While fatigue is not unique to spondyloarthritis, it is a rather common symptom of it, and one that doesn’t often receive the attention it deserves. Fatigue can negatively impact one’s work, social life, relationships, ability to focus, and even emotional state. To successfully treat fatigue we must first identify and untangle its often-multifaceted causes and tackle fatigue at its source.
Speaking with your rheumatologist about your 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 fatigue. According to rheumatologist Lianne S. Gensler, MD, common causes of fatigue associated with spondyloarthritis include:
Uncontrolled systemic inflammation and disease activity
Studies show this to be the singular factor most closely associated with fatigue in spondyloarthritis.2, 3 When inflammation is not well controlled, the body must use energy to deal with it. The release of cytokines in the process responsible for inflammation can produce the sensation of fatigue, as well as mild to moderate anemia in some cases – which can also contribute to fatigue.
This is something your rheumatologist should address with proper treatment. A change in medications may be warranted in some cases. When inflammation is well controlled, and disease activity properly managed, fatigue can lessen and energy can improve. If fatigue is caused by uncontrolled inflammation, it is often among the first symptoms to
Not sleeping well at night
This is often caused by uncontrolled pain, stiffness, inability to get comfortable, etc. Here again it is important to identify the particular causes of sleeplessness, and treat them appropriately. When symptoms such as pain and stiffness are appropriately treated, sleep often improves, and fatigue diminishes.
Besides causing fatigue, not sleeping well can also increase pain, creating a feedback loop of pain causing sleeplessness, which then causes more pain, and so on. For this reason effective pain management is crucial in addressing fatigue. 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. (Please see our ‘Q&A with a Physical Therapist’ piece on page four for guidance on doing this safely and effectively.) 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 illnesses, including spondyloarthritis, 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.
Depression can be short lived, or chronic, and should be treated by a skilled medical professional, as would any other medical condition.
Other causes of fatigue may include untreated anemia, and thyroid diseases, among other medical causes.
Lastly, staying healthy and being active can prevent fatigue. 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.
In conclusion, 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.
“I’m always moving through molasses and it takes endless internal self will to do anything. So not only are you physically exhausted, emotionally you are always drained.”
“For me, fatigue slows down all my processes, including physical and brain functioning. All my symptoms are heightened when I’m having a fatigue-flare, and the flare itself impacts all my other symptoms. I have yet to find a way to help fatigue, but something that makes it worse is trying to push through responsibilities. I absolutely have to listen to my body and slow down until I’m back at my baseline. Until then…the dishes, the phone calls, the litter box all have to wait.”
“Like living in a fog. Like having to will yourself out of bed. Like having to rest after doing a small task. Like wanting to sleep all the time. Like being too tired to be tired. Like being too tired to watch a movie because you keep falling asleep.”
“The fatigue is awful because it limits my life so much. I feel overwhelmed and depressed because I’m missing so much. Thankfully it comes in bouts and I have good stretches without it. And I do have doctors who listen now. That is KEY!”
“It’s the tiredness that lingers even after a nights (restless achy) sleep. It’s living in slow motion. It’s trying to “perk up” but realizing you can’t. It’s like trying to walk through water every minute of the day. It’s living life on slow speed, when your heart wants to fly and be free…but cant…”
“Mine is caused by not being able to sleep. Day after day of no sleep! For me finding a pool at YMCA or a kind friend with a pool relaxes me beyond belief.”
“I can’t sleep even though I’m exhausted. I lay awake listing all the things I will get done the next day, but then I’m so tired I can’t get anything done!”
“It feels so heavy, weighing me down physically, mentally and emotionally without end. I feel so guilty for not being the person I was before the disease completely took over and becoming a burden to my family and friends.”
“Others live in, what I call, “The land of the living.” I remember what it was like to live there. Clear mind, fluid thoughts, laughter, contributor. Chronic pain, vertigo, fatigue, and brain fog leave me more asleep than awake. I see those in the land of the living. I pretend to be normal, because I look healthy, but I feel 90 and I’m not yet 50.”
“Constant pain causes physical and mental fatigue. The best therapy I have found to combat all these symptoms is water aerobics in a heated salt water pool, and yoga. Keep moving!”
- Gensler, L. (2016, February 18) “Troubleshooting Spondylitis: Complications and Comorbidities” [Webinar].InSAA’sWebinarSeries.Retrievedfrom www.spondylitis.org/Updates/troubleshooting- spondylitis-complications-comorbidities
- Chauffier, K. et al. Fatigue in spondyloarthritis: A marker of Disease Activity. A cross-sectional study of 266 patients. Clinical and Experimental Rheumatology [online.] 2013 Nov-Dec; 31(6):864- 70. Epub 2013 Oct 11. www.clinexprheumatol. org/abstract.asp?a=6755
- López-Medina, C. et al. Assessment of Fatigue in Spondyloarthritis and Its Association with Disease Activity. The Journal of Rheumatology. 2016 Apr;43(4):751-7. doi: 10.3899/jrheum.150832. Epub 2016 Feb 15.