Fatigue assessment and its impact in the quality of life of patients with ankylosing spondylitis

Abstract

The most frequently reported symptoms by patients with ankylosing spondylitis (AS) are pain, stiffness, and fatigue. Previous studies have estimated a 63% prevalence of fatigue in AS, with a low correlation of fatigue with pain and functional capacity. The objective of this study is to assess fatigue prevalence in AS patients and establish the main associated factors. A case-control study including AS patients according to New York modified criteria was carried out. The control group included individuals of the general population without rheumatic conditions, matched by gender, age, and socioeconomic level. Disease-related variables were recorded. Functional capacity, disease activity, and quality of life were assessed using Bath Ankylosing Spondylitis Funcional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and ankylosing spondylitis quality of life (ASQoL). CES-D questionnaire was used to evaluate depression and fatigue severity scale (FSS) to evaluate fatigue. Sixty-four consecutive AS patients and 95 controls were included. Patients' median age was 44 years (interquartile range (IQR), 33.25-53), 89.1% were male, and had a median disease duration of 17 years (IQR, 10.3-25). Fatigue prevalence in AS was 73.4% compared to 30.5% in the control group (p < 0.001; OR, 2.08 (95% CI, 1.53-2.83)). Furthermore, fatigue in AS correlated with ASQoL (r = 0.65), BASFI (r = 0.52), BASDAI (r = 0.52), and depression (r = 0.51), whereas no correlation with age or disease duration was found. In the linear regression analysis using fatigue as the dependent variable, depression was the only associated variable (p = 0.01). No association with age, gender, disease duration, BASDAI, BASFI, or presence of comorbidities was found. Finally, BASDAI fatigue question correlated with the FSS (r = 0.55). Fatigue was significantly more prevalent in AS than in healthy controls. The main determinant factor of fatigue was the presence of depression, explaining 30% of its variability. Recognizing these factors could have important therapeutic implications.

Relationship between dementia and ankylosing spondylitis: A nationwide, population-based, retrospective longitudinal cohort study

“…Because enthesopathy involves the multiple skeletal organs and symptoms usually develop relatively early in life, the AS patient shows decreased physical activity from a young age and chronic progression of symptoms over time. [6–8,10] As a natural result, decreased social, physical, and workforce activity are common findings (work disability, unemployment, disturbed sexual function, decreased the quality of life, and fatigue symptoms). [6,7,10,11] Physical activity is known to have a significant effect on cognitive ability.…”

“…[4,5,7,9–15] Especially among psychological abnormalities, the association between AS and depression, anxiety, and sleep disturbances have been well studied. [5,6,8–10,12] Currently the same cannot be said for the measurement of dementia (Alzheimer’s or vascular), despite their clinical importance. Dementia is known as the representative elderly mental illness, with a high prevalence (10% of men greater than 65 years worldwide) that increases the socio-economic burden in recently aging societies worldwide.…”

Evaluation of Sexual Dysfunction in Females With Ankylosing Spondylitis

“…Moreover, fatigue was reported to be more common in AS patients compared to controls 38 and affect sexual health negatively. 39 However, fatigue has many different forms; thus, discrimination may be challenging. Mental or physical fatigue may be reported despite lack of any underlying reason.…”

Spondyloarthritis and fibromyalgia: interfering association or differential diagnosis?

“…In a postal survey of 451 patients, frequent and severe fatigue is mentioned by 75 % of the patients [4], and in 67 % from a Canadian cohort of 681 patients, similar between ankylosing spondylitis and nonradiographic axial SpA [5]. In a controlled study, prevalence of fatigue was 73 % among 64 AS patients and 30 % among 95 controls (p 0.001) [6]. Fatigue is correlated with Ankylosing Spondylitis Quality of Life questionnaire (ASQoL), Bath Ankylosing Spondylitis Functional Index (BASFI), BAS DAI, and depression [6].…”

“…In a controlled study, prevalence of fatigue was 73 % among 64 AS patients and 30 % among 95 controls (p 0.001) [6]. Fatigue is correlated with Ankylosing Spondylitis Quality of Life questionnaire (ASQoL), Bath Ankylosing Spondylitis Functional Index (BASFI), BAS DAI, and depression [6]. In a cross-sectional multicentric study (REGISPONSER) including 2251 patients with SpA, high fatigue score was related with female sex, ASQoL, stiffness, vertebral pain, and patient's global assessment of disease activity [7].…”