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.
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.
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.
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.
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.”
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.
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.
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.
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.
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.
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.
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.
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.
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