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Beyond Back Pain: 5 Warning Signs of Ankylosing Spondylitis

Is It Just a Sore Back—or Is It Something Else?

Back pain is a top medical complaint. It’s also a leading cause of missed work. According to the National Institute of Neurological Disorders and Stroke, virtually all adults will seek attention for back pain at some point in their lives. The institute reports that Americans spend about $50 billion a year on treating low back pain.

There are many possible causes of low back pain. Usually the cause is mechanical, which means it’s caused by trauma from a sudden strain on the spine. But you should be aware that back pain can also signal a more serious condition called ankylosing spondylitis.

What Is Ankylosing Spondylitis?

Unlike ordinary back pain, ankylosing spondylitis (AS) is not caused by physical trauma to the spine. Rather, it is a chronic condition caused by inflammation in the vertebrae (the bones of the spine). AS is a form of spinal arthritis.

Although intermittent flare-ups of spinal pain and stiffness are the most common symptoms, the disease can also affect other joints, as well as the eyes and the intestines. In advanced AS, abnormal bone growth in the vertebrae may cause joints to fuse, severely reducing mobility. Patients may also experience vision problems, or inflammation in other joints, such as the knees and ankles.

Who Is the Typical Patient?

AS is more likely to affect young men, but it can strike males or females. Initial symptoms usually appear in the late teen to early adult years. AS can develop at any age, however. The tendency to develop the disease is inherited, but not everyone with these marker genes will develop the disease. It is as yet unclear why some people get AS and others don’t. A majority of Caucasian people with the disease carry a particular gene called HLA-B27, but not all people with the gene develop AS. Up to 30 genes have been identified that may play a role.

What Are the Warning Signs?

Sign #1: Unexplained pain in the lower back.

Typical back pain often feels better after rest. AS is the opposite. Pain and stiffness are usually worse upon waking. While exercise may make ordinary back pain worse, AS symptoms may actually feel better after exercise.

Lower back pain for no apparent reason is not typical in young people. Teens and young adults who complain of stiffness or pain in the lower back or hips should be evaluated for AS by a doctor. Pain is often located in the sacroiliac joints, where the pelvis and spine meet.


Sign #2: You have a family history of AS.

There is no single test for AS. Diagnosis involves a detailed patient history and physical exam. Your doctor may also order imaging tests, such as computed tomography (CT), magnetic resonance imaging (MRI), or X-ray. Some experts believe MRI should be used to diagnose AS in the early stages of the disease, before it shows up on X-ray.

People with certain genetic markers are susceptible to AS. But not all people who have the genes develop the disease, for reasons that remain unclear. If you have a relative with either AS, psoriatic arthritis, or arthritis related to inflammatory bowel disease, you may have inherited genes that put you at greater risk for AS.

Unexplained Heel, Joint, or Chest Pain

Sign #3: You’re young, and you have unexplained pain in the heel(s), joints, or chest.

Instead of back pain, some AS patients first experience pain in the heel, or pain and stiffness in the joints of the wrists, ankles, or other joints. Some patient’s rib bones are affected, at the point where they meet the spine. This can cause tightness in the chest that makes it hard to breathe. Talk to your doctor if any of these conditions occur or persist.

It’s Getting Worse

Sign #4: Your pain may come and go, but its gradually moving up your spine. And it's getting worse.

AS is a chronic, progressive disease. Although exercise and/or pain medications may help temporarily, the disease may gradually worsen. Symptoms may come and go, but they won’t stop completely. Often the pain and inflammation spread from the low back up the spine. If left untreated, vertebrae may fuse together, causing a forward curvature of the spine, or humpbacked appearance (kyphosis).

Treatment Helps

Sign #5: You get relief from your symptoms by taking NSAIDs.

At first, AS sufferers will get symptomatic relief from common over-the-counter anti-inflammatory drugs, such as ibuprofen or naproxyn. These drugs, called NSAIDs, do not alter the course of the disease, though.

If your doctors think you have AS, they may prescribe more advanced medications. These drugs target specific parts of the immune system. Immune system components called cytokines play a central role in inflammation. Two in particular—tumor necrosis factor alpha and interleukin 10—are targeted by modern biological therapies. These drugs may actually slow the progression 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.

More Resources

The Progression of Ankylosing Spondylitis
Video: Symptoms of Ankylosing Spondylitis
Diagnosing Ankylosing Spondylitis