Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group An explanation of fatigue in AS

In this study it appears that autonomic disfunction as in orthostatic parasympathetic withdrawal is common in AS:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1752931/

More overt autonomic disfunction of either sympathetic or parasympathetic nervous system is found in Chronic fatigue syndrome and in conditions of postural hypotension or orthostatic intolerance such as POTS or OI. All of these conditions have the cardinal hallmark of fatigue as the main symptom.

Secondly, autonomic disfunction is suggested as the possible cause of fatigue in other systemic autoimmune illnesses such as Sjorgen SYndrome and RA and is commonly found in more severe forms in MS.

Thank you for posting this. It seems very interesting, but could someone please give me a layman's translation of the results? Honestly, my brain simply wouldn't take it in, today.

Hugs,

I am not sure what the autonomic nervous system does precisely and how that correlates to the cardiovascular system and thus would impact on fatigue but the conclusion was:

"the autonomic nervous system involvement could be related to the inflammatory process. This autonomic strain may be related to the cardiac involvement in AS patients."

Seems sketchy at best to conclude that this dtudy means anything to AS and why fatigue is such a factor.

On the other hand trying to decipher what autonomic cardiovascular contro was I came across an article that indicated that it may impact on the vestibular system. OF course that by definition means it may not. I sure would like to know how my AS is causing my vertigo. Oh well.

Hi Steve,

When a person transitions from lying to standing, more blood pressure is required to maintain proper blood flow to the brain. The autonomic nervous system controls the regulation of how much pressure / pumping is needed. If the autonomic nervous system is malfunctioning, it won't adjust properly for the change to standing fast enough, and the person feels light headed due to a lack of oxygen reaching the brain (Called orthostatic hypotension). The oppposite can also happen if the autonomic system over responds and increases the heart rate too much when standing(Called POTS).

Before I was diagnosed with AS, I had a severe problem with orthostatic hypotension. Almost everytime I stood up quickly, I would feel dizzy and my vision would be off, feeling like I might pass out. Interesting, dysfunction of the autonomic nervous system is closely associated with thiamine deficiency. I found that my thiamine level was low due to malabsorption caused by AS (at one point, the level was undetectable - causing beriberi), and upon supplementing vitamin B1, my orthostatic hypotension completely resolved, along with a host of dysfunctions of the autonomic system.

I haven't seen much other information on thiamine deficiency in AS, but I think it may be the culprit behind autonomic dysfunction in others. Thiamine is also essential for the cnoversion of fuel to energy, so a deficiency causes severe fatigue, the fuel is there, it just can't be utilized properly. The body only stores about two to three weeks of thiamine, so if you are malabsorbing, it is one of the first substances to go deficient.

Check out the work of Dr. Derrick Lonsdale regarding Thiamine and autonomic dysfunction.

-Ryan

I used to get really severe fatigue from malabsorption caused by too many years of undiagnosed coeliac disease. That also had the effect paradoxically of causing a leaky gut syndrome at the same time. The explanation I got for that was that in a leaky gut protein molecules don't get totally broken down to the smallest amino acids before they leak through into the blood stream, and some protein components have a real sedative effect on the brain (similar to morphine type substances). That really explained the brain fog for me - where I couldn't stay awake after a meal with protein. I do get a bit fatigued now, mostly in a flare, and I wonder if some of that is pain related. Nowhere near as bad as when my gut was really destroyed by the coeliac disease (it got to severe villous atrophy stage on biopsy).

I have often wondered if I still have some element of orthostatic hypotension - not so much in blood pressure dropping, but heart rate increasing.

'Seems sketchy at best to conclude that this dtudy means anything to AS and why fatigue is such a factor.'

So while you state that you dont really understand the autonomic nervous system or its function you state that it seems sketchy that it may behind fatigue in AS...

Autonomic function is established to cause fatigue. There are a myriad of studies published that suggest that autonomic disfunction in MS, Sjorgens and RA is likely to the culprit behind fatigue in these autoimmune disorders. Since autonomic abnormalities appear present in AS as well it is also likely - based on established medical research - that the parasympathetic withdrawal found in this study would result in sustained fatigue in these patients.

TNF alpha is a potent vasoconstrictor and may also be affecting vasomotor control and endothelial function in AS.

But far more disturbing is this:


http://www.ncbi.nlm.nih.gov/pubmed/20620092
http://www.ncbi.nlm.nih.gov/pubmed/20945076

High levels of assymetric demethylarginine are also found in Fibromyaglia and heart failure and is associated with reduced vasodilation, cardiac disease and autonomic disfunction.

Hi Ramakentesh, and welcome

http://www.tuberose.com/Adrenal_Glands.html

I was looking up The Adrenal Glands, they talk about Hypoadrenia, in regard to Addison's disease (another autoimmune disease), which I'am investigating further.

It tells how Adrenal glands, through Addison's disease can cause severe allergies/insensitivities, and dizziness.

I have known for a while about the cyst on my adrenal gland. The fatigue you describe is by far one of the worse symptoms I am dealing with.

Hugs
Gerri and Makaylah (service dog)

I experience mild fatigue when off NSAIDs. Chronic inflammation seems to consume considerable energy.