Spondyloarthropathies
Fatigue in Ankylosing Spondylitis: Treatment Should Focus on Pain Management

https://doi.org/10.1016/j.semarthrit.2012.06.002Get rights and content

Objectives

Fatigue is an important symptom associated with ankylosing spondylitis (AS). This study examines patients' perspectives and clinical associations of fatigue to help inform potential strategies to alleviate fatigue in AS.

Methods

A mixed methods approach was taken to examine fatigue in a cohort of people with AS. Fatigue levels were evaluated from 3 consecutive monthly questionnaires. Open-ended questions on fatigue were analyzed using thematic analysis and logistic regression was used to examine quantitative data. In addition, fatigue levels were examined before and after treatment with anti-tumor necrosis factor (TNF) compared to nontreated controls.

Results

Three hundred forty-eight of 385 participants completed a fatigue questionnaire. Fatigue was reported to have significant physical, social, and psychological effects. A third of the participants reported that there was nothing they could do to reduce their fatigue, whereas other participants reported that medication, exercise, and resting helped. The main factor associated with fatigue was pain [β-coefficient: 0.74 (95% CI: 0.66 to 0.81)], whereas depression was much less strongly associated. However, these factors only explained 40% of the variation in fatigue levels. Starting anti-TNF therapy reduced fatigue and pain levels compared to the period of time before taking anti-TNF [difference: 14.4 (95% CI: 5.3 to 23.5) on a scale of 0-100] and this reduction was not seen in controls over the same period.

Conclusions

Fatigue is not strongly associated with anxiety, motivation, and depression; instead the factor most associated with fatigue is pain. This suggests that in addition to treatments to reduce disease activity, strategies for alleviating fatigue in AS should focus on pain management techniques and actively treating inflammation.

Section snippets

Materials and Methods

Participants were people with AS, residing in Wales, UK, who were recruited into an AS cohort via their rheumatologist, general practitioner, or local AS patient support groups. The protocol for the development of the cohort has been published previously (20). Briefly, 572 patients were recruited between 2008 and 2011 and were sent questionnaires every 3 months.

Results

This analysis looks at the first 6 months of follow-up for the cohort. Of 572 cohort patients, 187 only completed 1 or 2 questionnaires (179 recently recruited, moved, or dropped out and 8 died) and so were not sent a fatigue questionnaire. This meant that 385 people were sent the questionnaire.

Discussion

This study confirms that fatigue is a major symptom of AS, with significant physical, social, and psychological effects. The findings suggest that measures to address fatigue in AS need to focus primarily on the pain rather than anxiety, physical activity, motivation, or sleep. Pain is the single factor examined that contributes most to explaining variation in fatigue. Depression had an effect on fatigue, although the contribution was relatively minor. Additionally, pain was associated with

Acknowledgments

This study was funded by the Medical Research Council (MRC) and the National Institute for Social Care and Health Research (NISCHR). We would like to thank all the people with ankylosing spondylitis who have participated in the study.

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  • Cited by (0)

    The work was supported by a Medical Research Council and the National Institute for Social Care and Health Research Patient Research Cohort Initiative grant.

    The authors have no conflicts of interest to disclose.

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