title: Fatigue in Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis: Analysis from a Longitudinal Observation Cohort.
abstract: OBJECTIVE
  In this study, we aimed to address the prevalence of fatigue, its associated factors, and the effect of tumor necrosis factor inhibitors (TNFi) on this subgroup of patients in a large axial spondyloarthritis (axSpA) cohort.
  
  
  METHODS
  The study included 681 patients [ankylosing spondylitis (AS) and nonradiographic axSpA (nr-axSpA)]. The Fatigue Severity Scale (FSS) and the Bath AS Disease Activity Index question 1 (BASDAI Q1) indices were used for fatigue assessment. Severe fatigue was defined as an FSS ≥ 4 or a BASDAI Q1 ≥ 5. Disease activity, function, and quality of life (QoL) measures were recorded. Patients who had been treated with TNFi were identified, and baseline and followup data were analyzed.
  
  
  RESULTS
  Of the cohort, 67.3% had severe fatigue, and the prevalence was similar between AS (67.2%) and nr-axSpA (68.2%). Severely fatigued patients tended to have higher disease activity scores, increased acute-phase proteins, and decreased QoL measures. TNFi therapy was associated with improvement in disease activity, and although this treatment led to significantly decreased fatigue scores, this reduction was not optimal in the majority of patients with 80% continuing to have severe fatigue according to their posttreatment scores. Health Assessment Questionnaire, mean scores of BASDAI Q5 and Q6, and BASDAI enthesitis were independent predictors of fatigue severity.
  
  
  CONCLUSIONS
  Fatigue is a common symptom in axSpA, and the burden of fatigue among patients with nr-axSpA is similar to that seen in AS. While biologics are effective in improving disease activity, their effect on fatigue is more limited. In axSpA, fatigue remains unresponsive to TNFi in nearly 80% of patients.
authors.affiliation: From the Division of Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Department of Rheumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.M. Bedaiwi, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University; I. Sari, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Rheumatology, School of Medicine, Dokuz Eylul University; A. Thavaneswaran, MSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R. Ayearst, BSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; N. Haroon, MD, PhD, DM, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R.D. Inman, MD, FRCPC, FACP, FRCP, Division of Rheumatology, Toronto Western Hospital, University of Toronto.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bedaiwi
authors.affiliation: From the Division of Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Department of Rheumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.M. Bedaiwi, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University; I. Sari, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Rheumatology, School of Medicine, Dokuz Eylul University; A. Thavaneswaran, MSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R. Ayearst, BSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; N. Haroon, MD, PhD, DM, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R.D. Inman, MD, FRCPC, FACP, FRCP, Division of Rheumatology, Toronto Western Hospital, University of Toronto.
authors.forename: Ismail
authors.initials: I
authors.lastname: Sari
authors.affiliation: From the Division of Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Department of Rheumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.M. Bedaiwi, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University; I. Sari, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Rheumatology, School of Medicine, Dokuz Eylul University; A. Thavaneswaran, MSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R. Ayearst, BSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; N. Haroon, MD, PhD, DM, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R.D. Inman, MD, FRCPC, FACP, FRCP, Division of Rheumatology, Toronto Western Hospital, University of Toronto.
authors.forename: Arane
authors.initials: A
authors.lastname: Thavaneswaran
authors.affiliation: From the Division of Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Department of Rheumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.M. Bedaiwi, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University; I. Sari, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Rheumatology, School of Medicine, Dokuz Eylul University; A. Thavaneswaran, MSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R. Ayearst, BSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; N. Haroon, MD, PhD, DM, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R.D. Inman, MD, FRCPC, FACP, FRCP, Division of Rheumatology, Toronto Western Hospital, University of Toronto.
authors.forename: Renise
authors.initials: R
authors.lastname: Ayearst
authors.affiliation: From the Division of Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Department of Rheumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.M. Bedaiwi, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University; I. Sari, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Rheumatology, School of Medicine, Dokuz Eylul University; A. Thavaneswaran, MSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R. Ayearst, BSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; N. Haroon, MD, PhD, DM, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R.D. Inman, MD, FRCPC, FACP, FRCP, Division of Rheumatology, Toronto Western Hospital, University of Toronto.
authors.forename: Nigil
authors.initials: N
authors.lastname: Haroon
authors.affiliation: From the Division of Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Department of Rheumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.M. Bedaiwi, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Medicine, Division of Rheumatology, King Khalid University Hospital, King Saud University; I. Sari, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, and Department of Rheumatology, School of Medicine, Dokuz Eylul University; A. Thavaneswaran, MSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R. Ayearst, BSc, Division of Rheumatology, Toronto Western Hospital, University of Toronto; N. Haroon, MD, PhD, DM, Division of Rheumatology, Toronto Western Hospital, University of Toronto; R.D. Inman, MD, FRCPC, FACP, FRCP, Division of Rheumatology, Toronto Western Hospital, University of Toronto. dr.mkbedaiwi@gmail.com.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Inman
mesh_terms: D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D015897:Comorbidity; D005221:Fatigue / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D016013:Likelihood Functions; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011859:Radiography; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D025241:Spondylarthritis / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D013167:Spondylitis, Ankylosing / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000187:drug effects
chemical_list: D014409:Tumor Necrosis Factor-alpha
keywords: ANKYLOSING SPONDYLITIS; FATIGUE; INFLAMMATION; QUALITY OF LIFE; SPONDYLOARTHROPATHIES; TUMOR NECROSIS FACTOR-α