Learn how your inflammatory disease and other factors may be causing your extreme tiredness.

Everyone gets worn out from time to time. But exhaustion that disrupts your daily life and doesn’t get better after a good night’s sleep has its own medical term: fatigue.

Fatigue significantly affects the quality of life for people with axial spondyloarthritis (axSpA). Your lack of energy may be caused by your arthritis and other health conditions you have, as well as medications side effects and lifestyle habits.

Disease activity and fatigue

Fatigue and arthritis go hand in hand for many people with axSpA. The main culprits are the inflammatory disease process and the accompanying chronic pain.  

Inflammation

Your body’s immune system normally helps to keep you healthy. But if you have an autoimmune disease, like axSpA, your immune system attacks your body and inflammation is the result. The body undergoes stress as it tries to cope with the release of inflammatory cytokines (proteins) in the blood. That can cause fatigue, especially when disease activity is high or low-grade inflammation remains for a long time.

Chronic pain

The pain/fatigue connection can be a vicious circle. Dealing with axSpA pain for months at a time over many years can wear you down. It can affect your sleep habits, which adds to your exhaustion. Being fatigued, in turn, can worsen pain and make it more difficult to manage.

Other sources of fatigue

Your fatigue is not always directly related to your axSpA disease activity, inflammation or pain. In fact – according to a 2017 study published in Current Rheumatology Reports -- your fatigue level is influenced by other contributing factors, including weight, physical inactivity, sleep disturbance and depression. Several of them may work together to cause your extreme tiredness, but identifying and treating even one of these factors can provide relief.

Medication side effects

Several medications, including some you may take for axSpA, can cause drowsiness or fatigue. Common types include some prescription non-steroidal anti-inflammatory drugs and certain disease-modifying anti-rheumatic drugs, such as methotrexate. Corticosteroids may cause daytime tiredness by keeping you awake at night.

Inactivity

The more rest, the more exhausted you may feel.  Unused muscles can weaken or decondition, and you get tired more easily. 

Anaemia

Fatigue in axSpA may be caused by anaemia – a lack of red blood cells. Without enough red blood cells, your muscles get tired fast, resulting in fatigue. Up to two-thirds of people with arthritis have a condition called anaemia of chronic disease, which occurs when inflammatory chemicals interfere with the body’s production of red blood cells. You may also develop anaemia if you have an ulcer caused by medications. Your GP can identify anaemia with a simple blood test.

Lack of sleep

Fatigue may be triggered by insomnia and unrefreshing sleep. Getting into a comfortable sleeping position or staying asleep can be a challenge when joints are swollen and sore. That’s why tossing and turning in bed or waking up repeatedly is a reality for some people with arthritis pain. Sleep apnoea, a condition in which breathing is interrupted during sleep, can also contribute to poor sleep.

Obesity

Being very overweight can cause sleep apnoea or other sleep problems, resulting in daytime fatigue. But studies show that obese people with no sleep disturbance are fatigued. Lack of exercise, the energy that is needed to move a larger body mass, and metabolic changes that often accompany obesity also contribute to fatigue.

Poor nutrition

Not getting adequate and healthy food and fluids can be causes of fatigue that fly under the radar. Your body needs plenty of water, vitamins and minerals to operate efficiently. If you love junk-food and don’t drink enough water or other healthy beverages, your fatigue could be from dehydration and vitamin deficiency.  

Depression

Arthritis pain can take you away from doing the things you enjoy, so it’s no surprise depression often goes hand-in-hand with the disease. Research shows depression may also result from changes in your hormones and brain caused by dealing with the stress of a chronic illness.

Loss of muscle mass

When you lose muscle tissue, the remaining muscles have to bear the burden of moving your body. Many people with severe inflammatory arthritis have a condition called cachexia, in which muscle mass decreases and fatigue increases. Cachexia is linked with high levels of inflammatory cytokines produced by the overactive immune system.

Other medical conditions

Having arthritis increases your risk of other health problems, such as heart disease, lung disease, diabetes, and inflammatory bowel disease - all of which can be associated with fatigue. Other conditions not specifically related to axSpA may also lead to fatigue. These include infection, liver or kidney disease, thyroid disease and chronic fatigue syndrome.

Relieving fatigue often involves treating the underlying situation causing it. Learn some ways to manage arthritis fatigue.

This resource has been developed based on the best available evidence. A full list of references is available upon request.