Fatigue in ankylosing spondylitis--why is it ignored?

Area of Science:

• Rheumatology
• Clinical Immunology
• Patient-Reported Outcomes

Background:

• Fatigue is a prevalent yet under-recognized symptom in ankylosing spondylitis (AS).
• Physicians and medical literature often neglect fatigue as a major complaint in AS patients.
• Patients frequently identify fatigue as a primary concern impacting their quality of life.

Purpose of the Study:

• To investigate the prevalence and significance of fatigue in patients with ankylosing spondylitis.
• To compare fatigue levels in AS patients with those experiencing pain or stiffness as primary symptoms.
• To evaluate fatigue in AS patients relative to rheumatoid arthritis (RA) patients.

Main Methods:

• Cross-sectional evaluation of 1950 consecutive ankylosing spondylitis patients to define symptoms.
• Prospective 14-day follow-up of 60 patients categorized by primary symptom (pain, stiffness, fatigue).
• Comparative prospective study involving 50 AS and 50 RA patients.

Main Results:

• Initially, 6% reported fatigue as the main symptom, but prospective follow-up revealed it as the primary concern for over 50% of patients.
• Fatigue was more prevalent than stiffness (p=0.009) and pain (p<0.001) in patients initially reporting pain as their main issue.
• Rheumatoid arthritis patients reported significantly more fatigue and pain than ankylosing spondylitis patients (p=0.002, p=0.007 respectively), with similar stiffness levels.

Conclusions:

• Fatigue is a major, often underestimated, problem in ankylosing spondylitis.
• Further research into the etiology and therapeutic strategies for fatigue in AS is warranted.
• Clinical recognition and management of fatigue should be prioritized for AS patients.