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Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a form of arthritis affecting the spinal joints. It often starts in the sacroiliac joints, where the spine connects to the pelvis. Although AS causes common arthritis symptoms such as pain and stiffness, it can also lead to digestive problems, skin rashes, and weight loss.

The most prevalent symptom of ankylosing spondylitis is lower back pain.

By Able Health I Medically reviewed by Dr. Alireza Estedlal

Page last reviewed: February 2024 I Next review due: February 2026

What is Ankylosing Spondylitis?

Ankylosing spondylitis is a kind of arthritis that primarily affects the joints in the spine. It is sometimes referred to as axial spondylarthritisby medical practitioners.

In addition, ankylosing spondylitis (AS) affects the joints where the spinal base connects to the pelvis, known as the sacroiliac joints. These joints serve as the link between the spine and pelvis, precisely where the sacrum (the triangular last segment of the spine) joins the ilium (the upper and back section of the pelvis).

The sacroiliac joints are among the largest joints in the body and are used whenever one moves or shifts the hips.

Though less common, ankylosing spondylitis can also impact other joints, like the shoulders, knees, and hips.

Ankylosing spondylitis leads to stiffness, pain, and other gastrointestinal (GI) symptoms. So, if you experience lower back pain that worsens or interferes with your everyday activities, seek immediate medical attention.

Symptoms and Causes

What are ankylosing spondylitis symptoms?

Every person with ankylosing spondylitis has a varying set of symptoms. One of the most prevalent symptoms is lower back pain caused by sacroiliitis, which is the painful tenderness of the sacroiliac joints.

This pain is likely to radiate or spread to other areas. Hence, you may also experience various forms of pain, such as:

  • Hip pain
  • Buttock pain
  • Neck pain
  • Abdominal or stomach pain

Additional symptoms of ankylosing spondylitis are:

  • Stiffness or difficulty moving the hips and lower back, mainly early in the morning or after prolonged periods of inactivity
  • Fatigue (persistent tiredness)
  • Shortness of breath (dyspnea)
  • Loss of appetite or unexplained weight loss
  • Diarrhea
  • Skin rashes
  • Eyesight problems

What causes ankylosing spondylitis?

AS is an autoimmune conditionthat occurs when the immune system mistakenly attacks the body rather than defending it.

The exact cause of AS is not known. However, research has discovered a strong genetic correlation between AS and particular genetic mutations. Genetic mutations refer to DNA sequence alteration that occurs from the division of cells and replication.

Over 60 mutated genes have been linked to the occurrence of AS. Human leukocyte antigen-B (HLA-B27) gene is a key example. Also, about 90% of white individuals with AS carry a mutated HLA-B27 gene.

What are the risk factors?

Anybody can be susceptible to ankylosing spondylitis. Nevertheless,specific groups of peopleare at a higher risk of developing the condition. They include;

  • Persons aged below 40 years (over 80% of individuals with AS are usually diagnosed around the age of 30).
  • Persons who are assigned male at birth (AMAB).
  • Those who have close blood relatives with AS (particularly a biological parent).

Also, some health conditions increase the chances of developing ankylosing spondylitis. These include;

  • Crohn's disease
  • Ulcerative colitis
  • Psoriasis

What are the complications of ankylosing spondylitis?

Having ankylosing spondylitis increases the risk of getting spinal fractures or broken spinal bones.

More complications that can arise are;

  • Fused vertebrae (spinal bones merging).
  • Kyphosis (the spine forwardcurvature).
  • Osteoporosis
  • Eyesight and vision problems such as uveitis or light sensitivity.
  • Heart problems like aortitis, arrhythmia, and cardiomyopathy.
  • Nerve injury or damage

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Diagnosis and Tests

How do providers diagnose ankylosing spondylitis?

Ankylosing spondylitis is diagnosed through a physical examination. The medical practitioner will look at your body and ask about the symptoms. It's thus important to inform your doctor when the pain and other symptoms first started, as well as the time and activities that worsen them. Also, you may be required to see a rheumatologist, a professional specializing in arthritis and related conditions.

What tests do healthcare providers use to diagnose ankylosing spondylitis?

No single test can confirm that a person has AS. The provider may thus have to conduct a number of tests to assist in diagnosis. These tests include;

  • Sacroiliac joint and spinal X-rays that assess the arthritissigns.
  • Magnetic resonance imaging (MRI) which provides more details compared to X-rays.
  • Blood tests to determine the presence of mutated HLA-B27 gene.

Management and Treatment

How is ankylosing spondylitis treated?

The medical practitioner will recommend treatments to manage symptoms and minimize their impact on your everyday life.

The most common ankyloses spondylitis treatment options are:

  • Exercise: Physical activities can help lower stiffness and prevent AS from worsening. Most individuals experience serious pain as a result of inactivity. Physical therapists can thus recommend certain exercises and stretches to build up muscles supporting the spine and back.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): These are over-the-counter (OTC) drugs that relieve pain and swelling. Examples are ibuprofen and naproxen. Ensure you consult your provider before using NSAIDs continuously for 10 days or more.
  • Biologic disease-modifying anti-rheumatic drugs (DMARDs): These are prescription drugs that relieve pain and swelling. They are also used to prevent AS from worsening.
  • Corticosteroids: These are prescription anti-inflammatory drugs. They may include cortisone shots or corticosteroid injections that are administered directly into the damaged joints.
  • Surgery: Surgery is rarely needed to address AS. It is often considered only when the symptoms are severe and don't improve with other treatment options.

How soon will I feel better?

You are expected to start feeling better once you begin your treatment. Although the symptoms may not entirely disappear, they should improve with the right treatment. Consult with your provider on when the improvement will commence.

Physical therapies and exercises are a steady process, while medications vary on how fast they are effective.

Outlook/ Prognosis

What can I expect if I have ankylosing spondylitis?

Given that ankylosing spondylitis is a long-term (chronic) disorder, you should expect prolonged or lifetime management of symptoms. Some individuals with AS experience remission periods in which the symptoms are fewer and milder. However, there is always the possibility that the symptoms can recur even after a long period without them.

While AS and other forms of arthritis have no cure, it does not imply that you will have to endure pain. Explain to your doctor how you feel and how the symptoms affect your daily activities.

The Role of Exercise in Managing Ankylosing Spondylitis

Exercising is essential when it comes to ankylosing spondylitis management. This is because frequent physical activitieshelp relieve stiffness and pain, enhance flexibility as well as maintain general health and wellness. Ensure you choose exercises that are not vigorous to the joints and boost flexibility.

Swimming, yoga, and cycling are examples of low-impact activities that therapists usually recommend for people with AS. They help strengthen muscles, enhance range of movement, and support an improved posture. To prevent overexertion, it is advisable to begin slowly and steadily as you increase the exercise duration and intensity.

How to Manage Ankylosing Spondylitis Pain and Discomfort

Pain and discomfort management is a constant challenge associated with ankylosing spondylitis. Other approaches that can ease symptoms are available in addition to medicines and exercise. Placing hot or cold packs on the affected parts can temporarily relieve pain and stiffness. Likewise, keeping a good posture and utilizing ergonomic aids like supportive chairs and pillows can as well assist in alleviating spinal strain.

Sometimes, healthcare providers recommend assistive tools, including walkers or canes, to assist with movement. Occupational therapy can also give guidance on how to adjust everyday routines that will save energy and reduce pressure on joints.

Ankylosing Spondylitis and the Spine: What You Need To Know

AS mainly affects the spine resulting in inflammation of the joint located between vertebrae. This inflammation could cause vertebrae fusion (ankylosis) with time, leading to spine mobility and flexibility loss.

Ankylosing spondylitis causes spinal symptoms such as long-term stiffness andback pain, which usually worsen in the mornings or following prolonged inactivity periods. As time progresses, the condition may lead to a stooped posture and limited range of motion in the spine.

The goal of AS treatment is to slow down or stop the occurrence of morespinal damage. Medicines, physical therapy, and routine exercise may assist in maintaining flexibility and relieving pain. Some severe cases require surgery to repair deformities and reduce strain on the spinal cord.

The Impact of Ankylosing Spondylitis on Daily Life

AS can have significant effects on a person's everyday life and impact physical and emotional wellness. Long-term pain and stiffness might make it challenging to do daily tasks, including cooking, dressing, or sitting down for long. Another common AS symptom is fatigue, which may contribute to limited energy levels and reduced productivity.

In addition, the emotional effects associated with AS should never be ignored. It can be challenging to live with a chronic disease, and this may result in a sense of sadness, frustration, and isolation. Therefore, people with ankylosing spondylitis should find support from medical doctors, family members, and friends to assist them in coping with both physical and emotional difficulties.

Ankylosing Spondylitis and Other Health Conditions: What to Watch Out For

Ankylosing spondylitis is linked with a high risk of other health problems, including uveitis (eyes inflammation), psoriasis (skin condition), inflammatory bowel disease (like Crohn's disease or ulcerative colitis), and cardiovascular disorders.

People with AS should be well-informed about possible complications so that they can seek proper medical attention when symptoms occur. Also, regularly following up with your provider can assist with monitoring the signs of associated problems and enable early intervention when required.

Living With

How do I take care of myself?

Besides sticking to theankylosing spondylitis treatment plan, these steps can also help ease inflammation and relieve joint stress:

  • Following a healthy diet and exercise plan.
  • Lowering your alcohol intake levels.
  • Quitting smoking.

When should I see my healthcare provider?

If the symptoms worsen or new ones emerge, seek medical care as soon as possible. Inform your doctor if the treatments are no longer helping manage symptoms effectively like before.

Visit your practitioner if you notice any of these symptoms:

  • Chest pain
  • Breathing difficulties
  • Eyesight problems
  • Severe back pain or joint pain
  • Unusual stiffness or rigidity in the spine
  • Weight loss that is unexplainable

What questions should I ask my healthcare provider?

  • Do I have AS or another form of arthritis?
  • Will I require genetic testing?
  • Which treatments will help manage my symptoms?
  • Will I require physical therapy?