Skip to main content
Log in

Fatigue in patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status, and sleep disturbance

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

This study aims to evaluate the frequency of fatigue in Moroccan patients with ankylosing spondylitis (AS), and its relationships with disease-specific variables, psychological status, and sleep disturbance. A cross-sectional study included patients fulfilled the modified New York classification criteria for ankylosing spondylitis. To assess fatigue, the first item of Bath ankylosing spondylitis disease activity index (BASDAI) and the multidimensional assessment of fatigue (MAF) was used. The evaluation included the activity of the disease (BASDAI), global well-being (Bath ankylosing spondylitis global index), functional status (Bath ankylosing spondylitis functional index), metrologic measurements (Bath ankylosing spondylitis metrological index), and visual analog scale of axial or joint pain. The erythrocyte sedimentation rate and C-reactive protein were measured. To assess psychological status, the hospital anxiety and depression scale (HADS) was used. Sleep disturbance was assessed by the fourth item of Hamilton anxiety scale. One hundred and ten patients were included, of average age 38.0 years ± 12.6. In our data, 66.4% experienced severe fatigue (BASDAI fatigue ≥5). The mean total score of MAF was 26 ± 12.77. The disease-specific variables contributed significantly with both BASDAI fatigue and MAF as dependent variables, accounting for 71.3 and 65.6% of the variance, respectively. The contribution of the depression, anxiety, and sleep disturbance were 24.9, 18.4 and 15.4%, respectively. This study state the importance of fatigue in AS patients. Even though disease activity was the most powerful predictor of fatigue, the effects of psychogenic factors and sleep disturbance, should be taken into consideration in the management of AS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Swain MG (2000) Fatigue in chronic disease. Clin Sci 99:1–8

    Article  PubMed  CAS  Google Scholar 

  2. Belza B (1994) The impact of fatigue on exercice performance. Arthritis Care Res 7:176–180

    Article  PubMed  CAS  Google Scholar 

  3. Missaoui B, Revel M (2006) Fatigue in ankylosing spondylitis. Ann Readapt Med Phys 49:389–391

    Article  Google Scholar 

  4. Goldenberg DL (1995) Fatigue in rheumatoid diseases. Bull Rheum Dis 44:4–8

    PubMed  CAS  Google Scholar 

  5. Günaydin R, Göksel Karatepe A, Ceşmeli N, Kaya T (2009) Fatigue in patients with ankylosing spondylitis: relationships with disease-specific variables, depression, and sleep disturbance. Clin Rheumatol 28(9):1045–1051

    Article  PubMed  Google Scholar 

  6. Van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27:361–368

    Article  PubMed  CAS  Google Scholar 

  7. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the bath ankylosing spondylitis disease activity index. J Rheumatol 21:2286–2291

    PubMed  CAS  Google Scholar 

  8. Rostom S, Benbouaaza K, Amine B, Bahiri R, Ibn Yacoub Y, Ali Ou Alla S, Abouqal R, Hajjaj-Hassouni N (2010) Psychometric evaluation of the Moroccan version of the Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for use in patients with ankylosing spondylitis. Clin Rheumatol 29(7):781–788

    Article  PubMed  Google Scholar 

  9. Van Tubergen A, Coenen J, Landewe R, Spoorenberg A, Chorus A, Boonen A et al (2002) Assessment of fatigue in patients with ankylosing spondylitis: a psychometric analysis. Arthritis Rheum 47:8–16

    Article  PubMed  Google Scholar 

  10. Dernis-Labous E, Messow M, Dougados M (2003) Assessment of fatigue in the management of patients with ankylosing spondylitis. Rheumatology (Oxford) 42:1523–1528

    Article  CAS  Google Scholar 

  11. Belza B, Henke C, Yelin E, Epstein W, Gilliss C (1993) Correlates of fatigue in older adults with rheumatoid arthritis. Nurs Res 42(2):93–99

    Article  PubMed  CAS  Google Scholar 

  12. Belza B (1995) Comparison of self-reported fatigue in rheumatoid arthritis and controls. J Rheumatol 22:639–643

    PubMed  CAS  Google Scholar 

  13. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  PubMed  CAS  Google Scholar 

  14. Malasi TH, Mirza IA, el-Islam MF (1991) Validation of the hospital anxiety and depression scale in arab patients. Acta Psychiatr Scand 84:323–326

    Article  PubMed  CAS  Google Scholar 

  15. Michopoulos I, Douzenis A, Kalkavoura C, Christodoulou C (2008) Hospital Anxiety and Depression Scale (HADS): validation in a Greek general hospital sample. Ann Gen Psychiatry 7:4

    Article  PubMed  Google Scholar 

  16. Olssøn I, Mykletun A, Dahl AA (2005) The hospital anxiety and depression rating scale: a cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry 5:46

    Article  PubMed  Google Scholar 

  17. Hamilton MT (1959) The assessment of anxiety states by rating. Br J Med Psychol 32:50–55

    Article  PubMed  CAS  Google Scholar 

  18. Calin A, Edmunds L, Kennedy LG (1993) Fatigue in ankylosing spondylitis: why is it ignored? J Rheumatol 20:991–995

    PubMed  CAS  Google Scholar 

  19. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291

    PubMed  CAS  Google Scholar 

  20. Jones SD, Koh WH, Steiner A, Garrett SL, Calin A (1996) Fatigue in ankylosing spondylitis: its prevalence and relationship to disease activity, sleep, and other factors. J Rheumatol 23:487–490

    PubMed  CAS  Google Scholar 

  21. Ward MM (1999) Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res 12:247–255

    Article  PubMed  CAS  Google Scholar 

  22. Smets EM, Garssen B, Bonke B, De Haes JC (1995) The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 39:315–325

    Article  PubMed  CAS  Google Scholar 

  23. Dagfinrud H, Vollestad NK, Loge JH, Kvien TK, Mengshoel AM (2005) Fatigue in patients with ankylosing spondylitis: a comparison with the general population and associations with clinical and self-reported measures. Arthritis Care Res 53:5–11

    Article  Google Scholar 

  24. Da Costa D, Drista M, Ring A, Fitzcharles MA (2004) Mental health status and leisure-time physical activity contribute to fatigue intensity in patients with spondyloathropathy. Arthritis Rheum 51:1004–1008

    Article  PubMed  Google Scholar 

  25. Turan Y, Duruöz MT, Bal S, Guvenc A et al (2007) Assessment of fatigue in patients with ankylosing spondylitis. Rheumatol Int 27(9):847–852 Epub 2007 Jan 25

    Article  PubMed  Google Scholar 

  26. Fifield J, McQuillan J, Tennen H, Sheehan J, Reisine S, Hesselbrock V et al (2001) History of affective disorder and the temporal trajectory of fatigue in rheumatoid arthritis. Ann Behav Med 23:34–41

    Article  PubMed  CAS  Google Scholar 

  27. Krupp LB, LaRocca NG, Muir J, Steinberg AD (1990) A study of fatigue in lupus erythematosus. J Rheumatol 17:1450–1452

    PubMed  CAS  Google Scholar 

  28. Cathebras PJ, Robbins JM, Kirmayer L, Haton BC (1992) Fatigue in primary care: prevalence, psychiatric comorbidity, illness behavior, and outcome. J Gen Intern Med 7:276–286

    Article  PubMed  CAS  Google Scholar 

  29. Fuhrer R, Wessley S (1995) The epidemiology of fatigue and depression: a French primary-care study. Psychol Med 25:895–905

    Article  PubMed  CAS  Google Scholar 

  30. Kirk KM, Hickie IB, Martin NG (1999) Fatigue as related to anxiety and depression in a community-based sample of twins aged over 50. Soc Psychiatry Psychiatr Epidemiol 34:85–90

    Article  PubMed  CAS  Google Scholar 

  31. Koschera A, Hickie I, Hadzi-Pavlovic D, Wilson A, Loyd A (1999) Prolonged fatigue, anxiety and depression: exploring relationships in a primary care sample. Aust N Z J Psychiatry 33:545–552

    Article  PubMed  CAS  Google Scholar 

  32. Schneider RA (1998) Concurrent validity of the Beck depression inventory and the Multidimensional Fatigue Inventory-20 in assessing fatigue among cancer patients. Psychol Rep 82:883–886

    Article  PubMed  CAS  Google Scholar 

  33. Bakker C, van der Linden S, van Santen-Hoeufft M, Bolwijn P et al (1995) Problem elicitation to assess patient priorities in ankylosing spondylitis and fibromyalgia. J Rheumatol 22(7):1304–1310

    PubMed  CAS  Google Scholar 

  34. Barlow JH, Macey SJ, Struthers GR (1993) Gender, depression, and ankylosing spondylitis. Arthritis Care Res 6(1):45–51

    Article  PubMed  CAS  Google Scholar 

  35. Ibn Yacoub Y, Amine B, Laatiris A, Abouqal R, Hajjaj-Hassouni N (2010) Assessment of fatigue in Moroccan patients with ankylosing spondylitis. Clin Rheumatol 29(11):1295–1299

    Article  PubMed  Google Scholar 

  36. El Mansouri L, Bahiri R, Abourazzak FE, Abouqal R, Hajjaj-Hassouni N (2009) Two distinct patterns of ankylosing spondylitis in Moroccan patients. Rheumatol Int 29(12):1423–1429

    Article  PubMed  Google Scholar 

  37. Rkain H, Allali F, Bentalha A, Lazrak N, Abouqal R, Hajjaj-Hassouni N (2007) Socioeconomic impact of ankylosing spondylitis in Morocco. Clin Rheumatol 26(12):2081–2088

    Article  PubMed  Google Scholar 

  38. Heiberg MS, Nordvag BY, Mikkelsen K, Rodevand E, Kaufmann C, Mowinckel P et al (2005) The comparative effectiveness of tumor necrosis factor-blocking agents in patients with rheumatoid arthritis and patients with ankylosing spondylitis. Arthritis Rheum 52:2506–2512

    Article  PubMed  CAS  Google Scholar 

  39. Wolfe F, Michaud K, Pincus T (2004) Fatigue, rheumatoid arthritis, and anti-tumor necrosis factor therapy: an investigation in 24831patients. J Rheumatol 31:2115–2120

    PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This work was supported by grants from the University Mohammed V, Souissi, Rabat-Morocco.

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to N. Aissaoui.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aissaoui, N., Rostom, S., Hakkou, J. et al. Fatigue in patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status, and sleep disturbance. Rheumatol Int 32, 2117–2124 (2012). https://doi.org/10.1007/s00296-011-1928-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-011-1928-5

Keywords

Navigation