recommended to help alleviate the fatigue. DISCUSSION: No valid, relevant composite tool of multidimensional and multifactorial characters exists to assess fatigue in AS. Treatment such as anti-TNF therapy may facilitate rehabilitation. Regular physical activity helps alleviate fatigue and improves quality of life.
A Turkish study (iv) which evaluated fatigue by using the multidimensional assessment of fatigue (MAF) index in 68 AS patients, suggested that fatigue was a significant symptom in AS and it seemed to occur in severe AS patients. The study recommended that fatigue should appropriately be measured with respect to its intensity with appropriate measures, such as MAF. Moreover, fatigue may increase functional disability, which is already present as a feature of the disease.
References:
i)Da Costa, D., Dritsa, M., Ring, A., and Fitzcharles, M.A. (2004, Dec 15). Mental health status and leisure-time physical activity contribute to fatigue intensity in patients with spondylarthropathy. Arthritis Rheum.;51(6):1004-8.
ii) Dagfinrud, H., Vollestad, N.K., Loge, J.H., Kvien, T.K., and Mengshoel, A.M. (2005, Feb 15). Fatigue in patients with ankylosing spondylitis: A comparison with the general population and associations with clinical and self-reported measures. Arthritis Rheum.;53(1):5-11.
(iii) Missaoui, B., and Revel, M. (2006, Apr 19). Fatigue in ankylosing spondylitis. Ann Readapt Med Phys.;49(6):305-8, 389-91.
(iv) Turan, Y., Duruoz, M.T., Bal, S., Guvenc, A., Cerrahoglu, L., and Gurgan, A. (2007, Jan 25). Assessment of fatigue in patients with ankylosing spondylitis. Rheumatol Int.; Department of Physical Medicine and Rehabilitation, Ataturk Research and Education Hospital, Izmir, Turkey.
Dernis-Labous, E., Messow, M., and Dougados, M. (2003, Dec). Assessment of fatigue in the management of patients with ankylosing spondylitis. Rheumatology (Oxford). 42(12):1523-8.
Frane GrubiĊĦic and Zrinka Jajic. (2006, Nov). Fatigue in Patients With Rheumatoid Arthritis and Ankylosing Spondylitis: Its Relationship to Disease Activity and Functional Ability. University Hospital Sestre Milosrdnice, Zagreb, Croatia. Presented at the American College of Rheumatology Annual Meeting.
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