Overlooked Cause of Lasting Back Pain

Whether it’s a dull ache or a sharp stab, back pain is among the most common of all medical problems. In any three-month period, about one-fourth of U.S. adults suffer through at least one day of back pain.

Many people lump all back aches and pains together as a “bad back.” But there are actually many causes for back pain, including muscle spasms, ruptured disks, back sprains, osteoarthritis, infections, and tumors. One possible cause that rarely gets the attention it deserves is ankylosing spondylitis (AS), a form of arthritis that’s associated with long-term inflammation of the joints in the spine.

If you’ve never heard of AS, you’re certainly not alone. Yet it’s more prevalent than you might think. AS is head of a family of diseases—also including psoriatic arthritis and reactive arthritis—that cause inflammation in the spine and joints. As many as 2.4 million U.S. adults have one of these diseases, according to the National Arthritis Data Workgroup. So maybe it’s time you got to know AS better.

Ankylosing Spondylitis 101

AS mainly affects the spine and sacroiliac joints (places where the spine joins the pelvis). Inflammation in these areas can cause back and hip pain and stiffness. Eventually, long-lasting inflammation may lead some bones of the spine, called vertebrae, to fuse together. This makes the spine less flexible and may lead to a stooped-over posture.

At times, AS also affects other joints, such as those of the knees, ankles, and feet. Inflammation in joints where the ribs attach to the spine may stiffen the ribcage. This limits how much the chest can expand, restricting how much air the lungs can hold.

Occasionally, AS affects other organs, too. Some people develop inflammation of the eyes or bowel. Less often, the largest artery in the body, called the aorta, may become inflamed and enlarged. As a result, heart function may be impaired.

How the Disease Progresses

AS is a progressive disease, which means that it tends to get worse as time goes by. Typically, it starts with pain in the low back and hips. Unlike many kinds of back pain, however, the discomfort of AS is most severe after a rest or upon rising in the morning. Exercise often helps it feel better.

Typically, the pain comes on slowly. Once the disease is established, the symptoms may go through good and bad periods. But as the years pass, the inflammation tends to move up the spine. It gradually causes greater pain and more restricted movement.

The symptoms of AS vary from person to person. Here’s a look at how they might progress:

  • As your lower spine stiffens and fuses: You can’t get close to touching your fingers to the floor when bending over from a standing position.
  • As pain and stiffness increase: You may have trouble sleeping and be bothered by fatigue.
  • If your ribs are affected: You may find it difficult to take a deep breath.
  • If the disease spreads higher up your spine: You may develop a stooped-shoulder posture.
  • If the disease reaches your upper spine: You may find it hard to extend and turn your neck.
  • If inflammation affects your hips, knees, and ankles: You may have pain and stiffness there.
  • If inflammation affects your feet: You may have pain at your heel or the bottom of your foot.
  • If inflammation affects your bowel: You may develop abdominal cramps and diarrhea, sometimes with blood or mucus in the stool.
  • If inflammation affects your eyes:You may suddenly develop eye pain, sensitivity to light, and blurred vision. See your doctor immediately for these symptoms. Without prompt treatment, eye inflammation can lead to permanent vision loss.

Why Treatment Is Important

There’s still no cure for AS. But treatment can ease its symptoms and may possibly keep the disease from getting worse. For most people, treatment involves taking medication, doing exercises and stretches, and practicing good posture. For severe joint damage, surgery is sometimes an option.

If you’re bothered by long-term pain and stiffness in your low back and hips, don’t just write it off to having a bum back or not being 20 anymore. See your doctor. If it turns out to be AS, early treatment can make you feel more comfortable now, and it might prevent some serious problems in the future.

Read Video Transcript »

Ankylosing Spondylitis: Much More Than Back Pain

Ankylosing spondylitis is a form of arthritis caused by inflammation of the joints.

Patients often begin experiencing painful symptoms in early adulthood, including aches and stiffness in the lower back and hips. These are often the worst after periods of inactivity or immediately after waking up.

Unlike typical back pain one might experience from injury or spending too many hours in a chair, ankylosing spondylitis can affect other joints, particularly joints in the spine at the lower back and pelvis. The hip and shoulder joints can also be affected as well.

The vertebrae in the back are of particular concern because, if left untreated, these joints can fuse together. This can cause a person to have a hunched over posture and may affect a person’s ability to breathe.

While many patients endure these painful symptoms for up to 10 years before receiving a proper diagnosis, those who work with their doctors to find proper treatment experience a much greater quality of life.

Experts agree that ankylosing spondylitis and other related diseases can run in families, so if you have relatives with a history of immune problems, you may be more likely to develop ankylosing spondylitis.

If you’re experiencing lasting pain for more than three months that feels worse in the morning and better with movement, you should talk to your doctor about ankylosing spondylitis as the potential cause of your symptoms.

Your doctor will perform a physical exam and ask you about your symptoms and whether you have a history of injuries in the affected joints. Your doctor may order imaging tests, such as an X-ray or MRI, to get a better look at what’s causing your pain. You can also expect a simple blood test to check for signs of inflammation, as well as to rule out other potential illnesses.

Your family doctor may initially diagnose you with inflammatory back pain, and refer you to a rheumatologist, a doctor who specializes in medicine related to joints and autoimmune diseases. As ankylosing spondylitis is not associated with mechanical issues that occur with injury-related back pain, it cannot be simply remedied with surgery and requires other therapies.

While scientists continue to look for a cure for ankylosing spondylitis, there are many effective therapies that can relieve pain, improve dexterity, and delay advanced complications, such as joint damage.

Doctors often rely on drugs to reduce the painful and destructive joint inflammation with ankylosing spondylitis. These include nonsteroidal anti-inflammatory drugs, known as NSAIDs, and TNF, or tumor necrosis factor, blockers. TNF blockers are part of class of medications called biologics that suppress aspects of the body’s inflammatory response and may slow the progression of ankylosing spondylitis.

Many patients also benefit from regular exercises with a physical therapist. Patients often find that stretching and rage-of-motion exercises, such as yoga or pilates, can help relieve pain, increase flexibility in joints, and improve physical strength.

Ankylosing spondylitis may be a lifelong condition, but it doesn’t have to be a life-limiting one.

Working closely with your doctor about latest treatments and making smart lifestyle choices can help keep painful symptoms at bay so you can live your life as you see fit.

To learn more about Ankylosing Spondylitis, take a look at the information we have here at Healthline or make an appointment with your doctor.