Back pain is one of the most common ailments in the United States today. In fact, according to the National Institute of Neurological Disorders and Stroke, it’s the second most common neurological ailment reported. Many of these cases are caused by injury or damage. However, some cases may be the result of another condition.

One such condition is ankylosing spondylitis (AS). As much as one percent of Americans, or about 2.7 million adults, may be affected by AS. Men are affected more often than women. For the millions of Americans suffering day in and day out with chronic back pain, understanding this disease may hold the key to managing the pain.

What Is Ankylosing Spondylitis?

Ankylosing spondylitis is a progressive inflammatory disease and form of arthritis. The disease causes swelling in the spine and nearby joints. Over time, the chronic inflammation can cause the vertebrae in the spine to fuse together. As a result, the spine will be less flexible. Many people with the disease hunch forward to compensate for their rigid spine. In advanced cases of the disease, the inflammation may be so bad that a person cannot lift their head in order to see in front of them.

What Makes Ankylosing Spondylitis Different from Other Forms of Arthritis?

Ankylosing spondylitis primarily affects the spine and the vertebrae. Most people with the disease experience chronic back pain and loss of flexibility in the spine. However, ankylosing spondylitis can also affect joints outside the spine, including the shoulders, feet, knees, and hips. In rare cases, it can also affect organs and tissue.

Ankylosing spondylitis does have one unique characteristic when compared to other forms of arthritis: sacroiliitis. This is the inflammation of the sacroiliac joint, or the joint where the spin and the pelvis join. It is very common in people with ankylosing spondylitis, but is not common in people with other forms of arthritis.

What Tests Are Used to Diagnose Ankylosing Spondylitis?

Doctors do not have a single test with which to diagnose this disease. In order to diagnose this disease, your doctor must exclude other possible explanations for your symptoms. Several tests can rule out other possible causes. These tests include:

Your Medical History

To help understand your symptoms, your doctor will want to get your full health history. Your doctor will want to know:

  • how long you’ve been experiencing symptoms
  • when your symptoms are worse
  • what treatments you’ve tried, what has worked, and what hasn’t
  • what other symptoms you are experiencing
  • your history of medical procedures or problems
  • any family history of problems similar to what you’re experiencing 

A Full Physical Exam

Your doctor may want to conduct a physical exam. The exam allows them to find telltale signs and symptoms of ankylosing spondylitis. Your doctor may also have you do a few exercises so they can observe the range of motion in your joints.

Imaging Tests

Imaging tests give your doctor an idea of what’s happening inside your body. The imaging tests you may need include:

  • X-ray: An X-ray allows your doctor to see your joints and bones. He or she will look for signs of fusing or damage.
  • magnetic resonance imaging (MRI): An MRI sends radio waves and a magnetic field through your body to produce an image of your body’s soft tissues. This helps your doctor see inflammation around joints.
  • computed tomography (CT): A CT scan is another form of X-ray medical imaging. It allows doctors to see inside the body layer by layer.

Laboratory Tests

Lab tests your doctor may order include:

  • the HLA-B27 gene test: Decades of research into this disease has revealed one detectable risk factor: your genes. People with the HLA-B27 gene are more susceptible to developing ankylosing spondylitis. However, not everyone with the gene will develop the disease. Still, a test can help your doctor understand if this is a possibility for you.
  • complete blood count (CBC): This test measures the number of red and white blood cells in your body. A CBC test can help identify and rule out other possible conditions.
  • erythrocyte sedimentation rate (ESR): An ESR test uses a blood sample to measure inflammation in the body.

Before Your Appointment

Before your appointment, make a list of all the questions you have for your doctor. Bring with you a timeline of your symptoms, any test results you may have, and any medicine you may be taking. Take notes while you’re talking with your doctor. Being an informed patient makes you a better patient.

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.