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 American Chiropractic Association reports that Americans spend about $50 billion a year on treating back pain.
There are many possible causes of low back pain. Usually, 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 (AS).
Unlike ordinary back pain, AS isn’t caused by physical trauma to the spine. Rather, it’s a chronic autoimmune condition caused by inflammation in the vertebrae, the bones of the spine. AS is a form of spinal arthritis.
The most common symptoms are intermittent flare-ups of spinal pain and stiffness. However, the disease can also affect other joints, as well as the eyes and the intestines.
In advanced AS, abnormal bone growth or calcification of the ligaments of the vertebral bodies of the spine may cause the joints to fuse. This can severely reduce mobility.
People with AS may also experience inflammation in other joints, such as their knees and ankles, and they may develop vision problems due to inflammation of the eyes.
1. You have 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 isn’t 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 your pelvis and spine meet.
2. You have a family history of AS
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.
You may have inherited genes that put you at greater risk for AS if you have a relative with:
- psoriatic arthritis
- arthritis related to inflammatory bowel disease
3. You’re young, and you have unexplained pain in the heels, 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, knees, or other joints.
Some patient’s rib bones are affected at the point where they meet the spine or where the ribs meet the sternum (breastbone). This can cause tightness in the chest that makes it hard to breathe.
Talk with your doctor if any of these conditions occur or persist.
4. Your pain may come and go, but it’s gradually moving up your spine — and it’s getting worse
AS is a chronic, progressive disease. Although exercise 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 (kyphosis).
This can be avoided if the condition is diagnosed early and treatment is started.
5. You get relief from your symptoms by taking NSAIDs
At first, people with AS will get symptomatic relief from common over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen.
However, these medications don’t alter the course of the disease.
If your doctors think you have AS, they may prescribe more advanced medications. These drugs target specific parts of your immune system responsible for the inflammatory response.
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.
Typically, the pain felt with AS is a dull, ongoing pain. Generally, you may feel some of the following:
- stiffness and increased pain in the morning after waking up that lessens throughout the day as you move around.
- pain while sleeping that can wake you up
- relief from light exercise, stretching, or a hot shower.
- pain may move from side to side, especially initially
- symptoms that ease off temporarily, and then return later
- fatigue from your body dealing with the inflammation
AS is more likely to affect young men, but it can affect anyone. 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. A genetic marker called
It’s unclear why some people get AS and others don’t.
A history of gastrointestinal or genitourinary infections may also increase risk of developing AS, according to the National Institute for Health and Care Excellence (NICE).
There’s no single test for AS. Diagnosis involves a detailed patient history and physical exam including:
- physical exam and questions about pain
- mobility testing to determine flexibility and movement
- blood tests for genetic markers such as HLA-B27
- imaging tests, such as a CT scan, MRI scan, or X-ray
If you find that your lower back pain (or pain in other joints) is lasting longer than you expected or you find that symptoms worsen with rest, you may want to contact your doctor for testing.
There’s currently no cure for AS, but you can reduce your symptoms and slow down the progression of the disease by:
- finding it early
- starting medical treatment
- engaging in specific physical therapy and postural training exercises
Treatments are advancing, which will help you live an active and full life with AS.
Reach out to your doctor to see what could be behind your back pain.