Symptoms of Ankylosing Spondylitis
More Than Just Arthritis of the Spine
Medically reviewed by Anita C. Chandrasekaran, MD
Ankylosing spondylitis(AS) is a chronic inflammatory disease affecting the spinal joints and ligaments, sacroiliac joints, and often peripheral joints, like the shoulders, hips, and knees. Sometimes people have symptoms in other organ systems as well, like the eyes.
Symptom Variations
The symptoms of AS most commonly begin in early adulthood. These symptoms do not affect everyone the same way. In other words, some people with AS have much milder disease with minimal impact on their daily lives. Others have much more debilitating symptoms.
Takeaway
While symptoms vary in type and severity, they also may vary by gender. In a 2011 study in Clinical Rheumatology, back pain was reported as the main AS problem in both men and women. But women with AS were more likely to have pain in their neck, knee, or hip, whereas men were more likely to have feet pain.
Women may be more likely to experience fatigue and depression in relation to AS.
Research into sex differences is still relatively recent, however, and people of both sexes can have any of the symptoms of AS.
Related: How Common Is Ankylosing Spondylitis?
Frequent Symptoms
Low Back Pain
The most common symptom of AS is low back pain and stiffness, which is caused by inflammation of the spinal joints (called facet joints). For this reason, it is sometimes called "inflammatory back pain."
The inflammatory back pain of AS has distinct features. These features help doctors differentiate it from mechanical back pain, which is much more common. Inflammatory back pain is often characterized by the following:
Explainer
Chronic, lasting three months or longer
Onset when a person is less than 40 years of age
Coming on slowly over weeks to months
Improving with exercise and not improving with rest or lying down
Being worse at night (even waking a person up)
Improving with a non-steroidal anti-inflammatory (NSAID)
The quality of the pain in AS can also be helpful in distinguishing it from mechanical back pain. For instance, a person with AS will usually describe his or her back pain as dull and "all over," though sometimes the pain radiates into the buttock region.
The duration of back stiffness can be a clue in identifying inflammatory back pain. Back stiffness in AS usually lasts more than 30 minutes upon waking in the morning, and improves with exercise. Back stiffness from osteoarthritis (a non-inflammatory form of arthritis) lasts less than 30 minutes.
Takeaway
Back pain in AS can become quite disabling, and it tends to expand with time.
So while the pain of AS may begin on one side of the back, it eventually moves to both sides. The pain may eventually move up the spine and even into the neck.
Joint Pain
Sometimes AS causes pain in joints outside of the spine. For example, some people with AS also experience joint pain in places like the shoulders, hips, knees, elbows, and ankles. However, not everyone with AS will have problems with these other joints.
Enthesitis
Another symptom of AS is inflammation of the entheses (called enthesitis), which are the areas of the body where a tendon or ligament connects to a bone. The heel is the most common site of enthesitis. This might lead to symptoms of heel pain. Depending on which entheses are affected, you might have pain at other body sites as well.
Anterior Uveitis
Anterior uveitis, which refers to inflammation of the colored part of the eye, occurs in approximately 26 percent of people with AS, according to a 2015 study in Annals of Rheumatic Disease. Uveitis usually causes pain in one eye, sensitivity to light, and blurry vision.
Takeaway
It is more likely to occur in those who have had AS for a longer time and who test positive for the genetic variation human leukocyte antigen (HLA)-B27.
Systemic Symptoms
In addition to joint and tissue inflammation, a person may also experience symptoms of whole-body inflammation like malaise, tiredness, mild fever, and a diminished appetite. Some people also experience difficulties sleeping, due to pain.
"Hunchback" Appearance and Limited Mobility
As ankylosing spondylitis becomes more advanced, the inflammation can cause spinal deformities on the spine. This new bone formation may lead to spinal fusion, causing a person's back to curve forward (called hyperkyphosis). In severe cases, this can create a permanent "hunchback" appearance. In some cases, other changes to the spine may occur as well.
However, it's important to note that this only happens in a subset of people. This process may limit spinal mobility, making it more difficult to pick something up from the floor.
Takeaway
Getting treatment early on may help you prevent these long-term problems.
Rare Symptoms
Less commonly, AS can affect other systems of the body as well. For example, some complications may affect the heart, lung, or kidney. Both inflammation of the aorta and aortic valve regurgitation can cause heart failure, which can be fatal. Heart conduction defects are also possible.
Lung problems in AS may arise from limited chest wall and spine movement, or from lung fibrosis. Kidney problems such as IgA nephropathy can also occur. Though some of these problems may be life-threatening, they are much less common than the spinal symptoms of AS.
Research also shows an increased prevalence of inflammatory bowel disease and psoriasis in people with AS, so people with AS are more likely to have these other diseases as well. However, these are not thought to be direct complications of the disease. Instead, they are specifically linked to the HLA B27 gene, which may increase the risk of all three diseases.
Related: 10 Unusual Symptoms of Ankylosing Spondylitis
Complications
Complications from vertebral compression or fracture
People with AS have an increased risk of vertebral fracture. In some cases, such a fracture might damage the spinal cord. A spinal cord injury can lead to a variety of neurological symptoms like weakness, numbness, or even paralysis.
Severe misalignment of the spine from AS can also cause spinal cord compression, which is a neurological emergency. However, it is important to note that most people with AS will not experience these complications.
Related: How Does Ankylosing Spondylitis Affect Pregnancy?
When to See a Healthcare Provider
If your symptoms are worsening or not responding to treatment, make an appointment to see your physician. You may need to explore other treatment options.
Also make sure you know the symptoms that may signal a serious complication of AS, like sudden weakness or paralysis.
Takeaway
If you do experience sudden symptoms like weakness, paralysis, intense back pain, eye pain, or chest pain, see a doctor right away. That will give you the best chance of a good medical outcome.
Ankylosing spondylitis is a lifelong form of arthritis that affects the spine, sacroiliac joints, peripheral joints, and potentially other organs in the body like the eye, heart, and lung. It is a serious condition and affects everyone a little differently. But with close communication with your health team, you can optimize your health and minimize potential complications.
Frequently Asked Questions
What is ankylosing spondylitis?
Ankylosing spondylitis is a type of arthritis mainly affecting the spine that causes chronic inflammation and progressive stiffness. Joints of the pelvis and shoulder may also be involved. The condition tends to develop in early adulthood and is thought to be more common in men.
What are common signs and symptoms of ankylosing spondylitis?
Ankylosing spondylitis usually starts with chronic, dull pain in the lower back or buttocks area along with lower back stiffness. As the disease progresses, there will be a significant loss of mobility and flexion in the spine and chest, and some people might develop kyphosis ("hunchback"). Pain is common and often severe (especially at night). Symptoms may come and go and tend to improve with exercise.
What are uncommon symptoms of ankylosing spondylitis?
Ankylosing spondylitis is a systemic rheumatic disease, meaning that it is an autoimmune or autoinflammatory condition that affects the whole body. Although less common, complications can affect the heart, lungs, and kidneys. The exact cause of the disease is unknown, although it is believed to be the result of genetic and environmental factors. Around 85% of people with ankylosing spondylitis have a gene called HLA-B27. However, not everyone who is positive for HLA-B27 will have ankylosing spondylitis.
What causes ankylosing spondylitis?
Ankylosing spondylitis is a systemic rheumatic disease, meaning that it is an autoimmune or autoinflammatory condition that affects the whole body. The exact cause of the disease is unknown, although it is believed to be the result of genetic and environmental factors. Around 85% of people with ankylosing spondylitis have a gene called HLA-B27.
How is ankylosing spondylitis diagnosed?
There are currently no specific tests that can diagnose ankylosing spondylitis. Diagnosis is based on a set of clinical criteria—including the onset of symptoms before age 40, pain at night, and improvement with exercise—and supported by plain X-ray studies. Having the HLA-B27 gene is not diagnostic because only a small fraction of people with the gene ever develop ankylosing spondylitis. Autoantibodies specific to ankylosing spondylitis have not been identified.
What are the best treatments for ankylosing spondylitis?
Medications are the mainstay of treatment to relieve symptoms and slow disease progression. These include:
Biologic drugs like Enbrel (etanercept), Remicade (infliximab), and Humira (adalimumab)
Cosentyx (secukinumab)
JAK inhibitors like Xeljanz
Surgery to replace joints or repair spinal deformity may be used for severe cases.
Can you treat ankylosing spondylitis naturally?
Therapeutic exercise is generally endorsed, although high-impact activities like jogging are often avoided due to spinal jarring. There is some evidence to support the use of acupuncture for pain relief. Yoga, massage therapy, and the Alexander technique may also help.
Can herbal remedies help treat ankylosing spondylitis?
There is no solid evidence to support the use of herbal remedies for ankylosing spondylitis.
Read the original article on Verywell Health.