Connect with others who understand.

sign up log in
About MySpondylitisTeam

The Progression of Ankylosing Spondylitis

Posted on August 19, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Ali Gies, D.P.T.

  • Ankylosing spondylitis is a progressive condition, but treatment can slow that progression.
  • If left untreated, ankylosing spondylitis can lead to spinal fusion, mobility issues, and disability.
  • As it progresses, ankylosing spondylitis can affect other areas of the body, including the heart and eyes.

Ankylosing spondylitis (AS) is a progressive form of inflammatory arthritis. In AS, the immune system mistakenly attacks the spine, leading to pain and joint damage. Ankylosing spondylitis is also referred to as radiographic axial spondyloarthritis or radiographic axSpA.

The progression of ankylosing spondylitis can vary from person to person. While most people with ankylosing spondylitis notice back pain early on, others may have hip or knee pain. If left untreated, new bone can form in the spine, causing painful spinal fusion. Not everyone with AS will develop this complication.

Other joints may be affected too, such as the neck, shoulders, jaw, hips, hands, feet, fingers, and toes. Due to the progressive systemic inflammation caused by ankylosing spondylitis, some people develop complications outside the joints, such as eye problems, heart issues, fatigue, depression, and muscle weakness.

Early Stages

As with other types of inflammatory arthritis, like rheumatoid arthritis, early diagnosis and treatment for AS are important for stopping or slowing disease progression. This can help prevent joint deformity, new bone formation in the spine, disability, and associated health problems. Joint damage caused by AS is generally not reversible. Below are symptoms you may notice when ankylosing spondylitis is in its early stages.

Back Pain

People with ankylosing spondylitis usually experience lower back pain as their first symptom. The disease originates at the sacroiliac joints, where the lumbar spine connects to the pelvis. Pain can be on one side or both in the beginning.

In the early stages of disease activity, people often develop back pain slowly over a period of weeks or months. In contrast to mechanical back pain, such as pain after lifting something heavy, pain from AS is inflammatory. It lingers and may get worse over time. Inflammatory pain may feel worse after a period of inactivity, such as sleeping or sitting for a long period, and improve with movement.

Stiffness

Ankylosing spondylitis primarily affects the joints in the spine. When the joints don’t move for a period of time, they become stiff. Add inflammation to the picture, and it can be very painful when a person tries to get up and move again.

Fatigue

While fatigue tends to increase significantly over the course of the disease, it can also be an early indicator to help rheumatologists diagnose ankylosing spondylitis. Since ankylosing spondylitis is an inflammatory disease, the body has to constantly work harder than normal to fight the inflammation. The extra energy used leaves a person feeling fatigued. One MySpondylitisTeam member lamented, “I can muscle through pain, but it is very hard to function when you feel like the plug on the drain has been pulled and you are sitting on empty.”

Later Stages

While the spine may be the primary source of pain in AS, other joints may become involved as well. When this happens, tissues like muscles and tendons can be affected. In addition, complications in other organs — such as the eyes and heart — can occur.

Painful Joints

As ankylosing spondylitis progresses, other joints may become inflamed and painful. As a result, the muscles, ligaments, and tendons surrounding these joints may become weak. Aside from the back, commonly affected areas include the hips, shoulders, knees, ribs, and heels.

“My body feels broken, bruised, beaten, and wrapped in barbed wire all the time,” explained a MySpondylitisTeam member.

Eye Inflammation

Some people with AS may experience a painful, red eye caused by iritis or uveitis. This can cause blurred vision or sensitivity to light. If left untreated, vision damage or even blindness can occur. Doctors typically start by treating the inflammation with topical corticosteroids.

Read more about spondylitis eye inflammation.

Heart Complications

A small percentage of people with ankylosing spondylitis will have cardiovascular problems associated with the disease. These include ischemic heart disease, conduction problems, aortitis, aortic valve disease, and cardiomyopathy. Treatment focuses on managing symptoms and preventing complications.

Read more about how AS affects the heart.

Gastrointestinal Problems

The inflammation associated with ankylosing spondylitis may cause abdominal issues, such as diarrhea. In some cases, it can lead to Crohn’s disease, a type of inflammatory bowel disease.

Brain Fog

Fatigue and poor sleep in people with ankylosing spondylitis can lead to brain fog. Brain fog is a feeling of being mentally fuzzy or having a hard time focusing. Brain fog can make it hard to function at work and at home.

One MySpondylitisTeam member vented, “I’m amazed at how many other people are going through this too. I started mixing up words right after my neck surgery. It gets so frustrating. My kids made fun of me, not realizing how much it bothered me.”

Doctors may try to help reduce brain fog by treating the inflammation associated with AS. This can reduce the energy demand on the body and improve sleep.

Advanced Stages

In advanced cases of AS, new bone formation in the spine leads to spinal fusion. The new bone formation is called ankylosis, which gives the condition its name. The results of spinal fusion are immobility, kyphosis (a rounding of the spine), and an increased risk of vertebral fracture. Kyphosis gives the appearance of being bent forward even when trying to stand up straight. The fusing also prevents the rib cage from expanding, which makes it hard to take a deep breath. In rare cases, neurological complications such as cauda equina syndrome can occur.

Treatment for Preventing Progression of Ankylosing Spondylitis

While there currently is no cure for ankylosing spondylitis, there are many treatment options for managing symptoms and preventing disease progression. If left untreated, disease progression may significantly reduce a person’s independence and quality of life.

Treatment of ankylosing spondylitis may include nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, biologic drugs, and traditional disease-modifying antirheumatic drugs (DMARDs). A newer class of treatments known as Janus kinase (JAK) inhibitors are also an option for treating AS. Biologics, DMARDs, and JAK inhibitors are used to slow disease progression while NSAIDs are generally used to control pain. There is evidence that combining NSAIDs with tumor necrosis factor (TNF) inhibitors, a type of biologic medication, can slow the progression of inflammation in the spine.

If your current treatment isn’t adequately controlling your symptoms, it may be time to ask your rheumatologist about other treatment options. Read more about advanced treatments for ankylosing spondylitis.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with lymphoma and their loved ones. On MySpondylitisTeam, more than 67,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Are you living with spondylitis? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Overview of Ankylosing Spondylitis — Spondylitis Association of America
  2. The Natural History of Ankylosing Spondylitis as Defined by Radiological Progression — The Journal of Rheumatology
  3. Zygapophyseal Joint Fusion in Ankylosing Spondylitis Assessed by Computed Tomography: Associations with Syndesmophytes and Spinal Motion — The Journal of Rheumatology
  4. Effects of Physical Therapy for the Management of Patients With Ankylosing Spondylitis in the Biological Era — Clinical Rheumatology
  5. Investigation of Cardiac Complications and their Incidence in Patients with Ankylosing Spondylitis — Medical Archives
  6. Ankylosing Spondylitis — Symptoms & Causes — Mayo Clinic
  7. Possible Complications: How is a Person Affected? — Spondylitis Association of America
  8. Axial Spondyloarthritis — Arthritis Foundation
  9. Fatigue in Spondyloarthritis — Spondylitis Association of America
  10. Ankylosing Spondylitis (AS) — Cleveland Clinic
  11. Continuous NSAID Use Reverts the Effects of Inflammation on Radiographic Progression in Patients With Ankylosing Spondylitis — Annals of the Rheumatic Diseases
  12. Iritis or Anterior Uveitis — Spondylitis Association of America
  13. The Heart in Spondylitis — Spondylitis Association of America
  14. Cognitive Impairment in Patients with Ankylosing Spondylitis — Canadian Journal of Neurological Sciences
  15. Cauda Equina Syndrome in Ankylosing Spondylitis (The CES-AS Syndrome): Meta-Analysis of Outcomes After Medical and Surgical Treatments — Clinical Spine Surgery
  16. Ankylosing Spondylitis — Diagnosis & Treatment — Mayo Clinic
  17. Combination of NSAIDs and TNF Inhibitors Shows Benefit for Ankylosing Spondylitis — American College of Rheumatology
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Ali Gies, D.P.T. attended the University of Florida, where she earned her bachelor’s in health science and a doctorate in physical therapy.. Learn more about her here.

A MySpondylitisTeam Member said:

My life beginning as a young teen. I am now 78 and I fit it all.

posted 17 days ago

hug (3)

Recent articles

There are multiple treatment options for those with spondylitis that have been approved by the...

Alternative Treatments for Spondylitis

There are multiple treatment options for those with spondylitis that have been approved by the...
The Centers for Disease Control and Prevention (CDC) has recommended Pfizer COVID-19 vaccine...

COVID-19 Vaccine Boosters and Additional Doses for People With Spondylitis: Current Guidelines

The Centers for Disease Control and Prevention (CDC) has recommended Pfizer COVID-19 vaccine...
During the COVID-19 pandemic, MySpondylitisTeam will provide summaries and links to articles of...

COVID-19 and Spondylitis Essential Updates

During the COVID-19 pandemic, MySpondylitisTeam will provide summaries and links to articles of...
Managing pain is an essential part of living with spondylitis, yet many people with the condition...

Have You Been Treated Like a Drug Seeker While Living With Spondylitis Pain?

Managing pain is an essential part of living with spondylitis, yet many people with the condition...
In its advanced stages, ankylosing spondylitis (AS) can lead to a condition that is sometimes...

Bamboo Spine in Ankylosing Spondylitis

In its advanced stages, ankylosing spondylitis (AS) can lead to a condition that is sometimes...
Symptoms of spondylitis (also called spondyloarthritis) can increase during periods of high...

Managing Spondylitis Flare-Ups

Symptoms of spondylitis (also called spondyloarthritis) can increase during periods of high...
Spondylitis is an umbrella term that refers to a spectrum of related diseases also known as...

Is Spondylitis an Autoimmune Disease?

Spondylitis is an umbrella term that refers to a spectrum of related diseases also known as...
There’s no official diet for people with spondylitis, but many members of MySpondylitisTeam...

Snacks for Spondylitis: Ideas for Quick and Easy Bites

There’s no official diet for people with spondylitis, but many members of MySpondylitisTeam...
If you frequently experience chest pain with spondylitis, you’re not alone. Chest pain is a...

Chest Pain and Spondylitis

If you frequently experience chest pain with spondylitis, you’re not alone. Chest pain is a...
Life with spondylitis — also known as spondyloarthritis — has many challenges that can affect...

Living With Spondylitis: Your Guide

Life with spondylitis — also known as spondyloarthritis — has many challenges that can affect...
MySpondylitisTeam My spondylitis Team

Two Ways to Get Started with MySpondylitisTeam

Become a Member

Connect with others who are living with spondylitis. Get members only access to emotional support, advice, treatment insights, and more.

sign up

Become a Subscriber

Get the latest articles about spondylitis sent to your inbox.

Not now, thanks

Privacy policy
MySpondylitisTeam My spondylitis Team

Thank you for signing up.

close