Fatigue is one of the most common symptoms of ankylosing spondylitis (AS), along with pain, stiffness, and reduced mobility. However, not everyone with AS experiences fatigue.

Ankylosing spondylitis is a chronic condition that causes inflammation in the spine. It typically affects people between 20–40 years of age.

This article explores the connection between AS and fatigue, what may be the cause, tips for coping with AS fatigue, and more.

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Current research shows that fatigue is a significant symptom of AS, ranking as the third most common symptom people report after stiffness and pain.

According to a 2019 study, about 85% of people with AS have varying levels of fatigue symptoms, with about 32% having severe fatigue.

Fatigue due to AS may affect a person’s:

  • emotions
  • functional ability
  • quality of life
  • ability to maintain employment

While fatigue is a common symptom, not everyone will experience it the same.

Fatigue in AS can vary from person to person, but people generally describe it as a persistent feeling of tiredness and lack of energy that goes beyond normal tiredness.

People with fatigue due to AS may experience:

  • generalized tiredness
  • lack of energy or motivation
  • brain fog and difficulty concentrating
  • heavy limbs and muscle weakness
  • reduced endurance

In a 2019 study, people describe being unable to complete work responsibilities in the allotted time. Some express that fatigue makes general activities, such as grocery shopping, difficult.

While the exact cause of fatigue in AS remains uncertain, several factors may contribute to its occurrence. These factors include:

  • disease severity
  • level of pain
  • level of stiffness
  • low mood
  • reduced physical activity
  • poor diet
  • disrupted sleep patterns
  • medications

Inflammation is another factor that may cause fatigue. According to research from 2018, chronic inflammation causes a change in how the body uses and produces energy, leaving a person with a lower level of available energy.

A 2019 study reports that fatigue from AS may be due to thinner gray matter in the brain.

The research shows that people with severe fatigue from AS have thinner cerebral gray matter on MRI scans than those with AS without severe fatigue.

Coping with fatigue from AS can be challenging, but several strategies may help manage and minimize its impact on daily life.

  • Prioritize sleep and rest: A person should get adequate rest and quality sleep by establishing a regular sleep schedule and creating a comfortable sleep environment. They can take rest breaks during the day and listen to their body’s signals for rest.
  • Manage pain and inflammation: Working with a doctor to develop a comprehensive treatment plan that includes medications, physical therapy, heat and cold therapy, and other modalities can help people alleviate pain and inflammation.
  • Stay physically active: Engaging in regular physical activity appropriate for the condition can help fatigue. A person with AS should consult a physical therapist or doctor to develop an exercise program tailored to their needs.
  • Plan and conserve energy: People should plan out daily activities to avoid overexertion and break tasks into manageable segments and take frequent breaks.
  • Maintain a balanced lifestyle: Individuals should adopt a nutritious diet and regular hydration and avoid smoking and drinking alcohol to excess.

Doctors may have more suggestions for how to manage fatigue. They may also refer someone to an occupational therapist, who specializes in managing fatigue in people with chronic conditions.

During an AS flare-up, symptoms of AS worsen and become more intense. Flare-ups can vary in duration and severity from person to person. Common symptoms of a flare-up may include:

  • increased back pain
  • increased back stiffness
  • reduced flexibility and mobility
  • increased fatigue

Not all individuals with AS will experience the same combination or severity of symptoms during a flare-up. Working with a doctor during a flare can help people better manage symptoms.

Currently, there is no cure for AS. Treatment and management aim to alleviate symptoms, improve function, and slow disease progression.

Medications may include taking nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation.

Biologic medications may target specific inflammatory pathways. Janus kinase inhibitors may help decrease inflammation. Corticosteroids also decrease inflammation and relieve pain.

Physical therapy helps maintain flexibility, improve posture, and strengthen muscles. Together, these actions can help reduce pain. A physical therapist can provide guidance on specific exercises and stretches tailored to specific needs.

In rare cases, surgery repairs severely damaged joints.

A person with AS should contact a doctor if they are experiencing persistent or worsening fatigue, new or severe symptoms, or if fatigue affects their daily life.

Doctors can assess possible underlying causes and adjust the treatment plan if necessary.

Fatigue is a common symptom of AS. Several factors cause it, including chronic inflammation, pain, and sleep disturbances.

People with fatigue from AS may experience a lack of energy, brain fog, and reduced endurance.

While the intensity may vary from person to person, management involves a multidisciplinary approach, including addressing the disease and lifestyle modifications that include adequate sleep at night and time to rest during the day.

Consulting with a doctor experienced in AS can help a person develop an individualized approach to managing fatigue and improving their overall quality of life with AS.