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Spondyloarthritis is the most overlooked cause of chronic back pain among young adults. Spondyloarthritis isn’t always diagnosed right away. In fact, some people may go for years without a diagnosis. One study found that it took an average of two to five years from the onset of symptoms to a diagnosis of spondyloarthritis. Since the right treatment can’t always be started without a diagnosis, it’s important to know the symptoms so spondyloarthritis can be recognized as soon as possible.
The Spondylitis Association of America lists several different varieties of spondyloarthritis, including two broad categories that reflect the current classification system:
There are also several older classifications, which it may be helpful to know:
Regardless of how a case of spondyloarthritis is eventually classified, initial symptoms in the early stages can be very similar. Here are some of the early symptoms most common among people who are eventually diagnosed with spondyloarthritis. If you recognize these symptoms, it is important to report them to your health care provider or rheumatologist.
By far, the most common early symptom of spondyloarthritis is lower back pain. “The pain in my spine and hips have caused me to hurt never-ending,” one MySpondylitisTeam member said. One study conducted in Spain found that 72 percent of those who would later receive an ankylosing spondylitis diagnosis reported back pain as their first symptom. Since back pain is a common complaint among the general population — it’s estimated up to 80 percent of people will experience low back pain at some point — it can be difficult to distinguish between spondyloarthritis-induced back pain versus some other form.
Back pain in spondyloarthritis is a specific type called inflammatory back pain. There are several aspects of inflammatory back pain that distinguish it from other kinds.
While inflammatory back pain is the hallmark of spondyloarthritis, pain in other joints can also occur.
Sacroiliac joint syndrome (SI syndrome or sacroiliitis) is an alternating form of pain that affects the buttocks and the surrounding area, such as the thighs. Buttock pain may also cause difficulty sitting for long periods of time. In one study, 46 percent of people with ankylosing spondylitis reported SI syndrome as their first symptom.
Peripheral arthritis in the joints of the arms and legs was reported by 67 percent of people as an early symptom. Of those, 38 percent reported that peripheral arthritis started in the upper limbs, while 29 percent reported it starting in the lower limbs.
Neck pain is a less common symptom, but between 6 percent and 11 percent of people with ankylosing spondylitis reported it as an early symptom.
While back pain indicates to many people they may have a musculoskeletal issue, other early symptoms associated with spondyloarthritis may affect parts of the body outside the joints — or affect the body as a whole.
While fatigue is a symptom of many conditions, it occurs with some frequency among those who will later be diagnosed with spondyloarthritis. Fatigue may be a direct result of spondyloarthritis inflammation or it can be a consequence of poor sleep due to pain — sometimes referred to by MySpondylitisTeam members as “painsomnia.” One member wrote, “Fatigue is definitely a big problem for me. I seem to pay for every good day with days of fatigue, or even bad and stressful days with overwhelming fatigue. I have slept entire afternoons away.”
Psoriatic arthritis is a subset of spondyloarthritis, but psoriasis and other skin diseases themselves can also be a first symptom, especially skin and nail changes. Psoriasis is an autoimmune condition that causes the immune system to attack the skin.
Enthesitis is pain where tendons or ligaments and bone meet. It is especially common at the back of the heels. In one study, enthesitis was reported as an early symptom in 10 percent to 28 percent of those with spondyloarthritis.
Dactylitis, or swelling in the fingers and toes, is sometimes called “sausage fingers.” The swelling is not confined to one joint of the digit, but usually affects the entire finger or toe. Swelling is usually worse in the middle of the digit. The digit is usually reddened and hot to the touch. Between 7 percent and 10 percent of people with spondyloarthritis reported dactylitis as an early symptom.
Inflammatory bowel disease is an autoimmune condition that affects the intestinal tract. The two types of IBD are ulcerative colitis and Crohn’s disease. Pain, bloating, and other symptoms focused around the digestive tract are typical first symptoms of IBD. Between 17 percent and 39 percent of people with IBD also develop spondyloarthritis. When the two occur together, the condition may be referred to as IBD-associated spondyloarthritis or enteropathic arthritis.
Inflammation in spondyloarthritis can also affect the eyes, a condition known as uveitis. One study reported 7 percent of those with undifferentiated spondyloarthritis and 9 percent of those with ankylosing spondylitis had uveitis.
“I do have problems with my eyes also. It’s terrible. [It] feels like I have dirt in my eye or something,” said one MySpondylitisTeam member. The most common symptom of uveitis is redness and pain in the eyes, but vision deficits and sensitivity to light are also possible. Inflammation of the iris itself is a variation called iritis. Eye inflammation can be a constant symptom, or it can recede and reoccur over time.
In people with spondyloarthritis, chest pain can be caused by inflammation of cartilage in the chest, known as costochondritis. One MySpondylitisTeam member described chest pain as feeling like, “A huge vise grip that has me around the ribs.”
Cognitive changes, such as difficulty thinking, remembering, and communicating, are commonly reported symptoms in inflammatory conditions like spondyloarthritis. Some MySpondylitisTeam members describe this feeling as “brain fog.” As one member wrote, “I can be looking right at something and forget the word for it.”
If you have had low back pain for three months or longer, especially if it started before age 45, there’s a chance it could be spondyloarthritis. If you also experience any of the other symptoms described above, or have a family medical history of inflammatory diseases, these factors may make a diagnosis of spondyloarthritis more likely.
There is no one definitive test for spondyloarthritis. In some people with spondyloarthritis, blood tests show high levels of inflammation. In others, these tests may show normal results. Similarly, many people with spondyloarthritis test positive for a protein known as HLA-B27 that is linked with a higher risk for inflammatory conditions, but others test negative.
Read more about How Axial Spondyloarthritis Is Diagnosed.
When spondyloarthritis is suspected, imaging scans are usually performed. X-rays are capable of showing inflammation when the disease has been active for six to 10 years. Scans using magnetic resonance imaging (MRI) may identify inflammation earlier, but a negative MRI scan doesn’t rule out the possibility that someone has spondyloarthritis.
Living with spondyloarthritis can be a challenge, but once diagnosed, you can work with your rheumatologist to find effective treatment options and manage symptoms. When you join MySpondylitisTeam, you gain a support network of more than 51,000 people who experience similar symptoms and have traveled the path toward a diagnosis of spondyloarthritis.
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