Ankylosing spondylitis (AS) is a type of inflammatory arthritis that typically causes inflammation of the spine’s ligaments and joints. It can cause pain and stiffness, which may worsen over time, leading to vertebrae fusion.

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

Making certain lifestyle changes may help a person limit and manage fatigue from AS.

Multiple medications are also available to treat AS. These include systemic therapies, which help reduce inflammatory activity throughout the body. This may help reduce fatigue, as well as other symptoms.

The following infographic provides quick tips for managing fatigue with AS.

Practicing healthy habits is important for managing fatigue and promoting good overall health with AS.

The following habits may have benefits for reducing fatigue and other symptoms:

  • Getting enough rest: The Centers for Disease Control and Prevention (CDC) recommends that adults get at least 7 hours of sleep per night. Some adults 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 physiotherapist 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. A doctor or registered dietitian may also recommend certain nutritional supplements, such as omega-3 fatty acids or B vitamins.
  • 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.
  • 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, if necessary.
  • Limiting alcohol: Alcohol consumption can contribute to fatigue and may raise the risk of AS progression. If someone who drinks alcohol finds it difficult to limit, 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. It may also be helpful to practice relaxation techniques, such as meditation or rhythmic breathing.
  • Addressing mental health challenges: People with AS have increased risk of depression and anxiety, which may contribute to fatigue. A doctor may prescribe a combination of medication and counseling to treat depression, anxiety, or other mental health challenges.

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

The American College of Rheumatology (ACR), Spondylitis Association of America (SAA), and Spondyloarthritis Research and Treatment Network (SRTN)’s 2019 guidelines 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, which may limit fatigue and other symptoms.

Multiple systemic treatments are available for AS, including:

  • sulfasalazine (Azulfidine)
  • methotrexate (Rheumatrex)
  • Janus kinase (JAK) inhibitors, including:
    • tofacitinib (Xeljanz, Xeljanz XR)
    • upadacitinib (Rinvoq)
  • biologics, including:
    • tumor necrosis factor alpha (TNF-a) inhibitors, including:
      • adalimumab (Humira)
      • certolizumab pegol (Cimzia)
      • etanercept (Enbrel)
      • infliximab (Remicade)
      • golimumab (Simponi)
    • interleukin (IL)-17 inhibitors, including:
      • secukinumab (Cosentyx)
      • ixekizumab (Taltz)
    • IL-12/23 inhibitor, including:
      • ustekinumab (Stelara)

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 efficacy but often costs less.

Biosimilars are available for the following TNF-a inhibitors:

  • adalimumab (Abrilada, Amjevita, Cyletzo, Hadlima, Hulio, Hyrimoz, Idacio, Yuflyma, Yusimry)
  • etanercept (Erelzi, Eticovo)
  • infliximab (Avsola, Inflectra, Ixifi, Renflexis)

A person should inform a doctor if their symptoms do not improve with treatment. They may recommend a change to their treatment plan.

Some people may need to try multiple systemic treatments before finding one that works.

A doctor may also recommend nonsystemic medications to help relieve symptoms of AS.

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 efficacy 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. Information about ongoing clinical trials is available here.

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

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

A 2022 review found that physical therapy for AS helped reduce fatigue, as well as pain and other symptoms.

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

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 2020 article notes research that in people with AS, those who had a history of smoking had worse fatigue and sleep quality than those without a history of smoking.

The review also linked a history of smoking to:

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

People who currently smoked reported more severe symptoms than those who smoked in the past or had never smoked.

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

A person may experience less fatigue and improved 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, they may refer the person to a specialist such as a physiotherapist, registered dietitian, or smoking cessation counselor for support. 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 worsened symptoms or do not experience improvements with treatment.

The doctor may recommend changes to their lifestyle habits or treatment plan.

AS can cause fatigue as well as spinal swelling, stiffness, and pain. This may negatively affect a person’s quality of life and their 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 supporting weight management.

Avoiding smoking, limiting alcohol, and taking steps to manage stress and address mental health challenges is important for reducing fatigue and supporting good 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 other systemic treatment to treat AS.