Complications Of Ankylosing Spondylitis
The outlook for AS is highly variable. For some people the condition improves after an initial period of inflammation, whereas for others it can get progressively worse over time.
Some people with AS are able to remain fully independent or minimally disabled in the long-term.
However, some people eventually become severely disabled as a result of the bones in their spine fusing in a fixed position and damage to other joints, such as the hips or knees.
With modern treatments, AS does not normally affect life expectancy significantly, although the condition is associated with an increased risk of other potentially life-threatening problems.
For example, AS can lead to:
- weakening of the bones
- spinal fractures
Read about the complications of ankylosing spondylitis.
When To Seek Medical Advice
You should see your GP if you have persistent symptoms of AS.
If your GP thinks you may have the condition, they should refer you to a specialist in conditions affecting muscles and joints for further tests and any necessary treatment.
Further tests may include blood tests and imaging tests.
Read about diagnosing ankylosing spondylitis.
Tendon And Ligament Inflammation
Do you ever experience pain and swelling above your heel , under your heel , or at your elbow ? In addition to lower back, this pain where tendons and ligaments attach to bone is a common symptom in nr-axSpA. Enthesitis is unique to spondyloarthritis and can be an important way that a rheumatologist distinguishes your nr-axSpA from a different type of rheumatic disease, such as rheumatoid arthritis.
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Opioids: Not To Be Used In Non
What should not be used to treat nr-axSpA is opioids. In addition to the many known risk factors, such as addiction and side effects, with their long-term use, opioids dont really take care of the inflammation, and this is an inflammatory disease, explains Dr. Deodhar.
Taking opioids for nr-axSpA is like masking the pain. We try to avoid the use of opioids in the treatment of axSpA, says Dr. Norton. These dont address the underlying cause of the disease, and when we do treat the disease appropriately with approved medications, this treats pain as well as the underlying cause of the disease.
This educational resource was made possible with support from UCB, a global biopharmaceutical company focused on neurology and immunology.
Study: Biologics Improve As Axspa Disease Activity With Insufficient Improvement In Fatigue
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Patients with ankylosing spondylitis or non-radiographic axial spondyloarthritis demonstrated improvements in disease activity and fatigue after treatment with biologics, but severe fatigue remained in many patients, according to a recently published study.
Researchers studied 681 patients with ankylosing spondylitis . Of this group, 66 patients had non-radiographic axial spondyloarthritis and 489 patients were male with a median disease duration of 8 years. Almost half of the patients received tumor necrosis factor-alpha inhibitors, and 69.9% received NSAIDs.
Patients were evaluated using the Bath AS Disease Activity Index , AS Disease Activity Score , Bath AS Functional Index score, modified Stokes AS Spinal Score , Fatigue Severity Scale , AS Quality of Life questionnaire, EQ-5D20 health questionnaire, Medical Outcomes Study Short Form-36 and the Health Assessment Questionnaire .
Researchers discovered significant, but weak, correlations were observed between reported severe fatigue and enthesitis, arthritis, ESR and CRP. They also found a strong correlation between question 1 on the BASDAI and high FSS scores.
Disclosures: The researchers report no relevant financial disclosures.
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Exploring The Prevalence And Factors Associated With Fatigue In Axial Spondyloarthritis In An Asian Cohort In Singapore
- 1Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- 2Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- 3Duke-NUS Medical School, Singapore, Singapore
Aim: To evaluate the prevalence of fatigue and the factors associated with fatigue among patients with axial spondyloarthritis within an Asian population.
Method: We used the baseline data from a clinic registry in a tertiary referral center. All patients fulfilled the 2009 Assessment of SpondyloArthritis international Society classification criteria for axSpA. Severe fatigue was defined as Bath Ankylosing Spondylitis Disease Activity Index-fatigue 5/10 and vitality domain of Short Form-36 Health Survey 10th percentile of the general population.
Fatigue is prevalent amongst patients with axSpA in Asia and is associated with disease activity, disease impact as well as patient related factors.
How Fatigue Is Treated
Treating the causes of fatigue can help minimize or alleviate its impact on your life. Finding the appropriate treatments to address your inflammation with SpA can help reduce the inflammation and associated symptoms including fatigue. Inflammation is a main symptom of SpA and reducing this can also help address other symptoms like pain or stiffness. This may also help improve fatigue.
If you have anemia, your doctor may do an evaluation to determine if iron or other supplements would be helpful. If the anemia is related to inflammation, your doctor may need to adjust your medications to improve the treatment of your AxSpA. This can help with improving energy levels and reducing fatigue. If necessary, your doctor may also recommend dietary changes to help boost or maintain energy levels and ensure you get adequate nutrients.
Regular exercise can help improve range of motion and stiffness, and also help you sleep better at night.3 This may also help with fatigue. Prior to doing any physical activity, make sure youre cleared to do so with your doctor or health care team. Getting enough rest and recovery is important, too.
Pain and depression can be causes of fatigue, and sometimes these can be overlooked. Proper pain control is important and can affect energy and mood. If youre living with depression, finding a support group, counselor, or even medication may be helpful.
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The Importance Of Early Nr
The sooner nr-axSpA can be accurately diagnosed, the faster a person can get start treatment, get their inflammatory pain under control, and reign in other debilitating symptoms of axSpA.
Some patients with nr-axSpA will ultimately develop AS while some never progress to AS. With AS, there can be permanent damage to your spine, including fusion of your vertebra.
Even if there is no progression to AS, the pain alone that a person experiences from nr-axSpA can be debilitating and negatively impact a persons quality of life, ability to work, and personal relationships. It can lead to overlapping pain conditions such as fibromyalgia, which is characterized by widespread pain, as well as anxiety and depression. Because axSpA is driven by underlying inflammation, it can also be associated with other comorbidities, such as an increased risk of heart disease.
Whats more, there are good treatments for axSpA that can control symptoms, improve quality of life, and may help prevent disease progression. But these medications are very different from treatments recommended for mechanical back pain, which is why figuring out the root cause is so important.
Does Axial Spondyloarthritis Cause Fatigue
There are many reasons why fatigue occurs with SpA. The main factor associated with fatigue in SpA is uncontrolled systemic inflammation.3 This means inflammation throughout the body that is not managed. When inflammation happens, the body puts out a lot of energy to help control it and deal with the effects. The process of inflammation releases proteins called cytokines, which can also make you feel fatigued.3 Cytokines may also cause anemia in some people, further adding to the fatigue.3
Another cause of fatigue in SpA can be a result of not sleeping well due to uncontrolled or poorly controlled pain or stiffness, or not being able to get comfortable.3 Not getting enough or quality sleep can then increase pain, creating a vicious cycle. If you are having pain, especially at night, proper pain control is important.
Depression may be a factor in fatigue. It can reduce energy levels and impact sleep. People with chronic or progressive disorders are at higher risk of developing depression.3 Pain can also be associated with depression.3 It may not always manifest as sadness, but it can still impact you in other ways.
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Comparison Of Severe Versus Low Fatigue Patients
Comparison of patients with severe versus low fatigue states revealed that these factors were significantly higher in the severely fatigued subset: enthesitis, arthritis, acute-phase measures , ASDAS-CRP, total BASDAI, BASDAI inflammation, BASDAI spinal pain, BASDAI arthralgia, BASDAI enthesitis, BASFI, HAQ, ASQoL, and age . SF-36 mental component summary , SF-36 physical component summary , and EQ-5D indices were significantly higher in the low fatigue group . Between the groups, there were no differences in sex, disease duration, anemia, uveitis, inflammatory bowel disease, mSASSS, or TNFi use .
Other Key Symptoms May Include:
- Iritis / Uveitis Inflammation of the eye. Symptoms often occur in one eye at a time, and may include redness, pain, sensitivity to light, and skewed vision.
- Enthesitis Inflammation of the entheses, which is where ligaments or tendons attach to the bone. Symptoms include swelling and tenderness. Common areas impacted include the Achilles tendon at the back of the heel, the plantar fascia at the base of the heel, the rib cage, and the spine.
- IBD Gastrointestinal issues and bowel inflammation, which may be associated with Crohns disease or ulcerative colitis.
- Psoriasis A scaly skin rash.
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What Does It Look Like
X-rays will not show evidence of nr-AxSpA because the inflammation has not yet caused visible damage to the joints. However, an MRI may indicate active inflammation in the soft tissues surrounding the sacroiliac joints. These joints connect the hip bones to the sacrum the triangular bone that sits between the lower spine and the tailbone.
An MRI may also show swelling or edema in the bone marrow of the SI joints.
Taking Care Of Yourself
Your everyday habits can affect your symptoms. Making these moves may help you feel better:
If you smoke, quit. Studies show that tobacco makes your symptoms worse.
Exercise regularly. It may sound contradictory, but you can ease your back pain if you get moving. Physical activity also strengthens and stretches your muscles, which can prevent the stiffness caused by the disease.
Eat healthy food. There isn’t a specific diet to treat your condition. But making sure you get plenty of vegetables, fruit, protein, calcium, and omega-3 fats can help you keep to a healthy weight. That will lessen the strain on your joints. A healthy eating plan may also help ease inflammation in your body.
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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. 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.
Treatment Guidelines Overview For Patients & Families
The American College of Rheumatology, the Spondylitis Association of America, and the Spondyloarthritis Research and Treatment Network published updated recommendations for treating ankylosing spondylitis , and non-radiographic axial spondyloarthritis .
Developed in close collaboration with a volunteer team of patients, physicians, and other experts, this document presents key updates and specific treatment recommendations from the original manuscript, in clear and simple terms, so that you can better take charge of your treatment.
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Compliance With Ethics Guidelines
This article is a literature review based on previously conducted studies. All procedures performed in studies involving human participants that were cited in this review were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards, as reported in the primary reports.
Chronic Diarrhea And Digestive Issues
The same inflammation from an over-active immune system that is causing back pain can also affect the gastrointestinal tract. The spondyloarthritis umbrella of diseases also includes enteropathic arthritis, which occurs in inflammatory bowel disease like Crohns and ulcerative colitis. Some people with spondyloarthritis develop these associated intestinal conditions.
You could have chronic diarrhea that lasts more than two weeks, possibly with blood in the stool, abdominal pain and bloating, and weight loss.
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Exercise And Activity Information
Physical activity protects joints by strengthening the muscles around them. Strong muscles and tissues support those joints that have been weakened and damaged by arthritis. A properly designed program of physical activity reduces pain and fatigue, improves mobility and overall fitness, and alleviates depression. Physical activity allows someone with arthritis to have a more productive, enjoyable life. There are different types of exercises that you can do to lessen your pain and stiffness:
- Range of motion exercises reduce pain and stiffness and keep your joints moving. To achieve the most benefit, these exercises should be undertaken daily.
- Strengthening exercises maintain or increase muscle tone and protect your joints.
- Moderate stretching exercises help to relieve the pain and keep the muscles and tendons around an affected joint flexible.
- Endurance exercises strengthen your heart, give you energy, control your weight and help you feel better overall. These exercises include things like walking, swimming and cycling.
In addition to stretching exercises, it is important to do at least 30 minutes of moderate exercise on most days of the week for your general fitness. You can do this either in one go or break your exercise into smaller efforts .
Ask your physio or exercise physiologist to create a special exercise program you can do at home or at the local gym or swimming pool.
Effect Of The Exercise Program At 3
A significant beneficial effect of the intervention was seen on fatigue, vitality, and perceived general health and mood at the 3-month follow-up . Furthermore, compared with the control group, the exercise group reduced the rate of having severe fatigue and poor sleep quality at the 3-month follow-up. There was no effect of the intervention on sleep quality analyzed as a continuous variable. As shown in the forest-plot in , the effect sizes were medium for fatigue, vitality, and perceived general health, whereas it was small for mood and sleep quality.
The Effect of Exercise on Fatigue, Vitality, Emotional Distress, Sleep Quality, and General Health at 3- and 12-Month Follow-Up
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Forest plot of the effect of exercise on fatigue, vitality, mood, sleep quality, and perceived general health at 3- and 12-month follow-up. Data are shown as standardized mean difference with 95% CI. SMDs between 0.2 and 0.4 are considered a small effect size, from 0.5 to 0.7 a medium effect size, and 0.8 a large effect size.
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What Are The Symptoms Of Nr
The majority of the time, itâs low back, buttock, and hip pain. But itâs different than traditional back pain. It doesnât come on suddenly, but happens slowly, over weeks to months to even years. It improves with activity, not with rest, and may be intense enough to wake you up at night. You may also notice morning stiffness that takes a while to go away. About 40% of the time, patients develop other inflammatory diseases, such as uveitis or inflammatory bowel disease.
The problem is that back pain is a common complaint among patients, and the average primary care physician may not realize it could be due to inflammatory arthritis. But I would say if you develop chronic lower back pain before age 45, or already have an inflammatory disease, you should ask your doctor for a referral to a rheumatologist.
There are three things your doctor will need to make a diagnosis:
- An x-ray of the SI joint
- A blood test to check for the HLA-B27 gene
- An MRI of the area
If an X-ray shows no joint damage, but an MRI shows active inflammation, then you most likely have a diagnosis of nr-axSpA. If the X-ray does show damage, then you will be diagnosed with ankylosing spondylitis.
Questions For Your Doctor
To prepare for your appointment, it’s a good idea to write down a list of questions and take it with you to your doctor’s office. If possible, bring a friend or family member to help you remember what your doctor says.
The questions can include:
- What’s causing my symptoms?
- What’s the goal of my treatment and what do you recommend? Are there any side effects?
- How will you check my progress?
- Are there any other options I should consider, such as physical therapy or exercise?
- Should I see a specialist?
- What’s the best way to manage my other health issues?
- How often should I return for follow-up visits?
- Are there any resources or websites that you recommend?
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A Whole Range Of Different Factors Can Contribute To Fatigue
- The underlying inflammatory process in axial SpA can lead to fatigue. Researchers have found that chemicals called cytokines are found in inflamed tissue. These are similar to the type of chemicals released during viral illnesses such as colds and flu, and can cause extreme fatigue
- Anaemia is often found alongside inflammation. Do get this checked out with your GP
- Pain, especially long term pain, wears you down and can wake you up at night, adding to tiredness
- Sleep disturbance due to pain and stiffness in the night
- Certain drugs used to treat arthritis can cause drowsiness and interfere with concentration, which may make fatigue worse. Medications containing codeine or other opioids and medications such as amitriptyline are most likely to cause these side effects
- Weakness of the muscles can occur. This can contribute to fatigue since more effort will be required to perform certain activities
- Any long term condition can cause distress and uncertainty about the future. This can lead to depression, which is associated not only with a low mood but also with various physical symptoms, one of which is fatigue
