Disease Activity, Occupational Participation, and Quality of Life for Individuals with and without Severe Fatigue in Ankylosing Spondylitis

Abstract

Background. Fatigue is one of the most frequently reported symptoms by individuals with ankylosing spondylitis. However, it is often overlooked clinically and in research. Literature researching the impact of severe fatigue on occupational participation in ankylosing spondylitis is limited. Therefore, the aim of this research was to explore the impact of severe fatigue on occupational participation, disease activity, and quality of life in people with AS. Methods. A sequential exploratory mixed method study design was used in this study. Self-reported questionnaires gathered quantitative data which were analysed with descriptive and inferential statistics. Qualitative data were generated through semistructured interviews and analysed using a content analysis approach. Results. Fifty individuals with AS completed all study questionnaires. Participants had a mean age of 46.5 years; 72% were men with a mean disease duration of 14.5 years. High fatigue was reported by 38% of participants using the Multidimensional Assessment of Fatigue (MAF). Fatigue was significantly associated with lower occupational participation (p=0.018), higher disease activity (p<0.001), higher pain (p<0.001), reduced physical capacity (p=0.018), lower quality of life (p<0.001), and lower global well-being (p<0.001). There were significant differences between those with low and high fatigue levels for occupational participation (p=0.007), disease activity (p<0.001), physical capacity (p=0.015), pain (p<0.001), and quality of life (p<0.001). Participants discussed the impact of fatigue on productivity and leisure. They also discussed a range of strategies for managing their fatigue but reported a lack of education from health professionals on managing this symptom. Conclusion. Severe fatigue is a prevalent symptom for individuals with ankylosing spondylitis and results in reduced occupational participation in productivity and leisure. Early fatigue management interventions may reduce the occupational participation impact of this symptom for individuals with ankylosing spondylitis.

Exploring the Prevalence and Factors Associated With Fatigue in Axial Spondyloarthritis in an Asian Cohort in Singapore

“…Besides disease activity, we also found significant associations between disease impact and fatigue. In the multi-variable analysis, physical function (measured by BASFI), and BAS-G were associated with BASDAI-fatigue, while ASQoL was associated with SF-36 VT. Our findings are consistent with other studies that reported BASFI ( 7 – 9 , 14 , 15 , 17 ), BAS-G ( 5 , 9 , 14 ), and ASQoL ( 6 , 9 , 14 , 15 ) as predictors of fatigue. This highlights patients' perception of fatigue as a disabling symptom and accentuates the importance of recognizing and addressing fatigue in clinical practice.…”

“…Spinal damage, which was measured by BASMI 10 and clustered together with age and disease duration in the PCA, was associated with SF-36 VT. However, it was not associated with fatigue measures in the multivariable analysis, which is in keeping with other studies ( 6 – 9 , 15 , 17 ).…”

“…Patients rated the severity of their fatigue over the past week on a 0-10 numeric rating scale (NRS) (0: none, 10: very severe). We defined severe fatigue as BASDAI-fatigue ≥5/10 as with previous studies on fatigue and axSpA ( 5 , 6 , 9 , 10 , 31 , 32 ). The SF-36 VT is one of the eight domains of the SF-36, a generic measure of health-related quality of life (HRQoL) validated for axSpA patients in Singapore ( 33 ).…”

“…Fatigue is generally described as a subjective sensation of tiredness that is relentless, pervasive, unpredictable, and unresolving ( 12 , 13 ). It also has adverse impacts on how axSpA patients function in daily activities ( 7 – 9 , 14 – 16 ), work performance ( 9 , 16 ), and quality of life ( 6 , 9 , 14 , 15 ). However, the mechanisms driving fatigue in axSpA remains unclear.…”

Real-world experiences of the diagnosis process in Korean patients with ankylosing spondylitis based on a self-report questionnaire

“… 17 The burden on individual patients with AS is not limited to health care costs associated with controlling disease activity but also encompasses costs associated with managing extra-articular manifestations, comorbidities, and disability. 18 , 19 According to data of the National Health Insurance Service-National Sample Cohort, a Korean population-based cohort with submitted medical claims between 2002 and 2013, 28% of patients with AS experienced at least one extra-articular manifestation. 9 , 20 The impact of AS on mortality has recently been highlighted in nationwide, population-based cohort studies showing that all-cause mortality is significantly increased in patients with AS compared with the general population (OR = 1.60 in a Swedish cohort), and cardiovascular mortality (OR = 1.36 in a Canadian cohort) was found to be higher in patients with AS than in controls.…”