FATIGUE IN ANKYLOSING-SPONDYLITIS - WHY IS IT IGNORED

Objective. Fatigue in ankylosing spondylitis (AS) is largely ignored b y physicians and classical texts. By contrast, patients frequently all ude to it as a major complaint. Methods. To address the situation, 3 s tudies were performed: (1) Symptoms were defined in a cross sectional evaluation of 1950 consecutive patients with AS. (2) From each of the 3 groups who specified a particular main symptom (pain, stiffness or f atigue), a random cohort of 20 was selected and all 60 were prospectiv ely followed over a 14-day period. (3) An additional 100 patients [50 randomly selected with AS and 50 with rheumatoid arthritis (RA) ] took part in a comparative prospective study. Results. In the first study for those with a definitive major symptom, 34% (n = 670) described pai n while stiffness and fatigue were reported by 25% (n = 492) and 6% (n = 124), respectively. Thirty-two percent (n = 616) could not distingu ish between the 3. Strikingly, when prospectively studied over a 2-wee k period, over 50% of the patients revealed that fatigue was the main symptom. Moreover, in the cohort which expressed pain as their major p roblem initially, fatigue had the highest prevalence (mean fatigue val ue versus mean stiffness, p = 0.009; fatigue versus pain, p < 0.001). In the direct comparison between patients with RA and those with AS, t he RA cohort had statistically more fatigue and pain than the AS cohor t (p = 0.002, p = 0.007, respectively) with a similar amount of stiffn ess expressed by both groups (n = 0. 149). In both subsets, pain had t he least impact on the patients (mean 2.60 and 1.87, respectively). Co nclusion. Our data reveal that fatigue should be considered a major pr oblem for patients with AS, worthy of further exploration in terms of both etiology and therapy.