Ankylosing spondylitis is a type of
arthritis characterized by chronic
inflammation which primarily affects the back and neck (i.e., spine). In severe cases, bones in the spine may fuse (also referred to as ankylosis) resulting in a rigid and inflexible spine. Abnormal posture may be a consequence. Other joints may also be involved, including the hips, knees, ankles, or shoulders. The disease may also be associated with
systemic effects, affecting various organs of the body.
The condition primarily affects men. Two to three times more men than women develop the disease. However, anyone can develop ankylosing spondylitis. The age of disease onset is usually between 17 to 35 years old. According to the CDC (Centers for Disease Control and Prevention's NHANES study), at least 2.7 million adults in the U.S. have axial spondyloarthritis.
The earliest symptoms of ankylosing spondylitis are typically pain and stiffness in the lower back region. Symptoms usually start before the age of 45. The pain and stiffness evolve and develop into chronic symptoms. Typically, ankylosing spondylitis pain worsens following rest or inactivity and improves with activity. It can cause
morning stiffness that lasts more than 30 minutes.
Pain and stiffness, over time, can progress up the spine to the neck. The bones of the spine and neck may fuse, causing limited range of motion and decreased flexibility of the spine.
As already mentioned, shoulders, hips, and other joints may be involved. Hip pain is quite common with ankylosing spondylitis and may be associated with pain in the groin or buttocks, as well as difficulty walking. If the rib cage is involved, abnormal chest expansion may cause breathing difficulties. Tendons and ligaments may be affected (e.g., heel involvement with
Achilles tendonitisand
plantar fasciitis).
Ankylosing spondylitis is a systemic disease as well, meaning that people may develop fever, fatigue, eye, or bowel inflammation. Heart or lung involvement is rare but possible.
Diagnosis of Ankylosing Spondylitis
The diagnosis is essentially based on symptoms, a physical examination, blood tests, and imaging studies. Early symptoms of ankylosing spondylitis can mimic other conditions, so diagnostic tests are used to rule out other spondyloarthropathies and other
rheumatic diseases. The absence of
rheumatoid factor and
rheumatoid nodules help to distinguish it from
rheumatoid arthritis.
While there is no single blood test that can definitively diagnose ankylosing spondylitis, the HLA-B27 test provides an important diagnostic clue, especially in certain groups of people. For example, ankylosing spondylitis is an unlikely diagnosis in someone who is white, of European descent, and negative for HLA-B27. Tests for nonspecific inflammation (
sedimentation rate and
CRP) are useful for formulating the clinical picture, but they are not diagnostic.
Imaging studies characteristic of ankylosing spondylitis show changes in the
sacroiliac joints. While the changes can be seen on x-rays, it may take years after the onset of symptoms to be observable. MRI can also be utilized to look for the characteristic changes to the sacroiliac joints. X-rays are used to assess evidence of damage to the spine as well.
Treatment of Ankylosing Spondylitis
Treatments for the condition primarily focus on reducing pain, stiffness, and inflammation. Preventing deformity, maintaining function, and posture training are also goals of treatment.
Medications used to treat ankylosing spondylitis include the following:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first line of pharmacologic treatment. Many people use NSAID medication alone to manage it.
- Analgesics or pain medications may be used when pain is not well-controlled by NSAIDs alone.
- TNF-blockers (Humira (adalimumab), Remicade (infliximab), Enbrel (etanercept), Cimzia (certolizumab pegol), and Simponi (golimumab)) are approved to treat ankylosing spondylitis and have shown significant improvements in disease activity.
- Cosentyx (secukinumab), an IL-17 inhibitor, was just approved in January 2016 for the condition.
- DMARDs (disease-modifying anti-rheumatic drugs) may be used to slow disease progression. Typically, sulfasalazine is used in ankylosing spondylitis patients with peripheral arthritis who cannot use a TNF blocker. Methotrexate alone may help some people, but generally it is not considered effective for ankylosing spondylitis. Another DMARD, Arava (leflunomide), is regarded as having little or no benefit.
- Oral corticosteroids are rarely used, but when they are taken, it should be short term, not long term.
Physical therapy and exercise are a significant part of any treatment plan for ankylosing spondylitis. The importance of exercise, as part of managing the disease and preserving mobility and function, cannot be overstated.
Prognosis of Ankylosing Spondylitis
Some people with the condition have a mild disease course and are able to work and function normally. Others develop severe disease and live with considerable restrictions due to the axial disease. Some people with ankylosing spondylitis develop life-threatening extra-articular complications—but that is not the case for most.
Typically, an individual patient deals with fluctuating disease activity that, for the most part, is manageable. About 1 percent of people with the disease actually achieve a stage where symptoms diminish and they are considered in remission.
Pay Attention to These Things
A spine that has fused, or that is less flexible, is more susceptible to fracture. That said, you must be mindful of the extra risk and take precautions. You should limit or avoid any behaviors that may increase your risk of falling. This can include anything from limiting the amount of alcohol you consume to installing grab bars and picking up throw rugs in your house. Avoid high-impact activity. Basically, use common sense and be protective of your spine.
You should use a pillow that places your neck and back in good alignment while you rest or sleep. Always use your seat belt when driving or as a passenger in a vehicle. Also, people with ankylosing spondylitis who smoke are advised to quit in order to lower their risk of breathing problems. And don't forget the importance of participating in an exercise program to strengthen your spine and improve your overall joint health.
A Word From Verywell
How well you live with ankylosing spondylitis will depend on the severity of your disease, as well as how committed you remain to your treatment plan, regular exercise, and being protective of your spine. Verywell has provided you with the basic facts about the condition and is a source you can refer back to for the disease management tips you need.
Sources:
Van der Linden S et al. Ankylosing Spondylitis. Kelley's Textbook of Rheumatology. Chapter 75. Elsevier. Ninth edition.
