Fatigue: A Common AS Complaint
Excessive fatigue is a common symptom of ankylosing spondylitis (AS), according to the Spondylitis Association of America (SAA). “Some describe fatigue that is worse than pain,” says Susan Goodman, MD, a rheumatologist at the Hospital for Special Surgery in New York City. Different factors contribute to this fatigue, including not sleeping well because of discomfort and inflammation, a hallmark of AS. The inflammation associated with AS causes your body to release proteins called cytokines. These cytokines tell your body to create more white blood cells in order to fight the inflammation. This process expends energy, which can leave you feeling drained, Dr. Goodman explains.
Here are some tips to fight the fatigue associated with AS.
Improve Sleep Quality
Pain from inflammatory arthritis can cause you to wake up during the night, according to a study published in February 2013 in Rheumatology International. But you need your rest to be re-energized come morning. Practicing good sleep hygiene will help, Goodman says. This entails sleeping in a cool, dark, quiet room without distractions; going to sleep at the same time every night; and waking up at the same time every morning. Goodman also recommends not taking long naps during the day, not having dinner late at night, and not starting long, detailed projects just before bedtime.
Be More Active
As counterintuitive as it might seem, staying active is one of the best ways to fight fatigue, says Anca Askanase, MD, MPH, a rheumatologist with Columbia University Medical Center in New York City and director of its rheumatology clinical trials. Exercise can help boost energy levels and improve cardiovascular health, which can increase endurance throughout the day. Additionally, when you’re tired from exercise, you sleep better, and when you sleep better, you’re more likely to wake feeling refreshed, according to the National Ankylosing Spondylitis Association of the United Kingdom. Just try not to exercise right before bed, as that can disrupt your sleep. Talk to your healthcare team about the best exercises for you.
Maintain a Healthy Weight
Being at a healthy weight is part of controlling fatigue, Dr. Askanase says. When you’re overweight, you need to exert more effort to do the same level of activity, she explains. Extra weight can also put more stress on your joints and bones, according to the SAA. Being underweight isn’t ideal either — you may feel tired all the time — so be sure to eat enough to stay at a healthy weight. If you need to lose weight, eat smaller portions, stay hydrated so that you don’t mistake thirst for hunger, and be active. Also, make wise food choices, such as lean protein and fresh fruits and vegetables.
Rest as Needed
Pace yourself. Many people with arthritis — and spondylitis is a form of arthritis — find that resting between activities helps them conserve energy, the Arthritis Foundation says. Resting gives your muscles time to refuel and get ready for more activity. Your physical therapist also can show you how to move with greater efficiency so that you minimize fatigue and any frustration over your condition, according to the SAA.
When your body makes more cytokines, it makes fewer red blood cells, which carry oxygen from your lungs to the rest of your body. A decrease in your red blood cell count signals anemia, and anemia can contribute to your fatigue level. Ask your doctor if you should be tested for anemia and, if tests results show you have it, how to best treat it.
Eat a Healthy Diet
Eating a healthy, well-balanced diet is not only important for maintaining a proper weight, but also for fueling your body, Askanase says. So think of diet as another tool in your arsenal to fight fatigue, she adds. Enjoy a wide variety of foods to get the vitamins and minerals you need. Including anti-inflammatory foods, such as fatty fish, which contain omega-3 fatty acids, may also help. Reducing inflammation can help reduce pain as well as fatigue from AS.
People with ankylosing spondylitis are more prone to anxiety and depression than those who don’t have the condition, according to a study published in March 2016 in the Journal of Rheumatology. Feeling physically tired can go hand-in-hand with depression. If you have signs of depression, get help from a mental health professional. “I like to explain to patients that part of managing a chronic disease such as ankylosing spondylitis is being attuned to your body,” Askanase says. This includes your mental outlook. Work to reduce stressors that can contribute to your fatigue
Take Medication as Directed
Your fatigue can be the result of the pain and inflammation associated with the disease, but treatment can reduce disease activity, according to a study published in February 2013 in Seminars in Arthritis and Rheumatism. That translates to having an easier time dealing with both the pain and the fatigue that goes with AS, Askanase says. Work with your doctor to find the right medication for your level of disease activity, she adds. If your current medication isn’t working as well as it should, ask whether you might need a change or a tweak in dosage.