Fatigue in Ankylosing Spondylitis Is Associated With Psychological Factors and Brain Gray Matter

Abstract

Background: Ankylosing spondylitis (AS) is a rheumatic inflammatory disease with unknown etiology aetiology, and fatigue is one of the main systemic symptoms of AS. The aim of the current study was to explore the mechanism of AS-associated fatigue (ASF) from multiple aspects, including neuropsychological changes. Method: A total of 120 AS patients and 78 age- and sex-matched healthy individuals were recruited into the study. Fatigue was assessed by the fatigue item of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the mMultidimensional Aassessment of Ffatigue (MAF) scale. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). The cortical thickness and subcortical gray grey matter volume were assessed using a Philips Achieva 3.0 T TX MRI scanner. Result: Of the 120 AS patients, 103 (85.8%) reported varying degrees of fatigue. Among these fatigue cases, 33 (32.0%) were in the severe fatigue group (BASDAI-Fatigue ≥ 5), and 70 patients (68.0%) were considered to be in the mild fatigue group (BASDAI-Fatigue>0 but <5). The BASDAI, ASDAS-CRP, HAD-A and HAD-D scores in of AS patients in the severe fatigue group were all significantly higher when compared withthan those of patients in the mild fatigue and non -fatigue groupgroups (all, P<0.05). The structural equation model suggested that AS activity triggered the occurrence of fatigue throughby inducing the psychological change. FinalyFinally, head MRI imaging found that the left thalamus volume of thein AS patients with severe fatigue was significantly larger than that of in non -fatigue AS patients and healthy controls (both, P<0.05). Conclusion: The study revealed neuropsychological factors involvesinvolved in fatigue of in AS.