Hen I wasn't sure if it was the medication...other
Some participants implied they tried not to rely on medication for managing their AS because of the many sideeffects Til now, it has not been clear {whether|whether or not knowledgeable. It just comes on you..." whereas an additional participant implied "I never discovered that I was tired usually, only after a flare up." Function commitments had been on one hand viewed as a motivator for life, one participant mentioned "it [job] keeps me going", but alternatively a further participant who finished perform as a consequence of fatigue in AS stated "I have finished operate now so I am managing a great deal much better, but when I was operating I found it very hard, you can just cry or you felt physically sick since you felt so tired." In agreement one particular participant stated "In the end I just gave up perform...it created it much easier physically not obtaining to go in, but I still discover I'm possessing periods of mood swings and depression...the longer it [sleep problems] goes on then the extra mood swings kick in." Yet another participant located it "hard to concentrate in perform for the reason that you felt so tired." There was a common consensus more than the uncertainty of irrespective of whether the symptoms of AS (such as discomfort, impaired sleep) brought on fatigue or if fatigue was a symptom of AS. 1 participant questioned "Has the humira [adalimumab] helped me using the fatigue or has it helped with my sleeping pattern which has indirectly helped with my fatigue?". The following theme highlights self-management interventions utilised by participants including experiences and challenges. (2)Current limitations (of self-management) Participants have been encouraged within the focus group to talk about what interventions or remedies they had tried, or wanted to try with regard to self-managing their fatigue. Responses ranged from; obtaining a good attitude "just retain on going" and "trying to find out the glass half complete not half empty", self-medication "I will take a lot more co-codamol",Davies et al. BMC Musculoskeletal Issues 2013, 14:163 http://www.biomedcentral.com/1471-2474/14/Page four ofkeeping active "every day I walk to get a superior hour with all the dogs, I swim and I preserve active", and being a member of a gym. Hydrotherapy was a common activity, but getting a warm pool and the price involved were viewed as problematic "it could be lovely to swim in a warm pool however the costs these locations are charging." 1 participant stated they felt they "had to workout that was the leveller.....if I do not do it [exercise] I am in actual problems." Other participants reported sleeping for short periods of time "a 10 minute power nap and I am fine again". Some participants implied they attempted not to rely on medication for managing their AS due to the several sideeffects skilled. The following quote illustrates this predicament: "I was taking indomethacin for the pain however it triggered the bowel to flare up and I was hospitalised with that....so I try and manage without the need of drugs if I can...but naturally you will need to in the event the discomfort is quite negative." As element on the focus group participants had been shown a 3 minute video clip on amitriptyline medication [24] (which is often prescribed ahead of bedtime for fatigue and discomfort in chronic musculoskeletal circumstances), including how it functions, dosage and its advantages for managing chronic nerve discomfort.