Fatigue and Axial Spondyloarthritis

Reviewed by: HU Medical Review Board | Last reviewed: May 2020 | Last updated: June 2021

Fatigue is often used synonymously with feeling tired or worn out, and that definition is correct. But it is also a symptom and feature of many conditions, including spondyloarthritis (SpA). Fatigue associated with medical conditions is often not relieved by mere rest and is almost constant. It can happen over time and become chronic. Knowing how to manage your fatigue can help minimize its effects on your life and improve quality of life.

What is fatigue?

While fatigue is like being tired, chronic fatigue with AxSpA is a bit different. The fatigue is often not helped with sleep or rest, and it’s not because of exhaustion.1 It may be a tiredness that is different from anything you’ve felt before.1 Fatigue can negatively impact work, concentration, relationships, and your emotions. This makes it important that it gets addressed like any other symptom would and treatment is given.

Those with radiographic axial spondyloarthritis (r-AxSpA)/ankylosing spondylitis (AS) and those with non-radiographic AxSpA (nr-AxSpA) have similar reported rates of fatigue, especially severe fatigue.2

Does axial spondyloarthritis cause fatigue?

There are many reasons why fatigue occurs with SpA. The main factor associated with fatigue in SpA is uncontrolled systemic inflammation.3 This means inflammation throughout the body that is not managed. When inflammation happens, the body puts out a lot of energy to help control it and deal with the effects. The process of inflammation releases proteins called cytokines, which can also make you feel fatigued.3 Cytokines may also cause anemia in some people, further adding to the fatigue.3

Another cause of fatigue in SpA can be a result of not sleeping well due to uncontrolled or poorly controlled pain or stiffness, or not being able to get comfortable.3 Not getting enough or quality sleep can then increase pain, creating a vicious cycle. If you are having pain, especially at night, proper pain control is important.

Depression may be a factor in fatigue. It can reduce energy levels and impact sleep. People with chronic or progressive disorders are at higher risk of developing depression.3 Pain can also be associated with depression.3 It may not always manifest as sadness, but it can still impact you in other ways.

How fatigue is treated

Treating the causes of fatigue can help minimize or alleviate its impact on your life. Finding the appropriate treatments to address your inflammation with SpA can help reduce the inflammation and associated symptoms – including fatigue. Inflammation is a main symptom of SpA and reducing this can also help address other symptoms like pain or stiffness. This may also help improve fatigue.

If you have anemia, your doctor may do an evaluation to determine if iron or other supplements would be helpful. If the anemia is related to inflammation, your doctor may need to adjust your medications to improve the treatment of your AxSpA. This can help with improving energy levels and reducing fatigue. If necessary, your doctor may also recommend dietary changes to help boost or maintain energy levels and ensure you get adequate nutrients.

Regular exercise can help improve range of motion and stiffness, and also help you sleep better at night.3 This may also help with fatigue. Prior to doing any physical activity, make sure you’re cleared to do so with your doctor or health care team. Getting enough rest and recovery is important, too.

Pain and depression can be causes of fatigue, and sometimes these can be overlooked. Proper pain control is important and can affect energy and mood. If you’re living with depression, finding a support group, counselor, or even medication may be helpful.

If you’re experiencing fatigue, talk with your doctor about that symptom and any others you may be feeling. Sometimes what doesn’t seem related may, in fact, be related – and addressing it can make all the difference. There are treatments out there that may help to reduce your fatigue and help you feel better.

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