Fatigue in Spondyloarthritis

Fatigue is a common complaint in spondyloarthritis, and one that doesn’t often receive the attention it deserves. Different from feeling “tired,” fatigue doesn’t just go away after a good night’s sleep, and can affect many aspects of life. Fatigue, sometimes appearing with brain fog, can negatively impact one’s work, social life, relationships, ability to focus, and even emotional state. 

It is important to note that fatigue is often a manifestation and indicator of underlying issues, and other under-treated symptoms. As such, it is often a clue that something is amiss and requires the attention of a knowledgeable physician.

Studies show that uncontrolled systemic inflammation is the factor most closely associated with fatigue in spondyloarthritis. If inflammation is extensive, then the body must use energy to deal with it. The release of certain cell messengers (cytokines) during the inflammatory process can produce the sensation of fatigue, as well as mild to moderate anemia in some cases – which can also contribute to fatigue. When inflammation is well controlled, and disease activity properly managed, fatigue can lessen and energy can improve.

Uncontrolled pain and stiffness can disturb sleep and make it difficult to get rest. This of course contributes to fatigue. Besides causing fatigue, not sleeping well can also increase pain, creating a feedback loop of pain causing sleeplessness, which then causes more pain and fatigue, and so on. When symptoms such as pain and stiffness are appropriately treated, sleep often improves, and fatigue diminishes. Other things to help bring about better sleep include slowly increasing physical activity – which can help by tiring the body, helping with stiffness and pain, as well as reducing inflammation. Practicing good sleep hygiene is also important. This includes avoiding caffeine and other sleep disruptive foods or drinks late in the evening, establishing a regular and relaxing bedtime routine, creating a comfortable and calming sleep environment, and considering the use of items to block out light and disruptive noises if needed.

Depression also causes fatigue directly by lowering energy levels, as well as indirectly by interfering with sleep. Depression lowers serotonin levels, which, among other things, helps regulate our circadian rhythm – the internal body clock controlling sleepiness and wakefulness. As such, depression is often linked with insomnia, while lack of sleep can worsen depression. Those with chronic pain are more likely than the general population to suffer from depression. There is also a feedback loop between pain and depression, with each making the other worse, and of course further impacting fatigue.

For all of these reasons, effective pain management is crucial. Though many people with spondyloarthritis respond well to traditional spondyloarthritis medications, as well as exercise and physical therapy, others experience breakthrough pain even with appropriate treatment. In these cases, it is important to work with your medical team to find appropriate solutions and design a comprehensive plan to treat the pain.

Other causes of fatigue may include untreated anemia, and thyroid diseases, among other things. Speaking with your rheumatologist about fatigue is the first step. Only after your particular causes of fatigue have been identified, can those causes be addressed, and appropriate changes made to help lessen it.

A physical therapist or an occupational therapist may be helpful in suggesting alternative ways of moving and functioning to help expand less energy and lessen the load on your muscles and joints. Energy conservation when needed, and being kind to yourself when feeling fatigued, are also important. Healthy eating habits can increase and maintain energy, as can regular exercise. As a bonus, exercise itself is anti-inflammatory, while smoking can increase inflammation. Peaceful mind-body practices can also help free up mental and physical energy.