Ankylosing Spondylitis: Symptoms, Causes & Treatment

Ankylosing spondylitis is an inflammatory disease that primarily affects the spine and may also affect large joints, such as the hips, shoulders, and knees. Common symptoms include back or hip pain, spinal stiffness, difficulty moving, and pain that improves with movement but worsens during rest.

Ankylosing spondylitis is also known as radiographic axial spondyloarthritis. It usually begins in the sacroiliac joints and lower back and may gradually progress to other areas of the spine.

Treatment is usually managed by a rheumatologist and may include nonsteroidal anti-inflammatory drugs, other pain-relieving medications, biologic medications, exercise, and physical therapy. An orthopedic specialist may be involved in severe cases or when surgery is needed.

Ankylosing spondylitis symptoms

The main symptoms of ankylosing spondylitis include:

• Lower back pain that improves with exercise and worsens with rest

• Morning stiffness and difficulty turning the head from side to side

• Pain in the buttocks and/or the back of the legs

• Difficulty taking a deep breath

• Numbness and/or tingling in the arms or legs

• A hunched posture, with the head leaning forward

• Pain or tenderness that spreads to the ribs, shoulders, hips, thighs, knees, and/or heels

• Joint swelling, excessive tiredness, and lack of energy

Symptoms of ankylosing spondylitis usually develop gradually. Over the years, they may become more frequent and noticeable.

When the condition is not diagnosed and treated, complications such as plantar fasciitis and uveitis may develop. Uveitis is inflammation of the uvea, the part of the eye that includes the iris, ciliary body, and choroid.

Confirming a diagnosis

Ankylosing spondylitis is diagnosed by an orthopedic specialist or rheumatologist. The doctor performs a physical examination and evaluates the person's symptoms, medical history, and the presence of other conditions, such as psoriasis, inflammatory bowel disease, or uveitis.

Imaging tests, such as an X-ray or magnetic resonance imaging (MRI) scan of the sacroiliac joints and spine, are also usually recommended.

The doctor may also order blood tests, such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), or an HLA-B27 test, because this genetic marker is associated with the condition.

Possible causes

The exact cause of ankylosing spondylitis is not fully understood. However, it appears to be associated with the HLA-B27 gene, which may cause abnormal immune system responses and changes in the bones and joints of the spine, chest, hips, shoulders, knees, and head.

However, not everyone who carries the HLA-B27 gene develops ankylosing spondylitis.

Risk factors for developing ankylosing spondylitis include:

• Being younger than 40

• Having a family history of the condition

• Being male

Certain conditions, such as ulcerative colitis, psoriasis, and Crohn's disease, also appear to increase the risk of ankylosing spondylitis.

Ankylosing spondylitis treatment

Treatment depends on the symptoms and severity of the condition and may include:

1. Exercise

Regular physical activity, such as swimming, Pilates, water aerobics, running, and dancing, is an important part of treatment. Exercise helps keep the joints moving, relieve inflammatory symptoms, and prevent the condition from progressing.

Exercises should be performed with guidance from a qualified fitness professional. This helps prevent injuries and ensures that the exercise program is appropriate for each person's needs and limitations.

It is also important to avoid activities that place excessive strain on the body or involve physical contact, such as combat sports or martial arts.

2. Physical therapy

A doctor may prescribe physical therapy with a licensed physical therapist. According to the American College of Rheumatology, active physical therapy interventions, such as supervised stretching and strengthening exercises, are strongly recommended for adults with active ankylosing spondylitis.

Physical therapy can improve joint mobility, flexibility, range of motion, and posture while helping relieve pain and other symptoms.

3. Medications

Medications that may be recommended by the doctor include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac, or naproxen

• Pain relievers, such as acetaminophen

• Opioid pain relievers, such as codeine

• Corticosteroid injections administered directly into the affected joint

• Biologic medications, including tumor necrosis factor (TNF) inhibitors, such as etanercept, adalimumab, infliximab, or certolizumab pegol, and interleukin-17 (IL-17) inhibitors, such as ixekizumab

• Immunosuppressive or disease-modifying medications, such as sulfasalazine, methotrexate, or tofacitinib

According to the American College of Rheumatology, NSAIDs are generally used first for active ankylosing spondylitis, while biologic medications may be considered when symptoms remain active despite treatment. Other medications may be recommended depending on symptom severity and how much the condition affects daily activities.

4. Surgery

Surgery for ankylosing spondylitis is recommended only in severe cases in which the condition makes it difficult to perform everyday activities.

In these cases, the doctor may recommend surgery to correct joint damage or replace a damaged joint with a prosthetic joint to improve range of motion.

Possible complications

The main complications of ankylosing spondylitis include:

• Uveitis, an inflammation of the eye that can cause blurred vision and increased sensitivity to light

• Compression fractures of the vertebrae

• Pulmonary fibrosis

• Cauda equina syndrome

• Cardiovascular problems

Regular medical follow-up and adherence to the recommended treatment plan can help reduce the risk of complications from ankylosing spondylitis.