Ankylosing spondylitis is a type of arthritis that affects your spine.
If you’ve recently received a diagnosis of ankylosing spondylitis, you’ll likely have a lot of questions for your doctor. These questions might include possible treatments and other basics about your condition.
Here are the answers to some of the most common ankylosing spondylitis questions. You can take this discussion guide with you to your next doctor’s appointment to use as a conversation starter.
Ankylosing spondylitis is also an inflammatory condition that involves inflamed or swollen joints. It often affects joints and bones in the spine and lower back. The spinal bones can fuse together over time.
There is currently no cure for ankylosing spondylitis, but it can be treated.
Ankylosing spondylitis is a type of inflammatory arthritis that affects the spine and the sacroiliac joints in the pelvis. Like other types of arthritis, ankylosing spondylitis causes pain and swelling in the joints.
This condition affects the bones of the spine (vertebrae) and joints in the lower back. It also causes swelling where the tendons and ligaments attach to bones in your spine. Your doctor might call this enthesitis.
Pain and discomfort from ankylosing spondylitis can lead to symptoms in other joints, such as your shoulders and hips.
More than 90 percent of people with ankylosing spondylitis carry the HLA-B27 gene. The prevalence of this gene varies in different ethnic populations.
According to the Spondylitis Association of America, in the United States, HLA-B27 is found in:
- 7.6 percent of the general white population
- 4.6 percent of the general Hispanic population
- 1 percent of the Black population
A 2017 study of 925 people with ankylosing spondylitis found that Black people had more severe cases of the disease than white or Hispanic people.
It is possible to have the HLA-B27 gene but not have ankylosing spondylitis.
Your doctor will likely start by asking about your symptoms and any family history of ankylosing spondylitis. An exam can reveal symptoms in your spine like:
The doctor may send you for an X-ray or MRI scan. Both tests can show damage to bones and soft tissues in your spine. An MRI creates more detailed images, and it can show damage earlier in the disease than an X-ray.
Another way to diagnose this condition is with a blood test for the HLA-B27 gene.
Your primary doctor might first suspect ankylosing spondylitis or may actually diagnose you. After this, they may refer you to a rheumatologist. This type of doctor specializes in diseases of the joints, bones, and muscles.
A rheumatologist might be your go-to doctor for treatment. You may also need to see a physical therapist, or an ophthalmologist if you have symptoms such as uveitis, swelling of the eye’s middle layer.
Ankylosing spondylitis treatment may involve:
- lifestyle changes
Most people with ankylosing spondylitis don’t need surgery unless their joints are very damaged.
A doctor may recommend one or more of the following treatments:
- nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to decrease pain and inflammation
- exercises that strengthen and stretch the affected joints in your back
- disease-modifying antirheumatic drugs (DMARDs) that decrease immune activity to reduce pain and inflammation in the joints, as an alternative to NSAIDs
- biologics, such as tumor necrosis factor (TNF) blockers, which are a DMARD made from living organisms
- corticosteroids may be injected into inflamed joints to help relieve pain
Diet hasn’t been well-studied for ankylosing spondylitis.
- whole grains
Try to avoid smoking, which drives inflammation. It can worsen joint damage from ankylosing spondylitis.
Surgery is a last resort option for people with severe joint damage. A joint replacement removes a damaged joint and replaces it with one made from metal, plastic, or ceramic.
Spinal surgery may be suggested when patients are severely impaired and unable to perform daily activities. Several procedures might be used based on the symptoms and imaging findings, including:
- Osteotomy. This involves cutting bone to straighten your spine and correct your posture.
- Laminectomy. This surgery relieves pressure on nerve roots by removing the lamina, part of the bone that forms the spine’s vertebral arch.
Physical therapy teaches you exercises, such as posture exercises, to improve your flexibility and range of motion, and decrease pain.
A review of studies found that, for people with ankylosing spondylitis, moderate exercise helped relieve their symptoms and improved their ability to perform daily activities.
Most people with ankylosing spondylitis have no complications.
For some people, there may be complications such as:
- fusion of the spinal bones and a forward curving of the spine
- weakening of the bones (osteoporosis) and fractures
- eye inflammation called uveitis
- cardiovascular disease such as aortitis, inflammation of the aorta
- cauda equina syndrome, a very rare condition that compresses the nerves at the bottom of the spine
- amyloidosis, another very rare condition in which the protein amyloid, found in your bone marrow, builds up in your heart, kidneys, or other organs
Symptoms that get worse can mean your treatment isn’t working as well as it should and your ankylosing spondylitis is progressing.
For example, your spine might feel stiffer or more painful than usual. Or, you might begin to experience symptoms in other joints. Excess tiredness is another sign of increased inflammation.
If you experience any new or worsening symptoms, call your doctor right away. They might recommend a change in your treatment plan to help relieve your discomfort and prevent your condition from getting worse.
There’s currently no cure for ankylosing spondylitis. There aren’t cures for most other forms of arthritis, either.
However, a combination of medications, physical therapy, and lifestyle changes can improve your symptoms and slow the rate of joint damage. A doctor will tell you your next steps based on your symptoms.
A diagnosis of ankylosing spondylitis can be confusing. That’s why it’s important to learn as much about your condition as you can.
If you still have questions, make sure you ask your doctor at your next appointment. This can help you get the treatment you need to prevent your condition from getting worse.