Can Fatigue Be a Symptom of Ankylosing Spondylitis?

Fatigue is common with ankylosing spondylitis (AS). The chemicals released when your body experiences inflammation can lead to extreme fatigue. In addition, chronic pain, sleep loss, and some medication side effects may contribute.

This article explains the relationship between ankylosing spondylitis and fatigue, what causes the fatigue, and which treatments may help.

What Is Fatigue

Fatigue is more than feeling a little tired. Instead, it is a complete lack of physical and emotional energy and motivation. This exhaustion usually interferes with daily life and your ability to carry out everyday tasks.

Since fatigue has many causes, it's important not to assume your fatigue is a symptom of AS. Other conditions that share fatigue as a symptom include:

• Depression
• Sleep disorders
• Thyroid conditions
• Substance use
• Addison's disease
• Eating disorders
• Autoimmune disease
• Cancer
• COVID-19
• Diabetes
• Fibromyalgia
• Heart failure
• Infection
• Kidney disease
• Liver disease
• Malnutrition

A healthcare provider can help rule out the above conditions and create a plan to help you manage AS-related fatigue.

Is Fatigue a Symptom of Ankylosing Spondylitis

Fatigue is a symptom of AS and is often a response to other things happening in the body when you have this condition.

Inflammation

Inflammation is the immune system's response to illness and injury. When your body detects a problem, your immune system sends chemicals throughout your bloodstream to help you heal.

The inflammation that accompanies AS can lead to fatigue. During inflammation, the immune system releases chemicals called cytokines, some of which act as anti-inflammatories.

Cytokines also act on the central nervous system, which can induce fatigue. Some researchers believe that cytokines may be to blame for AS-related fatigue.

Anemia

Anemia is a condition in which your body does not have a healthy supply of red blood cells. It is common with AS. Researchers estimate that 18.5% to 45.8% of people with AS have anemia. In AS, cytokines or iron deficiency may cause anemia. One of the primary symptoms of anemia is fatigue.

Pain

Pain is one of the most prominent AS symptoms due to inflammation, stiffness, and spine fusion. The pain associated with AS can also lead to fatigue. Managing chronic pain can be physically and emotionally exhausting. It can also result in loss of sleep, which naturally contributes to fatigue.

Medications

AS medications help control pain and sometimes slow down disease progression. However, some arthritis medications for AS may have side effects, like fatigue. For example, some disease-modifying antirheumatic drugs (DMARDs), such as Otrexup PF (methotrexate) and Azulfidine (sulfasalazine), may cause fatigue.

Muscle Weakness

Muscle weakness that occurs with AS can result in fatigue because it takes more effort to do certain things. Ankylosing spondylitis muscle weakness is caused by chronic inflammation, spinal muscle fibrosis (tissue scarring), fused spine, long-term immobilization, and joint stiffness.

Treatments and Management of Fatigue

There are many ways to manage AS-related fatigue, from self-care strategies to medical support.

Self-care strategies include:

• Getting regular exercise
• Getting enough nighttime sleep and daytime rest
• Using relaxation techniques
• Pacing yourself

Help from a healthcare provider may include:

• Medication to manage AS (like nonsteroidal anti-inflammatory drugs (NSAIDs), DMARDs, biologics, or corticosteroids)
• A change in medications if they contribute to fatigue
• Screening for anemia
• Iron supplements (if anemic)
• Antidepressants (if feeling anxious or depressed)

When to See a Healthcare Provider

You should talk to a healthcare provider if you experience fatigue. They can help you identify ways of managing it.

If any of the following accompanies your fatigue, make an appointment with a healthcare provider to discuss your symptoms:

• Unexplained weakness
• Constipation
• Dry skin
• Cold intolerance
• Unintended weight gain or loss
• Insomnia or disrupted sleep
• Headaches
• Medication that may cause fatigue
• Sadness or depression

Summary

Fatigue is a common AS symptom. Causes of AS fatigue include inflammation, pain, anemia, medication side effects, and muscle weakness. Some people can manage fatigue with enough sleep, daytime rest, and exercise. However, if those efforts are ineffective, a healthcare provider can help you with a plan to manage it.

A Word From Verywell

If you have ankylosing spondylitis–related fatigue, you may always feel exhausted. Considering how your body compensates for the symptoms of AS, including pain, inflammation, and muscle weakness, it makes sense that your body would become fatigued. Some people find that taking regular breaks to rest throughout the day helps.

Talk to a healthcare provider about your fatigue, especially if you take medications that may contribute or if you experience other symptoms related to your fatigue.