Ankylosing Spondylitis Fatigue: How to Boost Energy and Feel Better
Rheumatic ConditionsAnkylosing Spondylitis
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6 Ways to Beat Ankylosing Spondylitis Fatigue

6 Ways to Beat Ankylosing Spondylitis Fatigue
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Updated on June 10, 2025
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Ankylosing spondylitis (AS), a type of arthritis that affects joints, tendons, and ligaments in the lower back and the base of the spine, can make you feel as if your energy has been zapped. It’s a level of fatigue that people who don’t have AS often can’t understand.

Any form of arthritis can cause the kind of pain and stiffness that can ruin your sleep, but the fatigue that accompanies inflammatory forms of arthritis — such as ankylosing spondylitis and rheumatoid arthritis — is also caused by inflammation itself.

"Fatigue from inflammation in ankylosing spondylitis can feel like you have the flu. You can ache all over," says Rochelle Rosian, MD, the director of regional rheumatology at the Cleveland Clinic in Ohio. “That’s because inflammation affects your whole body, not just your joints.”

Still, there are ways to push back against this fatigue and boost your energy. Learn what you can do to give yourself the best chance of avoiding or reducing this ankylosing spondylitis symptom.

1. Adjust Your Treatment Plan

Uncontrolled inflammation is one of the most common causes of ankylosing spondylitis fatigue.

 Excessive fatigue may mean your medications or other therapies are not doing enough to address systemic inflammation in your body.

If you're experiencing high levels of fatigue, it may be time to discuss your treatment plan with your healthcare team.

Your rheumatologist may wish to review your current medications, since some ankylosing spondylitis drugs, such as methotrexate, can cause fatigue as a side effect.

 Your doctor may recommend adjusting your dose or finding other drugs to help manage your inflammation.
But the solution may not be as straightforward as changing up your medications. Some experts speculate that long-term inflammation alters parts of your brain, which may mean you still experience fatigue even after treatment gets your inflammation under control.

Alexis Ogdie, MD, MSCE, an associate professor of medicine at the Hospital of the University of Pennsylvania, explains, “Fatigue is highly multifactorial, so there are many things that can be happening, sometimes all at one time, to cause more fatigue.”

2. Try Physical Therapy

Research suggests that physical therapy for ankylosing spondylitis can help improve both pain and fatigue. Experts generally recommend adding physical therapy to your overall treatment plan.

A recent systematic review and meta-analysis of different physical therapy methods that could be useful for people with AS included:

  • Exercise connected to video games
  • Pilates
  • Rehabilitation programs
  • Cardiorespiratory and muscle-strengthening exercises
  • Stanger bath therapy (in which you sit in a bath while receiving low-frequency electrical currents)

The researchers did note that, while physical therapy can help reduce disease activity and functional limitations associated with AS, the effect on overall quality of life is not clear.

In general, physical therapy for ankylosing spondylitis aims to strengthen muscles and reduce stiffness in the spine and joints.

 A physical therapist (PT) should be able to create and guide you through an exercise program aimed at your individual needs.

Margaret Danilovich, DPT, PhD, the director of clinical strategy and policy at the physical therapy provider group TailorCare, explains that physical therapists develop treatment plans consisting of various elements: exercises, manual (hands-on) techniques, activities aimed at managing pain, and patient education on condition management.

3. Learn Pain Management Methods

Pain can interrupt sleep, while poor sleep can intensify pain. Pain management techniques can interfere with that feedback loop, leading to better rest and less fatigue.

Pain Medications

NSAIDs (nonsteroidal anti-inflammatory drugs) are a first-line treatment for ankylosing spondylitis inflammation and pain. A 2020 study estimated that 70 to 80 percent of people living with AS take NSAIDs, such as ibuprofen (Advil, Motrin), celecoxib (Celebrex), or naproxen (Aleve).

“Definitely talk with your doctor first, but sometimes taking an NSAID at night can help with the pain and this can then improve your sleep and subsequently reduce fatigue,” Dr. Ogdie says.

A 2024 study found opioid use to treat pain associated with AS and other forms of inflammatory arthritis is common in the United States, both at the time of diagnosis and afterwards. But rheumatologists are leery of prescribing opioids because of potential interactions with certain AS medications as well as other serious health risks.

Exercise

The right kinds of exercise for ankylosing spondylitis can help prevent the spine and joints from becoming stiff and painful.

“Research shows that regular exercise improves function and mobility for patients with AS and that exercising in a supervised clinic setting or at home are both beneficial for patients,” says Dr. Danilovich.

As for what kind of movement is most helpful, she says, “The best exercise is the one that you will do! For some, that may be resistance exercise and lifting weights. For others, it may be yoga or Pilates.”

The Spondylitis Association of America offers a number of free resources and videos for anyone interested in incorporating yoga into their pain-management plan.

Pool workouts may be well suited for people with AS, Danilovich adds, because the water’s buoyancy can reduce impact on joints.

4. Tweak Your Diet

Evidence suggests that diets rich in omega-3 fatty acids and fiber and low in ultra-processed foods can help reduce inflammation associated with AS. Adding these nutrients to your diet may help lower disease activity and improve symptoms, such as fatigue.

Foods high in omega-3s include salmon, flaxseeds, and certain nuts. Adding these to your diet, along with fruits and vegetables, may help improve symptoms such as fatigue.

Foods like these figure large in the Mediterranean diet. “The Mediterranean diet is the best-tested diet for inflammatory arthritis, and in some studies does show the benefit of improving fatigue,” says Ogdie.

You also should limit some of the following:

  • Alcohol
  • Saturated fats
  • Sugar and salt
  • Processed foods

Ogdie confirms that “just clean eating” that limits processed and sugary foods can be beneficial. “Many of our patients tell us that cutting out sugar helps reduce fatigue,” she says.

You may also find that drinking 8 to 10 glasses of water and staying hydrated helps.

If you’re not sure you’re getting enough nutrients in your diet, talk to your doctor about supplements that may benefit you and that won’t interact with your AS medications. Do not start taking supplements before discussing them with your doctor.

Anemia from iron deficiency is a common issue for people with AS and can contribute to fatigue.

5. Improve Your Sleep

The pain-insomnia cycle can be a major driver of ankylosing spondylitis fatigue. “Up to 90 percent of people with AS report this issue,” Danilovich notes.

She says that managing pain through physical activity can lead to improved sleep with AS. “Physical therapists can also help people with AS explore various sleeping positions that may promote alignment and give a better night of rest,” she adds.

6. Focus on Your Mental Health

Depression can negatively influence sleep and levels of fatigue. Living with AS puts you at a higher risk of developing depression compared to the general population, according to research.

Depression can also lower serotonin levels in the brain, which can affect your sleep-wake cycle and worsen your AS symptoms.

In addition to depression, Ogdie mentions stress, anxiety, and ADHD as causing sleep problems that make AS fatigue worse. She says, “If your brain is all over the place, that’s just exhausting and sleep is often affected as well.”

Treatments for mental-health problems may include medications or psychotherapy. Talk to your doctor or another member of your treatment team to develop the best plan for addressing your mental-health needs.

The Takeaway

  • Fatigue is a common, often debilitating symptom of ankylosing spondylitis.
  • To increase energy you may need to work with your healthcare team to adjust your treatment plans. Exercise, physical therapy, and dietary changes may make a difference as well.
  • Taking steps to manage your sleep and work on mental health can also help improve fatigue.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Fatigue in Spondyloarthritis. Spondylitis Association of America.
  2. Methotrexate: Managing Side Effects. Arthritis Foundation.
  3. Why Fatigue Plagues So Many With Spondyloarthritis: A Conversation with Leading Researcher, and Spondyloarthritis Warrior, Dr. Mechiel Korte. Spondylitis Association of America.
  4. Ankylosing Spondylitis (AS). Versus Arthritis.
  5. Gravaldi LP et al. Effectiveness of Physiotherapy in Patients with Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Healthcare. January 2022.
  6. Wang H et al. Drug Treatment of Ankylosing Spondylitis and Related Complications: An Overlook Review. Annals of Palliative Medicine. July 2020.
  7. Sheahan A et al. Opioid Use Surrounding Diagnosis and Follow-up in Patients With Ankylosing Spondylitis, Psoriatic Arthritis, and Rheumatoid Arthritis: Results from US Claims Databases. Clinical Rheumatology. April 2024.
  8. Liang H et al. The Comparative Efficacy of Supervised- Versus Home-Based Exercise Programs in Patients With Ankylosing Spondylitis: A Meta-Analysis. Medicine. February 2020.
  9. Yoga for AS. Spondylitis Association of America.
  10. Vergne-Salle P et al. Diet and Disease Activity in Patients with Axial Spondyloarthritis: SpondyloArthritis and NUTrition Study (SANUT). Nutrients. November 2022.
  11. Diet’s Effect on Spondylitis Symptoms. Spondylitis Association of America.
  12. Shevchuk S et al. Ab0157b Frequency and Spectrum of Anemic Syndrome in Patients with Ankylosing Spondylitis, Peculiarities of Cytometric Characteristics and Hemopoiesis. Annals of the Rheumatic Diseases. May 2019.
  13. Parkinson JT et al. Depression in Patients with Spondyloarthritis: Prevalence, Incidence, Risk Factors, Mechanisms and Management. Therapeutic Advances in Musculoskeletal Disease. November 2020.
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Alexa Meara, MD, is an assistant professor of immunology and rheumatology at The Ohio State University. She maintains a multidisciplinary vasculitis clinic and supervises a longitudinal registry of lupus nephritis and vasculitis patients. Her clinical research is in improving patient–physician communication. She is involved in the medical school and the Lead-Serve-Inspire (LSI) curriculum and serves on the medical school admissions committee; she also teaches multiple aspects of the Part One curriculum. Her interests in medical-education research include remediation and work with struggling learners.

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