Ankylosing Spondylitis

Condition Basics

What is ankylosing spondylitis?

Ankylosing spondylitis is a form of joint inflammation (arthritis) that is long-lasting (chronic) and most often affects the spine. Ankylosing spondylitis commonly causes pain and stiffness, with limited motion in the low back, middle back, neck, hips, chest wall, and heels. Over time, joints in the spine can fuse together and cause a fixed, bent-forward posture.

In early ankylosing spondylitis, there is inflammation of the joints and of the ligaments where they attach near the joints.

In advanced ankylosing spondylitis, there is:

• Fusion of joints in the spine.
• Flattening of the normal curve in the low back.
• Often a flattening of the normal curve of the neck, an increase in the forward curve of the upper back, and bent posture at the hips.

Other joints can become painful and stiff, including those in 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. Scarring of the lungs also happens in rare cases. The kidneys and the digestive tract can also be affected.

What are the symptoms?

Symptoms of ankylosing spondylitis include 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.

Early symptoms include:

• Dull pain in the back.
• Flares of increased pain.
• Limited motion.
• Feeling tired.
• Eye problems.

Advanced symptoms include:

• Scarring in the spine that causes the joints to grow together.
• Problems with balance and movement.
• Trouble breathing.
• Vision problems that get worse.

How is it diagnosed?

Your doctor will ask about your symptoms and if they've gotten worse over time. They'll also ask if you have a family history of joint disease.

You may have a physical exam to see how stiff your back is. Your doctor may also want to see whether you can expand your chest normally. Your doctor may also look for tender areas. This may include areas over the points of the spine, the pelvis, the areas where your ribs join your breastbone, and your heels.

Several tests will be done if your doctor thinks that you may have this disease. You may have an X-ray, a test for the HLA-B27 gene, or an MRI of the sacroiliac joints.

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.

How is ankylosing spondylitis treated?

Treatment for ankylosing spondylitis focuses on:

• Relieving pain and stiffness.
• Reducing inflammation.
• Keeping the condition from getting worse.
• Helping you to keep doing your daily activities.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, seem to work best for pain and stiffness. Treatment also includes exercise and physical therapy. They will help reduce stiffness so that you can move around better.

You'll need to get regular eye exams to check for inflammation in your eye, called iritis.

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 you to keep doing your daily activities for as long as possible.