Ankylosing spondylitis, or Bechterew’s disease, is a type of arthritis that primarily affects your spine and your sacroiliac joints. Ankylosing spondylitis can be difficult to diagnose because many other conditions can cause a similar type of back pain.
Doctors make an ankylosing spondylitis diagnosis by examining your medical history, symptoms, and results from imaging tests. Blood tests may be used to help rule out other conditions and look for signs of inflammation.
Read on to learn more about how doctors diagnose ankylosing spondylitis and what you can do if you’re diagnosed.
Ankylosing spondylitis is notoriously difficult to diagnose because there’s no single test your doctor can use, and inflammation may not show up on imaging tests in the early stages of the disease.
According to the Spondylitis Association of America, people average 8 to 11 years between symptom onset to the time of diagnosis.
The first step to getting an ankylosing spondylitis diagnosis usually starts with contacting a doctor. A doctor will examine your symptoms, medical history, and family history.
When analyzing your symptoms, your doctor will likely perform a physical exam.
Some tests they may perform include:
- asking you to touch your toes without bending your knees
- standing against a wall with a flat back
- measuring your ability to breathe in fully
Your doctor may ask you questions such as:
- What symptoms are you experiencing?
- When did your symptoms start?
- How long have you been experiencing symptoms?
- Are your symptoms worse at a particular time of day?
- Are your symptoms getting worse or staying the same?
Common early symptoms for most people with ankylosing spondylosis are lower back pain or hip pain. Some people develop pain in other parts of their body such as their ribs, hips, knees, or feet.
Cases of ankylosing spondylitis are typically idiopathic, meaning they have no clear cause. But having a close family member with ankylosing spondylitis may indicate that you carry genes that predispose you to its development. A 2014 research review found that people with siblings who have ankylosing spondylitis have up to a
If your doctor suspects you might have ankylosing spondylitis, they may order blood tests to search for signs of inflammation and to rule out other tests. If your blood test does show signs of inflammation, you may be referred to a rheumatologist for more tests.
Your doctor may recommend a genetic blood test to see if you have the HLA-B27 gene, which is common among people with ankylosing spondylitis. About 90 percent of people with ankylosing spondylitis have this gene.
Having the gene doesn’t necessarily mean you’ll develop ankylosing spondylitis. The Hospital for Special Surgery says that about 80 percent of people who are HLA-B27-positive never develop inflammatory disease.
Imaging tests may be able to show inflammation in your spine and evidence of your spine fusing to your pelvis. Damage to your joints may not show up in the early stages of the disease.
Imaging tests include:
According to the National Health Service, a diagnosis of ankylosing spondylitis is usually confirmed when an X-ray shows inflammation in your sacroiliac joints and one of the following is true:
- You’ve had back pain for at least 3 months that gets better with exercise and doesn’t improve with rest.
- You have limited movement in your lower back.
- You have a limited chest expansion capacity for your age and sex.
Mechanical vs. inflammatory pain
Back pain has many potential causes that can be mechanical or inflammatory.
Mechanical back pain is caused by putting stress on your spine. For example, a hard workout, sleeping on a poor-quality mattress, or injuring your back lifting something heavy.
Ankylosing spondylitis causes inflammatory back pain, which is when your immune system attacks your joints and causes damage. Unlike mechanical back pain, this type of back pain doesn’t generally respond well to rest. Regular stretching and medications that block your immune activity are generally the best options.
It’s important to get an early diagnosis for ankylosing spondylitis so you can start treatment early. Sometimes it can take years to receive your diagnosis. So, the sooner you start the process, the better you’ll be able to manage your symptoms.
People with a delayed diagnosis more commonly show less favorable:
- disease activity
- spinal function and mobility
- amounts of joint damage
- treatment response
Ankylosing spondylitis currently doesn’t have a cure. Treatment focuses on helping manage your symptoms and preventing your spine from fusing to your pelvis.
Treatment is usually made up of a combination of exercise, physiotherapy, and medications. If these treatments are not the best fit for you, surgery may be recommended to treat the affected joint.
Physical therapy and exercise
Physical therapy and exercise can help you improve strength and flexibility. Your physical therapist can provide you with specific exercises designed to improve your symptoms.
A number of medications may be recommended such as:
- nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen, or diclofenac
- other pain relievers such as paracetamol or codeine
- disease-modifying antirheumatic drugs, such as tumor necrosis factor inhibitor injections, secukinumab (Cosentyx), and Ixekizumab (Taltz)
Some general lifestyle changes or home remedies that can help you manage your symptoms include:
- stretching regularly
- applying heat to the inflamed area before exercise
- applying ice for up to 20 minutes after exercise
- avoiding alcohol and smoking
- exercising regularly
- getting plenty of rest
Doctors typically diagnose ankylosing spondylitis using a combination of tests. These include an in-depth review of your symptoms and medical history, physical assessments, and blood and imaging tests.
Early treatment and management of this condition is important. Call a doctor if you experience back pain that doesn’t seem to be related to mechanical causes, such as lifting heavy weight, or is not responding to rest.