College of Medicine, Swansea University, Swansea, South Wales, United Kingdom.
Semin Arthritis Rheum. 2013 Feb;42(4):361-7. doi: 10.1016/j.semarthrit.2012.06.002. Epub 2012 Aug 15.
Fatigue is an important symptom associated with ankylosing spondylitis (AS). This study examines patients' perspectives and clinical associations of fatigue to help inform potential strategies to alleviate fatigue in AS.
A mixed methods approach was taken to examine fatigue in a cohort of people with AS. Fatigue levels were evaluated from 3 consecutive monthly questionnaires. Open-ended questions on fatigue were analyzed using thematic analysis and logistic regression was used to examine quantitative data. In addition, fatigue levels were examined before and after treatment with anti-tumor necrosis factor (TNF) compared to nontreated controls.
Three hundred forty-eight of 385 participants completed a fatigue questionnaire. Fatigue was reported to have significant physical, social, and psychological effects. A third of the participants reported that there was nothing they could do to reduce their fatigue, whereas other participants reported that medication, exercise, and resting helped. The main factor associated with fatigue was pain [β-coefficient: 0.74 (95% CI: 0.66 to 0.81)], whereas depression was much less strongly associated. However, these factors only explained 40% of the variation in fatigue levels. Starting anti-TNF therapy reduced fatigue and pain levels compared to the period of time before taking anti-TNF [difference: 14.4 (95% CI: 5.3 to 23.5) on a scale of 0-100] and this reduction was not seen in controls over the same period.
Fatigue is not strongly associated with anxiety, motivation, and depression; instead the factor most associated with fatigue is pain. This suggests that in addition to treatments to reduce disease activity, strategies for alleviating fatigue in AS should focus on pain management techniques and actively treating inflammation.
疲劳是强直性脊柱炎（AS）的一个重要症状。本研究探讨了患者对疲劳的看法及其与疲劳的临床关联，以帮助确定减轻 AS 患者疲劳的潜在策略。
采用混合方法研究评估了 AS 患者队列中的疲劳。通过连续三个月的问卷调查评估疲劳水平。使用主题分析对疲劳的开放性问题进行分析，并使用逻辑回归分析检查定量数据。此外，还比较了抗肿瘤坏死因子（TNF）治疗前后与未治疗对照组的疲劳水平。
385 名参与者中有 348 名完成了疲劳问卷。疲劳被报告对身体、社会和心理都有重大影响。三分之一的参与者表示，他们无法减轻疲劳，而其他参与者则表示药物治疗、运动和休息可以帮助减轻疲劳。与疲劳最相关的主要因素是疼痛[β系数：0.74（95%置信区间：0.66 至 0.81）]，而抑郁的相关性要小得多。然而，这些因素仅解释了疲劳水平变化的 40%。与开始使用抗 TNF 治疗前相比，开始使用抗 TNF 治疗可降低疲劳和疼痛水平[在 0-100 的量表上差异为 14.4（95%置信区间：5.3 至 23.5）]，而在同一时期对照组中并未出现这种情况。
疲劳与焦虑、动机和抑郁没有很强的关联；相反，与疲劳最相关的因素是疼痛。这表明，除了减少疾病活动的治疗外，AS 患者疲劳缓解策略还应侧重于疼痛管理技术和积极治疗炎症。
