Psoriasis is an autoimmune disorder characterized by red, silvery scaly plaques on the skin though there are different kind of psoriasis and psoriasis symptoms can present differently. Up to 30 percent of people with psoriasis also develop joint pain and other symptoms, which is a separate disease called psoriatic arthritis.
But psoriasis can also co-occur with AS. If someone has axial involvement, which means pain and inflammation is occurring in the spine, and mild psoriasis, then they have both psoriasis and AS.
The inflammation throughout your body also causes fatigue, which some AS patients say is as bad as, if not worse than, the pain and stiffness. The tiredness feels physical, not just mental. For more information about ankylosing spondylitis, check out this list to help figure out if your back pain is mechanical or inflammatory.
Tags: Ankylosing Spondylitis , Axial Spondyloarthritis. CreakyJoints is a digital community for millions of arthritis patients and caregivers worldwide who seek education, support, advocacy, and patient-centered research. We present patients through our popular social media channels, our website CreakyJoints. We represent patients through our popular social media channels, our website CreakyJoints.
Only fill in if you are not human. Ankylosing Spondylitis Symptoms and Red Flags 1. Chronic pain and stiffness in the lower back where your spine meets your pelvis Ankylosing spondylitis causes chronic pain that can come and go. Pain that gets worse with inactivity or sitting still for long periods, such as while you sleep When your back pain occurs because your immune system is attacking your joints, inflammatory cells and proteins accumulate in the fluid in your joints.
Pain that gets better from a hot shower Similarly to exercise and activity improving AS back pain, a hot shower or a heating pad often helps inflammatory back pain feel better too. Pain in your ribcage, such as when you exhale AS can also cause inflammation at the point where your rib cage connects with your breastbone and spine. Pain in your heel or foot Another prominent feature of AS is that it causes inflammation of the entetheses, which is where ligaments and tendons attach to bones.
Psoriasis Psoriasis is an autoimmune disorder characterized by red, silvery scaly plaques on the skin though there are different kind of psoriasis and psoriasis symptoms can present differently. Fatigue The inflammation throughout your body also causes fatigue, which some AS patients say is as bad as, if not worse than, the pain and stiffness.
Was This Helpful? Share Facebook Twitter Email. Rheumatoid Arthritis Diet Patient Stories. Results Citations. Topics from this paper. Ankylosing spondylitis Pain. Rheumatoid Arthritis Stiffness. Chronic Fatigue Syndrome. Citation Type. Has PDF. Publication Type. More Filters. Fatigue in ankylosing spondylitis: treatment should focus on pain management. Definition of disease flare in ankylosing spondylitis: the patients' perspective.
No changes were made by participants to their transcripts or the analysis summaries. Fifty individuals with a confirmed diagnosis of AS participated in this study with 36 men and 14 women. The mean age of participants was Table 1 gives the demographic and disease-related information of the study cohort. Participants had their disease for a mean number of Overall, study participants engaged frequently in activities with a mean score of Spearman rank correlational analyses tested for relationships between fatigue, activity levels, and disease-specific variables disease activity, physical ability, pain, and quality of life Table 3.
As the MAF-GFI was significantly associated with all variables and it measures the impact of fatigue on daily activities, this measure was used to examine differences between individuals with high and low fatigue for activity participation, disease activity, physical abilities, pain, quality of life, and global well-being.
There were significant differences in all study measures between those with high and low fatigue levels Table 4. There were no significant differences between high and low MAF-GFI scores for age , disease duration , education levels , and employment status. Thirty-two people agreed to participate in an interview exploring the impact of fatigue on occupational participation.
Of these, 19 people participated in the interviews. The remaining 13 were either unavailable for interview or not responding to the research team when contacted to arrange an interview despite repeated efforts.
Table 5 provides the demographic characteristics and employment status of interview participants. Four themes were identified from analysis of the qualitative data: i impact of fatigue on productivity, ii impact of fatigue on social participation, iii fatigue management strategies, and iv fatigue management education.
Eleven of those interviewed were in employment, and they discussed the impact of fatigue on their work performance particularly in relation to cognitive skills such as concentration:. Four participants discussed having to work longer hours during the week and at weekends in order to get all their works completed:. So when that happens it impacts on other aspects of my life in terms of my fitness and in terms of getting away from work.
One participant whose work involved a considerable amount of time driving discussed the impact of this on stiffness and fatigue:. You get so tired. Over half of the participants discussed modifying their work hours because of fatigue. For example:. So I want to go back to doing part-time because full-time is too much for me.
A female participant discussed the impact of grocery shopping on her fatigue and the difficulty she experienced when shopping without her husband:. It takes a lot out of you! The majority of participants discussed opting out of social activities because of their fatigue and needing to conserve their energy for work.
One participant described how this impacted on his weekend social activities:. The majority of participants identified how being fatigued after work results in reduced energy for social activities:. Study participants identified various strategies they used to manage their fatigue such as pacing daily activities, planning their routines according to their energy levels, and making certain lifestyle choices.
Fourteen participants discussed how they pace their daily activities in order to reduce the impact of fatigue. One of the participants who worked in construction discussed how working outside in extreme weather conditions affected his back pain and subsequently increased his fatigue. He managed this by negotiating a change in his work duties with his colleagues:. Many participants discussed how early in their disease trajectory they tended to ignore their fatigue and to carry on with their activities regardless of how much fatigue they experienced.
However, this participant described how when we decided to communicate with family members and work colleagues about his fatigue that this helped him to accept the limitations caused by fatigue:.
Six participants identified that taking regular exercise was an effective method for managing fatigue. But you need to discipline that and to watch that. The majority of participants discussed how taking rests during the day was helpful in managing fatigue. One participant described how taking a short rest can help her to complete an activity if having difficulty:.
But you need that rest, that down time. Almost all participants identified a lack of education from health professionals regarding fatigue. They reported mixed responses to fatigue when they tried to bring it up during hospital appointments. One participant reported that fatigue was often a minor aspect in educational material on how to manage symptoms of AS.
One of the interview participants believed that this was due to people with AS not discussing their fatigue with their health professionals:. As a result of not having received any formal education on fatigue, the majority of participants reported that most of their management strategies were self-developed:.
You pick up on things as you go along, you just pick up on things day to day. Those with severe fatigue had significantly higher scores in all study measures including disease activity, pain, activity participation, and quality of life than those without sever fatigue.
The qualitative findings in this study indicated that occupational participation levels were most frequently reduced in work and social activities. In work, fatigue impacted on physical and cognitive abilities which resulted in longer working hours to complete work duties or swapping work tasks with colleagues to those which are less physically demanding.
There appeared to be a lack of education from health professionals on fatigue management. There were significant relationships between fatigue as measured by the BASDAI fatigue item and the MAF and self-reported disease activity, physical capacity, pain, quality of life, and well-being. This demonstrates the relationship between these variables and how changes in clinical aspects of the disease and in fatigue can impact on each other.
These significant relationships correspond with previous research examining relationships between fatigue, disease activity, and quality of life variables [ 4 , 5 , 13 , 14 ]. On testing differences between those with and without severe fatigue, individuals with severe fatigue had statistically significantly higher disease activity, lower levels of occupational participation, and poorer quality of life.
This corresponds with previous research [ 5 , 14 ] and demonstrates the impact of severe fatigue across many domains for individuals with severe fatigue. These findings support the need to provide fatigue management interventions which focus both on managing symptoms of AS in addition to managing the impact of fatigue on productivity-related and leisure occupations.
Leisure participation was discussed by interview participants who reported withdrawing from social activities because of fatigue.
Low levels of satisfaction with participation in social roles were also identified by van Genderen et al. Participation in leisure activities is considered a significant predictor of quality of life [ 10 , 11 ], and in this current study, there were significant differences in quality of life between those with high and low fatigue.
This therefore supports the need for occupational therapists to provide strategies to individuals with high levels of fatigue to maintain engagement in valued leisure occupations. In this study, physical ability was significantly related to fatigue and those with severe fatigue had significantly more difficulty with these movements. In their interviews, some participants identified housework and shopping as increasing their fatigue.
These types of activities involve sustained reaching, bending, and standing which perhaps explains the reported difficulties with housework. Education regarding joint protection and advice on rearranging home environments may assist with reducing the need for excessive bending and reaching to complete housework and shopping activities. Sixty percent of study participants were working, and this was an area discussed by interview participants as resulting in considerable fatigue. Participants discussed different requirements of their work such as driving and cognitive skills of concentration and memory, being impacted by fatigue.
Other studies have explored the impact of AS on work and have reported that individuals with AS are three times more likely to resign from work than the general population [ 45 ]. Work-focused self-management interventions result in significant improvements in work performance pain, fatigue, and mood [ 46 ].
This indicates that work-focused self-management interventions should be offered to individuals who report difficulty in work due to their fatigue. The mean score for total and nocturnal pain indicated that participants in this study experienced mild-moderate pain. Initial analysis revealed that overall pain, and pain at night, was significantly associated with fatigue.
This concurs with previous research which identified a relationship between pain and fatigue [ 12 , 47 ]. In this study, those with high levels of fatigue had significantly higher total and nocturnal pain scores. This would indicate that effective fatigue management education should include pain management and joint protection strategies.
Interview participants reported using various strategies for managing their fatigue. These included pacing daily activities, modifying work routines, taking regular exercises, and taking a rest period during the day.
Many of the strategies discussed were self-developed as participants in the qualitative part of this study reported a lack of formal education regarding fatigue in AS.
This has been identified in other studies of individuals with rheumatic diseases with fatigue management strategies mainly acquired through trial and error with little to no input from health professionals [ 15 , 47 , 48 ]. However, a participant in this study questioned whether the lack of formal education from health professionals on fatigue management was due to individuals not discussing fatigue with their health professionals.
Further studies are needed to examine the extent of this finding with other individuals with AS. Qualitative studies are also needed to examine in more depth the educational needs of people with AS regarding their educational needs such as when is the optimal time for receiving this education and in what format. How to measure fatigue in rheumatic diseases and the sensitivity of fatigue measures has received much attention in recent literature [ 26 , 27 ]. Although quick to administer, single-dimensional assessments, such as the FSS, have been criticised for the limited information yielded thus leading them to inadequately measure this symptom [ 25 ].
Therefore, it is suggested that multidimensional fatigue assessments may provide a more accurate assessment of fatigue and provide information on how fatigue impacts on different types of activities which is important information for guiding suitable fatigue management interventions. This study has provided information on the impact of AS-related fatigue on occupational participation. However, there are limitations to the study that could have impacted on the findings.
The sample size was small and is representative only of the individuals who attend this particular AS clinic. The findings are also limited as data were only collected at one point in time whereas a longitudinal mixed method study would yield more comprehensive information on fluctuations in fatigue and in occupational participation over time. The qualitative aspect of this current study provided a general overview of impact of fatigue on occupational participation. However, the qualitative phase of a longitudinal mixed method study could use a phenomenological perspective to gain a more detailed and in-depth exploration of the experience of fatigue for individuals with AS.
This study explored the prevalence and impact of fatigue for individuals with ankylosing spondylitis. Three fatigue measures yielded different prevalence of rates in this sample thus indicating the need to ensure that the measure chosen to assess fatigue in individuals with AS provides the necessary information.
For example, the FSS measure will provide information on severity of fatigue but is limited in measuring the impact of fatigue on daily activities. There were significant differences between those with high and low levels of fatigue for disease activity, pain, frequency of occupational participation, and quality of life. Study participants identified fatigue as impacting specifically on work and social and leisure occupations.
Fatigue management strategies were mainly self-taught indicating a need for formalised self-management support from relevant health professionals to reduce the impact of fatigue on productivity and leisure. Occupational therapists have specific skills and knowledge to provide these interventions. The data used to support the findings of this study are available on request from the corresponding author.
The authors wish to acknowledge the individuals with ankylosing spondylitis who participated in this study. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Journal overview.
Special Issues. Academic Editor: Lynette Mackenzie. Received 30 Jul Revised 24 Mar Accepted 11 Apr Published 01 Jul Abstract Background. Introduction Ankylosing spondylitis AS is a chronic inflammatory rheumatic condition of the spine with disease onset usually occurring between late adolescence and early adulthood [ 1 , 2 ].
Methods 2. Participants Participants were recruited from a dedicated weekly AS clinic in an urban hospital using convenience sampling [ 19 ]. Data Collection Three fatigue measures were used in this study. Pain Numeric Rating Scale NRS [ 33 ] Pain total and nocturnal was assessed using a numerical rating scale ranging from 0 no pain to 10 unbearable pain with higher scores indicating more severe levels of pain [ 33 ].
0コメント