Any form of arthritis can cause the kind of pain that keeps you awake at night, but fatigue that accompanies inflammatory forms of arthritis — such as ankylosing spondylitis and rheumatoid arthritis — 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, the director of regional rheumatology at the Cleveland Clinic in Ohio. “That’s because inflammation affects your whole body, not just your joints.” Here’s what you should know about what causes fatigue in AS, and what you can do to give yourself the best chance of avoiding or reducing this symptom.
Ankylosing Spondylitis Fatigue Factors
Fatigue appears to be very common in people with ankylosing spondylitis. In a study published in March 2020 in the journal Clinical Rheumatology, 150 participants with AS completed a series of questionnaires. The results showed that 47.8 percent of them experienced fatigue, with certain factors making fatigue more likely — including higher AS disease activity and sleep disturbances. People with severe fatigue reported a lower quality of life. Not everyone with ankylosing spondylitis experiences fatigue. Fatigue is related to many factors — not just AS disease activity or pain and sleep difficulty, but also psychological factors like depression and anxiety. “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.” Several factors can contribute to fatigue in AS, according to the Spondylitis Association of America. Inflammation Uncontrolled systemic (body-wide) inflammation is the factor that best predicts fatigue in AS. Cell messengers called cytokines that are part of the inflammatory process may cause the sensation of fatigue, and inflammation can also cause anemia (inadequate red blood cells), which also causes fatigue. Lack of sleep and inactivity As tired as you may be, sleep can be elusive if you experience pain and stiffness due to AS. And the longer you’re not moving, the more pain and stiffness you may develop. “You may fall asleep without pain and then wake up at night or early in the morning with pain,” Rosian notes. Depression Having a potentially painful and unpredictable condition like AS can lead to stress, despair, and depression. Depression may cause fatigue directly by lowering levels of serotonin — a hormone that helps with nervous system communication — as well as other key hormones. It may also lead to insomnia and other sleep disturbances.
Tips to Ease Ankylosing Spondylitis Fatigue
“One of the best ways to ease the 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.” In addition to getting enough physical activity, these steps may help you fight fatigue in AS.
Talk to your doctor about your treatment plan. Severe fatigue could be a 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 your symptoms or tests measuring AS disease activity suggest that your treatment should be changed or intensified.Try physical therapy. A physical therapist can show you ways to move that require less energy and cause less fatigue. Physical therapy may also help ease pain, a key contributor to fatigue in AS. If you are not yet working with a physical therapist, ask your doctor for a referral.Get serious about pain management. There isn’t a magic treatment for pain related to AS, and no single approach works for everyone. But if you experience pain more than occasionally, work with your doctor to develop a comprehensive plan to tackle your pain. This plan may include medications, exercise, and physical therapy, or even less-conventional therapies like meditation, yoga, or breathing exercises.Eat for energy. To have the energy you need to fight fatigue, feed your body a healthy 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 supplements to boost your energy level, such as B vitamins or omega-3 fatty acids.Set the right mood for sleep. Try sticking to a sleep schedule and a soothing bedtime routine. Go to bed around the same time each night, and try a warm bath or some gentle stretching to relax before bed instead of watching TV or checking your phone.Ask for help. If fatigue, poor sleep, or depression are taking a toll and you’re struggling to break out of the slump, ask your doctor for a referral to a mental health professional. Psychotherapy (talk therapy), with or without depression medications, will help to improve your mood and quality of life.
Fatigue is one of the most challenging symptoms of ankylosing spondylitis, and can make you feel powerless at times. But don’t forget that many fatigue-fighting measures are under your control, and that AS disease activity is the number one predictor of fatigue in people with the condition. If fatigue is bringing you down, have a talk with your doctor about the state of your AS — including your level of inflammation — and what therapies and strategies are available to get you to a better, more energetic place. Additional reporting by Quinn Phillips.
