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Understanding Fatigue and Ankylosing Spondylitis

How inflammation and other factors can contribute to chronic low energy levels when you have AS.

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Medically reviewed in August 2021

Ankylosing spondylitis (AS) is a type of inflammatory arthritis. While AS primarily affects the joints of the spinal column—which link together the vertebrae—it can cause a wide variety of symptoms. People with AS may experience pain in other areas of the body, such as the shoulders, the knees, the ribcage, and the heels of the feet. They are also at risk for a variety of complications, including cardiovascular disorders, inflammation in the eyes, and vertebrae becoming fused together, which can cause the spine to become stiff and hunched.

Another common symptom and complication of AS is fatigue. Here, we look at the relationship between AS and fatigue.

What is fatigue?
Fatigue is much more than feeling tired, and even much more than feeling a bit run down after a busy week. Fatigue refers to a feeling of chronic physical, mental, and emotional exhaustion that does not go away with rest. It typically develops over time. It leads to a lack of energy and motivation that impacts your ability to live a normal life. Work, relationships, and health are some of the areas of a person’s life that can be disrupted by fatigue.

Fatigue and AS
Fatigue can be the result of multiple contributing factors. Above, we described fatigue as both a symptom and a complication of AS. Thinking about it this way is helpful when identifying what may be causing fatigue and how to address it. Some of the contributing factors behind fatigue in people who have AS may include:

  • Inflammation. When a person has uncontrolled AS and disease activity is high, the body is in a chronic state of inflammation. The biological processes surrounding inflammation demand energy from the body, which leaves less available energy for everything else. In other words, your body is constantly tired from being inflamed and repairing damage, so you do not have the energy you need to work, do chores, exercise, or go out with friends.
  • Sleep, exercise, and food. AS can make it difficult to get a good night’s sleep, to stay physically active, and to eat a well-balanced diet. Poor eating habits, lack of physical activity, and poor sleep quality are all associated with fatigue.
  • Mental health. Mental health disorders, including depression, are common among people who have AS. The condition is also associated with other negative emotions, including anxiety and stress. All of these can disrupt a person’s energy levels and interfere with sleep.
  • Anemia. Anemia is common among people who have chronic inflammatory conditions like AS. This type of anemia is called anemia of chronic disease.
  • Medications. Fatigue can also be a side effect of some medications. Talk to your healthcare provider about all medications you take, including over-the-counter medications, prescription medications, and any nutritional or herbal supplements.
  • Other conditions or treatment needs. Fatigue may also be a sign of other underlying health issues or that your treatment needs are not being met.

Remember that AS is a chronic condition that requires ongoing management. It is also a condition that impacts everyone differently. The number one thing you can do if you are experiencing fatigue is talk to your healthcare provider.

Article sources open article sources

Cleveland Clinic. "Ankylosing Spondylitis (AS)."
UpToDate. "Patient education: Axial spondyloarthritis, including ankylosing spondylitis (Beyond the Basics)."
Mayo Clinic. "Ankylosing Spondylitis."
Mayo Clinic. "Fatigue."
MedlinePlus. "Fatigue."
Canadian Spondylitis Association. "Chronic Fatigue."
Spondylitis Association of America. "Fatigue in Spondylitis."
Karine Louati and Francis Berenbaum. "Fatigue in chronic inflammation - a link to pain pathways." Arthritis Research & Therapy, 2015. Vol. 17.
Yvette Brazier. "What causes fatigue, and how can I treat it?" MedicalNewsToday. June 4, 2020.
Ki-Jo Kim and Chul-Soo Cho. "Anemia of Chronic Disease in Ankylosing Spondylitis: Improvement Following Anti-TNF Therapy." Archives of Rheumatology, 2012. vol. 27, No. 2.

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