Ankylosing spondylitis fatigue
Ankylosing Spondylitis: Dealing With Fatigue
The fatigue common with ankylosing spondylitis is not the same as just being tired. Find out what makes spondylitis fatigue so potent, and discover ways to boost your energy.
By Chris Iliades, MD
Medically Reviewed by Pat F. Bass III, MD, MPH
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Ankylosing spondylitis can make you feel as though your energy has been zapped — a level of fatigue that people who don’t have spondylitis often can't understand. Any form of arthritis can cause the kind of pain that keeps you awake at night, but fatigue that accompanies the inflammatory types of arthritis (including rheumatoid arthritis and ankylosing spondylitis) is also caused by the inflammation process itself.
"Fatigue from inflammation in ankylosing spondylitis can feel like you have the flu. You can ache all over," says Rochelle Rosian, MD, director of regional rheumatology at the Cleveland Clinic in Ohio. “That’s because inflammation affects your whole body, not just your joints.”
To show how pervasive that fatigue is, researchers in Croatia measured fatigue symptoms in 35 people with rheumatoid arthritis and 31 people with ankylosing spondylitis and found that those with ankylosing spondylitis scored the highest. The researchers concluded that fatigue must be factored in when assessing how disabling spondylitis can be.
Ankylosing Spondylitis Fatigue Factors
Not everyone with ankylosing spondylitis experiences fatigue, but it’s very common. Fatigue is related to many things, including the condition itself, difficulty sleeping, and even psychological factors.
"Fatigue caused by pain is easy to understand," Dr. Rosian says. "Pain itself is exhausting, and if you have pain at night, it’s hard to sleep well. But the fatigue of inflammation is not just in your head — it’s due to a cascade of inflammatory reactions that affect your whole body."
Here’s how each factor contributes to what can feel like an onslaught of arthritis fatigue:
- Sleep.As tired as you may be, sleep can be especially hard for you if you have ankylosing spondylitis. That's because spondylitis pain and stiffness actually get worse with rest. The longer you're not moving, the more pain and stiffness you get. "You may fall asleep without pain and then wake up at night or early in the morning with pain," Rosian says.
- Cytokines.These are small proteins released by your cells that trigger inflammation. In addition to swelling, they may also produce fatigue because your body must use up a lot of energy to deal with inflammation.
- Anemia.The release of cytokines can also lead to a decrease in the amount of red blood cells you make, a condition called anemia. Anemia can also add to fatigue.
- Depression.Having a painful and unpredictable condition like spondylitis can lead to stress and depression. One symptom of depression that’s independent of spondylitis is insomnia — which just adds to your fatigue.
Tips to Ease Ankylosing Spondylitis Fatigue
"One of the best ways to ease fatigue of ankylosing spondylitis is to keep moving," Rosian says. "I tell my patients that rest is rust. Regular exercise helps reduce pain and inflammation, helps you sleep better, and helps ease fatigue."
Try these other fatigue-fighters as well:
- Talk to your doctor.Severe fatigue could be sign that your ankylosing spondylitis medication isn’t working as well as it should. Always let your doctor know about your fatigue symptoms and ask if something can be changed or added to your treatment plan.
- Try physical therapy.A physical therapist can show you ways to move that ease fatigue. If you are not yet working with a physical therapist, ask your doctor for a referral.
- Eat for energy.In order to have the energy you need to ease fatigue, feed your body an energy-boosting diet of lean proteins, healthy fats, fruits, vegetables, and whole grains. And don’t skip meals — start every day with a good breakfast. Talk to your doctor about whether you should also take any fatigue-fighting supplements, such as B vitamins and omega-3 fatty acids.
- Set the right mood for sleep.Try sticking to a sleep schedule and a soothing pre-sleep routine. Go to bed about the same time each night, and as you get ready for sleep, try a warm bath or some gentle stretching to relax you instead of watching TV in bed.
- Ask for help.If fatigue, poor sleep, or depression are affecting you and you are struggling to break out of the slump, ask your doctor if seeing a mental health professional might help. Talk therapy and depression medications can renew a more balanced perspective.
Fatigue is one of the most challenging symptoms of ankylosing spondylitis, but these steps can help you re-energize. Because fatigue is an important indication of how well your spondylitis treatment is working, it’s important to talk to your doctor about any necessary tweaks to your treatment plan.
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