Who gets fatigue:
People with fatigue are more likely to be women and those with severe disease.
Why do people get fatigue:
Fatigue is a major symptom of many inflammatory conditions. It is a common problem among people with cancer and in these people chemicals associated with inflammation (called cytokines) are found to be higher among those with fatigue than among those without fatigue. People with rheumatoid arthritis also report very severe fatigue. These people are also more likely to be women, have high levels of pain and active disease.
However, people with chronic fatigue syndrome and fibromyalgia also report high levels of fatigue but there is no evidence of inflammation or higher levels of cytokines. This has led some people to suggest that in some cases fatigue may be due to depression or psychological reasons not related to disease directly.
Yet, drugs which alter the levels of inflammatory chemicals in the body have been found to help fatigue. Therefore, this may provide evidence that in an inflammatory condition, like ankylosing spondylitis, the fatigue could be caused by the chemicals that lead to inflammation.
What drugs help fatigue:
At present, there are no known drugs that alleviate the fatigue symptom for people with AS. It was previously thought that anti-TNF may help reduce fatigue symptoms, however more recent studies have revealed this does not appear to be the case.
Other methods of dealing with fatigue:
Fatigue appears to be affected by biological, social and personal factors and so what may work for one person may not for another. Some people with AS related fatigue have found benefits from regular physical activity, for instance, exercise in the pool (ie water based exercise) is reported to help fatigue. Low dose amitriptyline (this is a muscle relaxant) before going to bed has been shown to help fatigue a little (an improvement of 23%). Other methods of managing fatigue in other disorders include dietary changes, rest, complementary therapies, cognitive behavioural therapy and regular sleep patterns. Since fatigue is a complex symptom related to other AS symptoms, successful control of additional symptoms may have positive effects in alleviating fatigue.
In summary:
Fatigue is a major symptom for some people with ankylosing spondylitis. It is a complicated symptom and could be caused by chemicals leading to inflammation. To date, no drugs appear to reduce fatigue, but research into fatigue and ankylosing spondylitis (as well as other inflammatory conditions) is continuing.
 [Top of page]
References :
Calin A et al. Fatigue in Ankylosing Spondylitis: why is it ignored? J Rheumatol 1993;20:991-5
Jones S et al. Fatigue in ankylosing spondylitis : its prevalence and relationship to disease activity, sleep, and other factors. J Rheumatol 1996; 23(3): 487-90.
Meeuwesen L et al. Communicating fatigue in general practice and the role of gender. Patient Educ Couns 2002;48:223-42.
Sundstrom B et al . Exercise habits among people with AS: A questionnaire based survey in the Country of Vasterbotten,Sweden. Scand J Rheumatol 2002; 31 (3): 163-7
Van Tubergen et al. Assessment of fatigue in patients with ankylosing spondylitis: a psychometric analysis. Arthritis Rheum 2002; 47(1): 8-16.
Missaoui B & Revel M. Fatigue in ankylosing Spondylitis. Ann Readapt Med Phys 2006; 49 (6): 305-8.
Brophy S et al . Factors associated with fatigue in AS and socio-economic implications. Arthritis Rheum 2002.
Wei-Howe Koh et al. Low dose amitriptyline in ankylosing spondylitis: a short term, double blind, placebo controlled study. J Rheumatol 1997; 24(11): 2159-2161.
Gorman J. Treatment of ankylosing spondylitis by inhibition of tumour necrosis factor alpha. BMJ 2002; 346 (18): 1349-1356
Braun J. Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial. Lancet 2002; 359: 1187-93.
|
[