10/1/26
According to a new case-control study published in the open-access Journal of Clinical Medicine, fatigue remains a significant and often underappreciated problem for people with axial spondyloarthritis (axSpA) age 50 and older, even when their inflammation is being treated with today’s medications. Researchers found that people with axSpA reported meaningfully more fatigue than people of similar age without the disease, and that fatigue was more closely tied to overall health and daily function than to standard inflammation markers like CRP. The findings support something many patients already know: controlling inflammation alone doesn’t necessarily make the exhaustion go away.
Researchers compared 173 adults with axSpA, average age 64, to 383 people of similar age without inflammatory arthritis. Everyone completed the FACIT-F, a well-established fatigue questionnaire used in axSpA research and clinical trials. The team then looked at how fatigue scores compared between the two groups, and also examined whether certain clinical factors, like disease activity, physical function, or lab markers of inflammation, were more closely linked to fatigue than others.
People with axSpA scored notably worse on fatigue than the comparison group: 61% of patients had fatigue levels considered clinically meaningful, compared to 31% of people without the disease. When researchers looked more closely, women with axSpA reported more severe fatigue than men with axSpA, and the gap between patients and similarly aged people without the disease was also wider for women than for men. Across the whole group, fatigue tracked most closely with a broader measure of overall health and daily functioning, more so than with CRP, a standard blood marker of inflammation. In other words, fatigue didn’t simply mirror how much inflammation was present in the body, it seemed to reflect a wider picture of how someone was doing overall.
This study has some real limits. It was conducted at a single hospital in Spain, and it’s a cross-sectional snapshot, so it can’t tell us how fatigue changes over time or confirm what’s actually causing it. Researchers also weren’t able to collect certain information, like physical activity levels or mental health history, in the same way for both the patient and comparison groups, so some of those unmeasured factors could be influencing the results. And because fewer women than men were included, the findings specific to women should be treated as a starting point for more research rather than a settled conclusion. Even with these caveats, the study adds to a growing recognition that fatigue deserves its own attention in axSpA care, not just as a side effect of inflammation, but as a distinct part of the disease that may need its own conversation with your care team.
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