Symptoms

Your spine does more than just hold you upright. It interacts with your immune, skeletal, muscular, and nervous systems. So when something goes wrong with your spine, it may have far-reaching effects throughout your body. Keeping your spine happy is an important part of your overall health.

Ankylosing spondylitis (AS) is a case in point. It’s a form of arthritis associated with long-term inflammation of the joints in the spine. The first symptoms of AS are usually pain in the low back and hips, and people often pass it off as just a “bad back.” But AS tends to get worse with time, especially if not treated. As the disease progresses, it may affect many parts of the body, including other joints and the eyes, bowels, feet, and heart.

Inflamed Spinal Joints

AS typically starts with pain in the low back and hips caused by inflammation of spinal joints there. As the years pass, inflammation—and the symptoms caused by it—may gradually move up the spine and give rise to complications.

These are three important features of AS:

  • Sacroilitis. An early hallmark of AS is inflammation of the sacroiliac joints, located where the spine meets the pelvis. This inflammation causes pain in the hips. Sometimes the pain radiates down the thighs, but never below the knees.
  • Enthesitis. Another characteristic of AS is inflammation of entheses—places where ligaments and tendons attach to bones. This type of inflammation causes much of the pain and loss of function that’s seen in the disease.
  • Fusion. The body’s repeated attempts to heal inflamed entheses can lead to the scarring of tissue, followed by the formation of extra bone. Ultimately, two or more bones of the spine may become fused, limiting flexibility in the back. In severe cases, the spine may develop a forward curvature, causing a permanently stooped posture. Fortunately, it’s far less common to reach this stage today, thanks to treatment advances.

Beyond the Spine

As time goes by, the inflammation caused by AS may affect other parts of the body as well:

  • Other joints. Inflammation may cause pain and stiffness in joints of the neck, shoulders, hips, knees, ankles, or, rarely, fingers and toes.
  • The chest. About 70 percent of people with AS develop inflammation at the junction of the ribs and spine. The point where the ribs meet the breastbone in front may also be affected, leading to chest pain. Eventually, stiffening of the ribcage may limit how much the chest can expand, reducing how much air the lungs can hold.
  • The eyes. Up to 40 percent of people with AS develop inflammation of the eye, called uveitis or iritis. This inflammation may cause eye pain and redness, sensitivity to light, and blurred vision. If not treated promptly, it can lead to vision loss.
  • The feet. Inflamed entheses may occur at the back or base of the heel. The pain and tenderness can seriously hamper a person’s ability to walk.
  • The bowels. Inflammation may cause symptoms of inflammatory bowel disease, including abdominal cramps and diarrhea, sometimes with blood or mucus in the stool.
  • The jaw. Inflammation of the jaw is uncommon, affecting no more than 15 percent of AS patients. But it can be especially troublesome, making it difficult to eat.
  • The heart. In rare cases, the body’s largest artery, called the aorta, becomes inflamed. It may enlarge so much that it distorts the shape of the valve connecting it to the heart.

Nerve Root Involvement

People with very advanced AS may develop cauda equina syndrome, a disorder affecting a bundle of nerve roots at the bottom of the spinal cord. These nerve roots transmit messages between the brain and the lower body. When damage caused by AS compresses the nerve roots, it can impair functioning of the pelvic organs or sensation and movement in the lower limbs.

Be alert for warning signs of cauda equina syndrome:

  • Problems with bladder or bowel function. You might either retain waste or be unable to hold it.
  • Severe or progressively worsening problems in the lower limbs. You may experience loss of or changes in sensation in key areas: between the legs, over the buttocks, on the backs of the legs, or in the feet and heels.
  • Pain, numbness, or weakness spreading to one or both legs. The symptoms may make you stumble when you walk.

If you develop these symptoms, it’s crucial to seek prompt medical attention. Left untreated, cauda equine syndrome can lead to impaired bladder and bowel control, sexual dysfunction, or paralysis.

What’s the Good News?

This long list of potential complications can be intimidating. However, treatment for AS may be able to prevent or delay many problems. In particular, some doctors believe that a newer group of medications called tumor necrosis factor (TNF) inhibitors may be able to change the course of the disease.

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.