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What Does Ankylosing Spondylitis Look Like?

Medically reviewed by Ariel D. Teitel, M.D., M.B.A.
Written by Brooke Dulka, Ph.D.
Posted on November 15, 2021

Ankylosing spondylitis (AS), otherwise known as Bechterew’s disease, is a type of inflammatory arthritis that primarily affects the spine and causes back pain. Ankylosing spondylitis is also referred to as radiographic axial spondyloarthritis (axSpA).

During the progression of ankylosing spondylitis, the condition can cause fusion of the spine. This is characterized by the vertebrae (spine bones) growing together, resulting in less flexibility, a hunched-forward posture, and — if the ribs are affected — difficulty breathing. Some of the changes that come with AS require an imaging device (such as an X-ray) to see, while others — including eye inflammation — are apparent and visible.

Changes Visualized Through Imaging

Physicians, such as rheumatologists, use several different forms of imaging techniques to monitor AS disease progression. For instance, X-rays can be used to visualize malformations of the spine. X-rays, also called radiographs, use radiation to take pictures of bones and other materials that are harder than soft tissue, like skin and organs. Magnetic resonance imaging (MRI) is also used.

Radiography is the conventional method for assessing structural damage in spine and sacroiliac joints (joints that link the spine and pelvis) in individuals with AS. MRI has gained a prominent role in monitoring disease activity during clinical trials and regular clinical practice. Radiography and MRI are useful in monitoring the disease progression of AS and can complement each other well when used together.

Spondylitis vs. spondylosis: understanding the key differences

Erosion and ankylosis (immobility due to fusion) of the sacroiliac joints are the hallmarks of AS, and X-rays are commonly used to visualize disease progression in this area of the body. Additionally, early radiographic signs of AS in the spine are most often due to inflammation (enthesitis).

Computed tomography (CT) and ultrasonography are also sometimes used, but each have their drawbacks. For example, CT scans use large amounts of radiation and do not assess damage to soft tissues well.

Changes Visible to the Naked Eye

People with AS may develop kyphosis, a forward curvature of the spine that can cause a hunched-forward appearance. (Dreamstime)

Ankylosing spondylitis isn’t always apparent in the beginning stages. However, at some point, changes to the spine structure, like kyphosis, can become apparent to the naked eye.

Kyphosis is a forward curvature of the spine in the upper back area, which gives an abnormally rounded or “humpbacked” appearance. The spine can normally bend up to 45 degrees; kyphosis is defined by curvature greater than or equal to 50 degrees on an X-ray.

Other inflammation-related changes can occur in a person with AS. For example, the middle layer of tissue in the eye wall — called the uvea — can become inflamed. This is known as anterior uveitis, the symptoms of which include redness, pain, and blurred vision.

Up to 50 percent of people with ankylosing spondylitis develop uveitis, inflammation of the eye that can cause redness, pain, light sensitivity, and skewed vision. (iStock)


Emotional Impact of a Changing Body

Living with a spine that is curving can be difficult. Among members of MySpondylitisTeam, pain is a common experience for those with AS and spine curvatures. One member wrote, “I have some kyphosis in my thoracic spine, but my neck looks horrendous. The inward curvature is so much worse due to my neck curving, so I can still look straight ahead! It looks so painful.” Another member wrote, “My spine is starting to curve! I have been in so much pain. Everything HURTS!”

Pain is not only physically exhausting; it is mentally taxing too. Research shows that chronic pain is associated with worse mental health outcomes, particularly for depression and anxiety. However, more research is needed to specifically understand how spine pain impacts the quality of life in those with AS long-term.

Learn more about how spondylitis can affect your mental health.

Can Changes to the Body From Ankylosing Spondylitis Be Prevented?

Some medications can slow the progression of AS and prevent some of the damage to the spine. Currently, there are several medications approved by the U.S. Food and Drug Administration (FDA) to slow disease progression and prevent joint damage.

Tips for Maintaining Healthy Posture

Beyond taking your AS medications as prescribed, there are several other things you can do to help facilitate a healthy posture. For instance, physical therapy can provide a number of benefits, including pain relief, improved strength, and increased flexibility.

Additionally, range-of-motion and stretching exercises — including yoga poses — can help maintain flexibility in your joints and preserve good posture. In general, practicing good posture can help.

The American Chiropractic Association has a number of tips for improving posture. Some of these include:

  • While sitting, keep your feet on the floor. If they don’t reach, use a footrest.
  • Avoid crossing your legs. Keep your ankles directly in front of your knees.
  • Make sure your back is well supported, either by adjusting the backrest of your chair or using some other type of support.
  • Adjust your seated position periodically. Remember to take breaks and move your body.
  • While standing, bend your knees slightly and keep your feet about shoulder-width apart.
  • When sleeping at night, avoid lying on your stomach.

One member of MySpondylitisTeam recommends a back brace for helping with posture and reducing low back pain.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with spondylitis and their loved ones. On MySpondylitisTeam, more than 72,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

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

Posted on November 15, 2021
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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.
Brooke Dulka, Ph.D. is a freelance science writer and editor. She received her doctoral training in biological psychology at the University of Tennessee. Learn more about her here.

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