Ankylosing spondylitis (say "ang-kill-LOH-sing spawn-duh-LY-tus") is a long-term form of arthritis that most often occurs in the spine. It can cause pain and stiffness in the low back, middle back, buttocks, and neck, and sometimes in other areas such as the hips, chest wall, or heels. It can also cause swelling and limited motion in these areas. This disease is more common in men than in women.
There is no cure, but treatment can control symptoms and prevent the disease from getting worse in most cases. Most people are able to do their normal daily activities and can still work.
This disease can cause several other problems. You may have redness and pain in the colored part of your eye (iritis). You also may have trouble breathing as your upper body begins to curve and your chest wall begins to stiffen.
The cause is unknown, but it may run in families. Most people with ankylosing spondylitis are born with a certain gene, HLA-B27. But having this gene does not mean that you will get the disease.
Research suggests that bacterial infections and your environment may have roles in causing this disease.
This disease causes mild to severe pain in the low back and buttocks that is often worse in early morning. Some people have more pain in other areas, such as the hips or heels. The pain usually gets better slowly as you move around and are active. Ankylosing spondylitis most often begins anywhere from the teenage years through the 30s.
It gets worse slowly over time as swelling of the ligaments, tendons, and joints of the spine causes the bones of the spine to join, or fuse, together. This leads to less range of movement in the neck and low back.
As the spine fuses and stiffens, the neck and low back lose their normal curve. The middle back curves outward. This can keep you in a bent-forward position and may make it hard for you to walk.
As the small joints that connect the ribs and collarbone to the breastbone get inflamed, you may find that it's harder for you to breathe. Other parts of the body, such as your eyes and your other joints, may also swell. Sometimes the disease affects the lungs, the heart valves, the digestive tract, and the major blood vessel called the aorta.
The early signs of this disease—dull pain in the low back and buttocks—are common. Your doctor will ask about your symptoms and if they have become worse over time. Your doctor will also ask if you have a family history of this joint disease or others like it.
The clearest sign of the disease is a change in the sacroiliac joints at the base of the low back. This change can take up to a few years to show up on an X-ray.
Treatment includes exercise and physical therapy. These will help reduce stiffness so that you can stand up straighter and move around better. Your doctor will also give you medicine for pain and swelling.
Because people with ankylosing spondylitis may be at a higher risk for spinal cord injury, it's important that you wear a seat belt every time you drive or ride in a car.
You will need to get regular eye exams to check for inflammation in your eye, called iritis. You may use a device such as a cane to help you walk and to help reduce stress on your joints.
Surgery for the spine is rarely needed. You may want to think about hip or knee replacements if you have severe arthritis in those joints.
There is no cure for this disease. But early diagnosis and treatment can help relieve pain and stiffness and allow you to keep doing your daily activities for as long as possible.
Ankylosing spondylitis is inflammation primarily of the joints of the spine. But it can also involve inflammation of the eye, other joints—especially those in the hips, chest wall, and around the heels—and, on occasion, the shoulders, wrists, hands, knees, ankles, and feet. Although it is unusual, ankylosing spondylitis can also cause changes such as thickening of the major artery (aorta) and the valve in the heart called the aortic valve.
If the inflammation continues over time, it will lead to scarring and permanent damage. In some people the disease is mild and progresses slowly, and symptoms may never become severe. Other people may have a more aggressive disease process.
Whether ankylosing spondylitis gets worse depends on a number of things such as how old you were when the disease began, how early it was diagnosed, and what joints are involved. It's too early to tell yet, but experts hope that early treatment with newer medicines will slow or minimize the inflammation, prevent scarring, and limit the progression of the disease.
Ankylosing spondylitis usually starts with dull pain in the low back and back stiffness. Some people with ankylosing spondylitis have "flares" of increased pain and stiffness that may last for several weeks before decreasing again.
If, over time, the inflammation continues, it will lead to scarring and permanent damage.
The stiffening of the chest can feel like the discomfort or "heaviness" of a heart attack. Ankylosing spondylitis can also cause the heart to work less efficiently.
If you have any symptoms of heart or lung problems—including heaviness of the chest or pain with deep breathing—talk to a doctor right away to make sure you don't have any serious heart or lung problems. For more information on heart and lung problems, see the topics Heart Attack and Unstable Angina and Pleurisy.
Ankylosing spondylitis is one disease in a group of joint diseases called the spondyloarthropathies (say "spon-dill-o-ar-THROP-a-thees"). These include psoriatic arthritis, reactive arthritis, and enteropathic arthritis (joint problems linked with inflammatory bowel disease). Although inflammation of the spine also occurs in these other conditions, it is less common and less severe than the inflammation that occurs in ankylosing spondylitis.
Your doctor will use a medical history, physical exam, and X-ray to diagnose ankylosing spondylitis.
By asking questions about your medical history, your doctor can evaluate your symptoms. Most people with ankylosing spondylitis have back pain with four or five of the following characteristics:
Your doctor will want to know whether you have any family members who have ankylosing spondylitis or a related joint disease. Many people with ankylosing spondylitis have a family member with the same condition. He or she may also ask whether you have had ongoing diarrhea, abdominal (belly) pain, multiple infections of the cervix (in women) or urethra (more common in men), psoriasis, or inflammation of the eye chamber (uveitis). These could be clues to having a condition other than ankylosing spondylitis.
You will have a physical exam to see how stiff your back is and whether you can expand your chest normally. Your doctor will also look for tender areas, especially over the points of the spine, the pelvis, the areas where your ribs join your breastbone, and your heels. You may experience chest pain and stiffness with ankylosing spondylitis.
Tests related to ankylosing spondylitis include:
Treatment for ankylosing spondylitis focuses on relieving pain and stiffness, reducing inflammation, keeping the condition from getting worse, and enabling you to continue daily activities. Early diagnosis and treatment may reduce pain, stiffness, inflammation, and deformity.
Talk with your doctor about the best treatment approach for your condition. A consultation with a rheumatologist is often recommended, especially to confirm the diagnosis and lay out a treatment plan. Your family medicine physician or internist can treat mild cases. Or you may be referred to a rheumatologist, orthopedist, or physiatrist.
Initial treatment for ankylosing spondylitis may include:
Talking with your doctor about your job. A job that is physically demanding—such as a job that requires lots of heavy lifting—could increase your symptoms.
If initial treatment does not sufficiently reduce the pain and inflammation linked with ankylosing spondylitis, and as your condition progresses, ongoing treatment may include:
Your doctor will treat complications of ankylosing spondylitis as they occur. For example, iritis may be treated with medicines that can help reduce inflammation of the eye, such as corticosteroids and mydriatic eyedrops.
In rare cases, you may need surgery to replace joints that are severely damaged by the inflammation of ankylosing spondylitis. The most common surgery done is hip replacement surgery. Spine surgery is done in a very small number of people who have ankylosing spondylitis. If there is loosening of the top two vertebrae in the neck and there are signs of pressure on the spinal cord such as numbness or clumsiness in the hands or arms, a surgeon may permanently join (fuse) the two vertebrae together. In very rare cases, spinal surgery may be done to straighten a part of the spine that has become severely curved, but the surgery is risky and cannot restore motion.
Because ankylosing spondylitis is a lifelong condition, other treatment may include complementary therapies, which can reduce symptoms, help manage pain, and improve quality of life. These therapies may include yoga and acupuncture.
Even if your symptoms are under control, you should see your doctor (often a rheumatologist) every year to watch for and treat any complications. People with hip symptoms and perhaps those whose disease started in their teens may be at risk for a more severe progression of ankylosing spondylitis.
If you have been diagnosed with ankylosing spondylitis, there are steps that you can take at home to help reduce pain and stiffness and allow you to continue daily activities. These steps include:
Other Works Consulted
- Deimel GW IV, Braverman SE (2015). Ankylosing spondylitis. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 3rd ed., pp. 609–613. Philadelphia: Saunders.
- Inman RD (2016). The spondyloarthropathies. In L Goldman, A Shafer, eds., Goldman-Cecil Medicine, 24th ed., vol. 2, pp. 1762–1769. Philadelphia: Saunders.
- Van der Linden SM, et al. (2013). Ankylosing spondylitis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 2, pp. 1202–1220. Philadelphia: Saunders.
- Ward MM, et al. (2016). American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis and Rheumatology, 68(2): 282–298. DOI: 10.1002/art.39298. Accessed April 29, 2016.
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