Work Instability Linked to Fatigue, Depression in Ankylosing Spondylitis

January 3, 2019
Sheila Jacobs

In patients with ankylosing spondylitis (AS), fatigue and symptoms of depression are associated with work instability, which creates a significant economic burden, according to the results of a case-control study published in Clinical Rheumatology.

The investigators sought to explore the association between work instability and fatigue, depression, and anxiety in working patients with AS compared with healthy controls. A total of 61 working patients with AS (aged 19 to 57 years) and 40 gender- and age-matched working healthy controls (aged 21 to 61 years) were enrolled in the study. Participants were evaluated with respect to age, educational level, type of work (sedentary or manual), time at job, medical comorbidities, and smoking habits. Disease duration, family history, current medications, and laboratory findings, including erythrocyte sedimentation rate and C-reactive protein, were also reported.

Data were obtained using the visual analog scale (VAS) for pain, Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index, and Bath AS Metrology Index in patients with AS, along with Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Multidimensional Assessment of Fatigue (MAF), and AS Work Instability Scale (ASWIS) in all participants.

Fatigue, depression, and work instability scores (MAF, BDI, and ASWIS) were all significantly higher in patients with AS compared with healthy controls (P <.001, P =.004, and P <.001, respectively). Moreover, strong positive correlations were demonstrated between ASWIS scores and BDI, BASDAI, and MAF scores (P <.001). ASWIS scores were also moderately associated with VAS, BAI, and BASFI (P <.001).

The most significant relationship with ASWIS scores was with MAF scores (P <.001). Further, VAS pain and BASFI scores were also shown to be influential variables linked to ASWIS scores (P <.05). In addition, ASWIS scores were significantly higher in working patients with AS compared with healthy controls (P <.001), suggesting that fatigue was the most important determinant of work instability.

Findings from this study demonstrated the negative effect of fatigue and depressive symptoms, in addition to pain, disease activity, and functionality, on work stability in patients with AS. Early recognition of symptoms of depression and fatigue in patients with AS may help lead to a decreased risk for job loss in this population. Targeted interventions designed to improve psychological health and fatigue in working patients with AS may prove to be beneficial.


Ulus Y, Akyol Y, Bilgici A, Kuru O. Association of work instability with fatigue and emotional status in patients with ankylosing spondylitis: comparison with healthy controls [published online November 17, 2018]. Clin Rheumatol. doi:10.1007/s10067-018-4366-x

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