AbstractObjectivesFatigue is frequent in axial SpA (axSpA) and is difficult to improve. This systematic review aimed to assess the effects of axSpA treatment on fatigue.MethodsA systematic review following the PRISMA recommendations was performed on PubMed, Cochrane and Embase databases. We included controlled interventional studies, cohort studies conducted in patients with axSpA meeting the ASAS 2009 criteria and measuring fatigue between 12 and 156 weeks of treatment. We excluded studies not written in English, case reports, abstracts, systematic reviews, meta-analysis and studies with missing data. A meta-analysis was performed for anti-TNF/anti-IL-17/JAK inhibitors randomized controlled trials evaluating fatigue at week 12–16.ResultsA total of 1672 studies were identified, of which 34 were selected for analysis. Twelve studies evaluated anti-TNF with a significant reduction in fatigue measured by various scores (FACIT, MFI, NRS, VAS, FSS) in 11 studies. Among the four studies evaluating anti-IL-17, three showed a reduction in fatigue, with a dose effect for secukinumab. Two studies evaluated JAK inhibitors and showed a reduction in fatigue. The meta-analysis showed no differences between the DMARDs. Concerning non-pharmacological treatments, 12 of 16 studies showed a reduction in fatigue using physical activity, cryotherapy and magnetotherapy. Two studies showed that the addition of physical activity to anti-TNF reduced fatigue more significantly. Finally, one study showed a greater efficacy in men, and two studies suggested it in non-radiographic form.ConclusionThis review shows a beneficial effect of DMARD and non-pharmacological treatment on fatigue in axSpA in short and medium terms with a greater effect when combining them.