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, roughly 80 percent of adults experience low back pain at some point in their lifetimes. Many of these cases are caused by injury or damage. However, some may be the result of another condition.

One such condition is ankylosing spondylitis (AS). This is a type of axial spondyloarthritis, which affects up to 1 percent of Americans, or about 2.7 million adults. Men are affected more often than women, though it may be less recognized in women. For the millions of Americans with chronic back pain, understanding this disease may hold the key to managing their pain.

What is AS?

AS is a progressive inflammatory disease. A form of arthritis, the disease causes swelling in your spine and nearby joints. Over time, the chronic inflammation can cause the vertebrae in your spine to fuse together, making your spine less flexible. Many people with the disease hunch forward because their extensor muscles, which allow extension, weaken. In advanced cases, a person with AS can’t lift their head in order to see in front of them.

What makes AS different from other forms of arthritis?

AS primarily affects the spine and the vertebrae, specifically where tendons and ligaments connect to bone. Most people with the disease experience chronic back pain and loss of flexibility in their spine. However, AS can also affect joints outside the spine, including the shoulders, feet, knees, and hips. In rare cases, it can also affect organs and tissue.

AS does have one unique characteristic when compared to other forms of arthritis: sacroiliitis. This is inflammation of the sacroiliac joint, or the joint where your spine and pelvis connect. It’s a hallmark of people with AS, and isn’t common in people with other forms of arthritis.

How is AS diagnosed?

Doctors don’t 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. To do this, your doctor first looks at your medical history, and then performs a physical exam and other tests.

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’re 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 AS. Your doctor may also have you do a few exercises or passively move your joints, 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 need may include:

  • X-ray: An X-ray allows your doctor to see your joints and bones. They will look for signs of fusing or damage.
  • MRI scan: 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 within and around joints.

Laboratory tests

Lab tests your doctor may order include:

  • 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 AS. However, not everyone with the gene will develop the disease.
  • 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 your body.
  • C-reactive protein (CRP): The CRP test also measures inflammation, but is more sensitive than an ESR test.

Before your appointment

Make a list of all the questions you have for your doctor before you see them. Bring with you a timeline of your symptoms, any test results you may have, any medicine you may be taking, and known family history of medical conditions. Being prepared will help you make the best use of your time when you see your doctor.

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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.