Fatigue in patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status, and sleep disturbance

Abstract

This study aims to evaluate the frequency of fatigue in Moroccan patients with ankylosing spondylitis (AS), and its relationships with disease-specific variables, psychological status, and sleep disturbance. A cross-sectional study included patients fulfilled the modified New York classification criteria for ankylosing spondylitis. To assess fatigue, the first item of Bath ankylosing spondylitis disease activity index (BASDAI) and the multidimensional assessment of fatigue (MAF) was used. The evaluation included the activity of the disease (BASDAI), global well-being (Bath ankylosing spondylitis global index), functional status (Bath ankylosing spondylitis functional index), metrologic measurements (Bath ankylosing spondylitis metrological index), and visual analog scale of axial or joint pain. The erythrocyte sedimentation rate and C-reactive protein were measured. To assess psychological status, the hospital anxiety and depression scale (HADS) was used. Sleep disturbance was assessed by the fourth item of Hamilton anxiety scale. One hundred and ten patients were included, of average age 38.0 years ± 12.6. In our data, 66.4% experienced severe fatigue (BASDAI fatigue ≥ 5). The mean total score of MAF was 26 ± 12.77. The disease-specific variables contributed significantly with both BASDAI fatigue and MAF as dependent variables, accounting for 71.3 and 65.6% of the variance, respectively. The contribution of the depression, anxiety, and sleep disturbance were 24.9, 18.4 and 15.4%, respectively. This study state the importance of fatigue in AS patients. Even though disease activity was the most powerful predictor of fatigue, the effects of psychogenic factors and sleep disturbance, should be taken into consideration in the management of AS.

Assessment of Fatigue in Undifferentiated Spondyloarthritis (USpA)

“…A recent study [20] showed that nonsteroidal antiinflammatory drug therapy strongly reduced pain and functional impairment in a group of AS patients, whereas the change in fatigue level was of lower magnitude. Similarly in other studies, we found no impact of nonsteroidal anti-inflammatory drugs [NSAID] and disease-modifying antirheumatic drugs [DMARD] on fatigue degree [14] [21]. In our study, laboratory measurements like ESR and CRP were no found to be related with fatigue.…”

“…Only a few studies have been published examining determinants of fatigue in SpA, and all have focused on ankylosing spondylitis [AS] [14]. To our knowledge, there is no study which have been published examining determinants of fatigue in USpA.…”

“…ASAS group has also adviced the fatigue question of the BASDAI as the most appropriate measure of fatigue in daily practice [6]. Advantage of the MAF is that it gives more details about different aspects of fatigue [14]. In our research, 60% of all patients experienced fatigue, determined as a BASDAI fatigue score of >5.…”

Fatigue in Ankylosing Spondylitis Is Associated With the Brain Networks of Sensory Salience and Attention

“…Patient demographic characteristics and diseasespecific variables included scores on the Bath AS Disease Activity Index (BASDAI) (3,24) and the Bath AS Metrology Index (BASMI) (25), as well as the serum C-reactive protein levels and erythrocyte sedimentation rates, and total back pain scores on a scale of 0-10 (0 ϭ no pain, 10 ϭ most intense pain imaginable). Cognitive/affective functions were evaluated using the Pain Catastrophizing Scale (PCS; range 0-52) (26) and the 40-item, 6-point Affect Intensity Measure (AIM) to assess the characteristic affect strength (27).…”

“…Yet, it is undertreated. In ankylosing spondylitis (AS), fatigue is a frequent and significant symptom, reported in 50-70% of patients (3)(4)(5)(6), and it is associated with disease severity, functional ability, global well-being, and mental health status. Traditional approaches to the treatment of fatigue, such as exercise programs, have proven difficult to institute in AS patients (7).…”