Ankylosing spondylitis (AS) is a type of inflammatory arthritis that can cause symptoms such as fatigue, joint pain, and stiffness. Doctors may suggest lifestyle changes or medications to manage fatigue due to AS.

AS typically causes inflammation of the spine’s ligaments and joints. Pain and stiffness in the joints may worsen over time, leading to vertebrae fusion.

The inflammation AS causes can be widespread, which means a person can experience symptoms in other areas of the body. One common symptom is fatigue — an extreme feeling of tiredness.

However, certain lifestyle changes may help a person limit and manage fatigue from AS. Medications to treat AS — including systemic therapies, which help reduce inflammatory activity in the body — may also relieve symptoms.

This article explores methods to manage fatigue due to AS, including lifestyle changes and medications that may help.

Certain lifestyle changes may help a person with AS manage fatigue and promote overall health. The following habits may reduce symptoms:

  • Getting enough rest: Most adults should get at least 7 hours of sleep per night. Some may need more sleep to feel rested. Taking short breaks to rest throughout the day may also help reduce fatigue.
  • Exercising regularly: Regular physical activity may help improve strength and mobility, sleep quality, and energy levels in AS. A doctor or physical therapist can recommend low impact exercises that are safe for people with this condition.
  • Eating a well-balanced diet: Following a diet rich in lean proteins, healthy fats, whole grains, vegetables, and fruits is important for meeting the body’s nutritional needs.
  • Managing weight: Excess weight puts strain on the joints, which may increase pain and fatigue. A doctor or registered dietitian may recommend changes to a person’s diet or exercise habits to manage their weight, if necessary.
  • Avoiding smoking: A 2020 review linked smoking to increased fatigue, spinal pain, and risk of AS progression. A doctor can recommend resources to help a person reduce or quit smoking.
  • Limiting alcohol: Alcohol consumption can contribute to fatigue and may raise the risk of AS progression. If someone finds it difficult to limit their alcohol consumption, a doctor may refer them to a substance misuse counselor.
  • Managing stress: Taking steps to limit or avoid sources of stress may help reduce fatigue and improve quality of life. A person may also find it helpful to practice relaxation techniques such as meditation or rhythmic breathing.
  • Addressing mental health conditions: People with AS have an increased risk of depression and anxiety, which may contribute to fatigue. A doctor may prescribe a combination of medication and counseling to treat mental health conditions.

A person can speak with a doctor to learn more about healthy lifestyle habits for AS.

The 2019 guidelines from the American College of Rheumatology, Spondylitis Association of America, and Spondyloarthritis Research and Treatment Network recommend nonsteroidal anti-inflammatory drugs (NSAIDs) as the first-line treatment for AS.

A doctor may prescribe other systemic treatments if NSAIDs alone are not enough to manage AS. Systemic treatments reduce inflammation throughout the body and, in turn, may relieve fatigue and other symptoms.

Multiple systemic treatments are available for AS, including:

Biologics and biosimilars

Biologics are a type of disease-modifying antirheumatic drugs that can help reduce inflammation. A doctor may prescribe the following biologics for someone with AS:

In some cases, a doctor or pharmacist may recommend a biosimilar medication instead of the original biologic. A biosimilar is highly similar to the original biologic. It provides the same safety and effectiveness but often costs less.

Biosimilars are available for the following TNF-alpha inhibitors:

  • adalimumab
  • etanercept
  • infliximab

A person should inform a doctor if treatment does not improve their symptoms. The doctor may recommend a change to their treatment plan. Some people may need to try multiple systemic treatments before finding one that works.

Researchers are continuing to develop and test new treatments for AS, which may help relieve fatigue and other symptoms.

Clinical trials are a type of study that researchers use to evaluate the safety and effectiveness of new treatments in humans.

Sometimes, a doctor may encourage a person to take part in a clinical trial to receive an experimental treatment that the Food and Drug Administration (FDA) has not yet approved for AS. The National Library of Medicine provides information about ongoing clinical trials.

A person can speak with a doctor to learn about the potential benefits and risks of participating in a clinical trial.

Physical therapy involves exercise and other techniques to relieve pain and improve physical function.

According to a 2022 review, physical therapy for AS can help reduce fatigue, pain, and other symptoms.

The review also linked physical therapy to improved spinal mobility and reduced functional limitations. This means that people with AS experienced fewer challenges in performing routine activities after taking part in physical therapy.

If a person smokes, taking steps to reduce or quit smoking may help limit the progression of AS, which is important for limiting fatigue.

A 2019 study found that people with AS who currently or previously smoked had worse fatigue and worse sleep quality than those who did not smoke.

A 2020 review also linked a history of smoking to:

  • worse spinal pain
  • higher symptom scores
  • worse mental health
  • worse quality of life

People who currently smoked reported more severe symptoms than those who had smoked in the past or had never smoked. People with AS who smoke may also have an increased risk of certain co-occurring conditions, such as psoriasis.

If a person smokes, a doctor can share resources to help them reduce or quit smoking. A doctor may prescribe medication to limit nicotine cravings or withdrawal symptoms. They may also refer a person to a smoking cessation counselor or support program.

A person may experience less fatigue and better quality of life if they consistently practice healthy lifestyle habits and follow their treatment plan for AS.

A doctor can recommend resources to help people develop consistent habits. In some cases, a doctor may refer someone to a specialist such as:

  • a physical therapist
  • a registered dietitian
  • a smoking cessation counselor

Some people may also find it helpful to use fitness-tracking apps or other tools to support healthy habits.

A person should inform a doctor if they experience new or worsening symptoms or do not experience improvements with treatment. The doctor may recommend changes to the person’s lifestyle habits or treatment plan.

Below are some common questions about AS and fatigue.

Do people with ankylosing spondylitis need more sleep?

Like most adults, people with AS need at least 7 hours of sleep per night. However, a 2023 review noted a high prevalence of sleep disorders among people with AS. A sleep disorder may make it harder for a person to get enough sleep.

Why does ankylosing spondylitis cause fatigue?

AS causes widespread inflammation throughout the body, which can contribute to symptoms, including fatigue. Other AS symptoms, such as joint pain, may also make it harder to get good quality sleep, and a lack of sleep can contribute to fatigue.

AS can cause fatigue, spinal swelling, stiffness, and pain. These symptoms may negatively affect a person’s quality of life and ability to complete routine activities.

Getting enough rest, exercising regularly, and eating a well-balanced diet may help limit fatigue and other symptoms of AS. These habits are also important for weight management and overall health.

A doctor will also recommend medication to reduce inflammation and relieve symptoms such as fatigue. NSAIDs are the first-line treatment for this condition. A doctor may also prescribe a biologic or another systemic treatment for AS.