Table of ContentsView AllTable of ContentsSigns & SymptomsDiagnosisCausesTreatmentFrequently Asked QuestionsNext in Ankylosing Spondylitis GuideSymptoms of Ankylosing Spondylitis (AS)
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Table of Contents
Signs & Symptoms
Diagnosis
Causes
Treatment
Frequently Asked Questions
Next in Ankylosing Spondylitis Guide
Ankylosing spondylitis(AS) is a type ofinflammatory arthritisthat causes chronic spineinflammation. AS also is anautoimmune disease, a condition in which the immune system malfunctions and attacks healthy tissues in and around the joints. It often starts in the lower back.
AS also causessacroiliitis—inflammation of the sacroiliac joints located between the pelvis and the base of the spine. AS can affect other joints throughout the body as well, including the shoulders, neck, hips, hands, feet, andheels. If AS becomes severe, it can lead to a hunched back and other spinal deformities.
There is no cure for AS, but the condition is treatable. Early diagnosis and treatment can reduce the risk of spinal damage, disability, and other disease complications.
This article will cover the early signs and symptoms of AS, diagnosis, causes, and treatment.
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Early Signs and Symptoms of AS
AS mainly causes pain and swelling of the low-back joints where the spine meets the pelvis. The earliest signs of AS are in the back and hips. Stiffness and pain are common in the morning and after being inactive. Some people with AS might also experience neck pain and fatigue.
Initially, symptoms of AS will be subtle or last for short periods. But over time, they worsen. They might also improve and stop, especially very early in the disease process. AS back pain and stiffness often improve with activity.
Additional early symptoms of AS are:
When to See a Healthcare ProviderYou should see a healthcare provider for low-back pain or buttocks pain that comes on slowly, is worse in the morning or after a long period of inactivity, or wakes you up at night. AS back pain will improve with movement and worsen with rest. You should also reach out to a healthcare provider if you have any eye problems.
When to See a Healthcare Provider
You should see a healthcare provider for low-back pain or buttocks pain that comes on slowly, is worse in the morning or after a long period of inactivity, or wakes you up at night. AS back pain will improve with movement and worsen with rest. You should also reach out to a healthcare provider if you have any eye problems.
Ankylosing Spondylitis Diagnosis
There aren’t any definitive testing methods that can confirm an AS diagnosis. This means your healthcare provider will rely on different diagnostic methods to determine the cause of your symptoms.
If your primary healthcare provider suspects AS, they might suggest you see arheumatologist. This is a doctor who specializes in diagnosing and treating arthritis, musculoskeletal conditions, and systemic autoimmune diseases.
A diagnosis of AS typically starts with a physical exam. Your healthcare provider might ask you to bend your back in different directions to check for stiffness and pain. They might also push on some body parts to look for tenderness or ask you to take deep breaths.
Breathing TroublesBreathing troubles are a sign of severe AS and are quite common in severe AS.Causes of breathing trouble in AS are lung scarring from chronic inflammation and the upper body having to curve forward so that the chest wall stiffens.
Breathing Troubles
Breathing troubles are a sign of severe AS and are quite common in severe AS.Causes of breathing trouble in AS are lung scarring from chronic inflammation and the upper body having to curve forward so that the chest wall stiffens.
Your healthcare provider will also want to know about your medical and family histories. They might ask about:
In addition to a physical exam and your medical and family histories, your healthcare provider will request blood work and imaging studies.
Blood work: Blood work can look for the presence of the HLA-B27 gene, which increases the risk for AS. According to a 2018 report in the journalClinical Medicine Insights: Arthritis and Musculoskeletal Disorders, up to 90% of people with AS will have a positive HLA-B27 blood test.
Imaging: Imaging helps diagnose AS, determine the extent of the disease, and monitor spine and bone changes.Imaging methods used in AS includecomputed tomography(CT) scans, ultrasound, andmagnetic resonance imaging(MRI). However, MRI is the most important imaging modality, as it allows healthcare providers to see early disease and distinguish between active and chronic disease.
The diagnostic criteria your healthcare provider will rely on to diagnose AS were established Assessment of SpondyloArthritis International Society (ASAS) in 2009.
According to ASAS’s standards, your healthcare provider can make a diagnosis of AS if you are under 45 years of age and have had low back pain or stiffness for three or more months, along with one or more of the following:
Ankylosing Spondylitis Causes
Anyone can get AS, but certain factors might increase a person’s risk for the disease. These include:
AS is a lifelong condition, and you will need treatment for if for the rest of your life. While there is no cure, treatment reduces the potential for joint damage and disability, eases pain, prevents complications, and improves your quality of life.
Treatments for AS includephysical therapy, medications, andsurgery.
Physical Therapy
Physical therapy can provide a number of benefits for people with AS, including pain relief and improved flexibility and strength. A physical therapist can teach you proper exercise techniques, managing posture, and proper sleeping and walking positions.
Medications
The most common medications used to treat AS arenonsteroidal anti-inflammatory drugs(NSAIDs), conventional and biologicdisease-modifying antirheumatic drugs(DMARDs), andcorticosteroids, which help in the following ways:
Surgery
Most people with AS will never need surgery. Your rheumatologist might recommend surgery if you have severe pain or a severely damaged joint. Spinal surgery can correct a curved spine.
Complications of Untreated ASIn rare cases, especially if AS is untreated or undertreated, AS becomes severe and a person may experience serious complications.Complications of AS might include:Kyphosis: A forward curvature of the spineBamboo spine: A widespread fusing of the bones in the spineOsteoporosis: Weakening of the bones that can lead to bone fracturesCauda equina syndrome(CES): With CES, there is extreme pressure and swelling at the nerves at the end of the spinal cord. This condition is a medical emergency and requires immediate medical intervention.Spondylodiscitis: Infection of one or more intervertebral disks or disk spacesPainful eye inflammation and vision lossHeart diseaseChest pain that causes breathing troublesFortunately, with proper treatment, most people with AS never experience these kinds of complications.
Complications of Untreated AS
In rare cases, especially if AS is untreated or undertreated, AS becomes severe and a person may experience serious complications.Complications of AS might include:Kyphosis: A forward curvature of the spineBamboo spine: A widespread fusing of the bones in the spineOsteoporosis: Weakening of the bones that can lead to bone fracturesCauda equina syndrome(CES): With CES, there is extreme pressure and swelling at the nerves at the end of the spinal cord. This condition is a medical emergency and requires immediate medical intervention.Spondylodiscitis: Infection of one or more intervertebral disks or disk spacesPainful eye inflammation and vision lossHeart diseaseChest pain that causes breathing troublesFortunately, with proper treatment, most people with AS never experience these kinds of complications.
In rare cases, especially if AS is untreated or undertreated, AS becomes severe and a person may experience serious complications.
Complications of AS might include:
Fortunately, with proper treatment, most people with AS never experience these kinds of complications.
Summary
Ankylosing spondylitis is a type of inflammatory arthritis that causes inflammation of the joints of the spine. AS can sometimes affect other joints, including the hips. Severe or untreated AS can lead to a rigid and inflexible spine.
Early symptoms of AS include pain and swelling of the joints of the low back where the spine meets the pelvis, severe fatigue, buttock pain, neck pain, back pain, and pain and swelling at entheses.
Early diagnosis and treatment are vital to preventing disease complications. AS is treatable with physical therapy, medications, and surgery.
Frequently Asked QuestionsSymptoms of AS typically appear between ages 17 and 45. However, AS can also develop in younger children, teens, and older adults.There are no specific lab tests that can confirm AS. Your healthcare provider will look at your family and symptom history, perform a physical exam, and request lab work and imaging to help determine the cause of your symptoms.Early signs of AS mainly affect the low back, where the spine meets the pelvis. Additional early signs include severe fatigue, buttocks pain, neck pain, and pain at the entheses.
Symptoms of AS typically appear between ages 17 and 45. However, AS can also develop in younger children, teens, and older adults.
There are no specific lab tests that can confirm AS. Your healthcare provider will look at your family and symptom history, perform a physical exam, and request lab work and imaging to help determine the cause of your symptoms.
Early signs of AS mainly affect the low back, where the spine meets the pelvis. Additional early signs include severe fatigue, buttocks pain, neck pain, and pain at the entheses.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Doherty T, Pilcher J, Njegovan N, et al.AB0564 A review of ankylosing spondylitis complications and associations.Annals of the Rheumatic Diseases;2013;72:A961-A962. doi:10.1136/annrheumdis-2013-eular.2886Li Y, Zhang S, Zhu J, Du X, Huang F.Sleep disturbances are associated with increased pain, disease activity, depression, and anxiety in ankylosing spondylitis: a case-control study.Arthritis Res Ther. 2012;14(5):R215. doi:10.1186/ar4054Berdal G, Halvorsen S, van der Heijde D, Mowe M, Dagfinrud H.Restrictive pulmonary function is more prevalent in patients with ankylosing spondylitis than in matched population controls and is associated with impaired spinal mobility: a comparative study.Arthritis Res Ther. 2012;14(1):R19. doi:10.1186/ar3699Akassou A, Bakri Y.Does HLA-B27 status influence ankylosing spondylitis phenotype?.Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544117751627. doi:10.1177/1179544117751627Ghasemi-Rad M, Attaya H, Lesha E, et al.Ankylosing spondylitis: A state of the art factual backbone.World J Radiol. 2015;7(9):236-252. doi:10.4329/wjr.v7.i9.236Poddubnyy D.Classification vs diagnostic criteria: the challenge of diagnosing axial spondyloarthritis.Rheumatology (Oxford). 2020;59(Suppl4):iv6-iv17. doi:10.1093/rheumatology/keaa250National Institute of Arthritis and Musculoskeletal and Skin Diseases.Ankylosing spondylitis.Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE.Gender differences in axial spondyloarthritis: Women are not so lucky.Curr Rheumatol Rep. 2018;20(6):35. Published 2018 May 12. doi:10.1007/s11926-018-0744-2Zakaryan A, Ginosyan K.Perioperative management of patients With ankylosing spondylitis undergoing spine surgery.Front Pharmacol. 2020;11:1017. doi:10.3389/fphar.2020.01017
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Doherty T, Pilcher J, Njegovan N, et al.AB0564 A review of ankylosing spondylitis complications and associations.Annals of the Rheumatic Diseases;2013;72:A961-A962. doi:10.1136/annrheumdis-2013-eular.2886Li Y, Zhang S, Zhu J, Du X, Huang F.Sleep disturbances are associated with increased pain, disease activity, depression, and anxiety in ankylosing spondylitis: a case-control study.Arthritis Res Ther. 2012;14(5):R215. doi:10.1186/ar4054Berdal G, Halvorsen S, van der Heijde D, Mowe M, Dagfinrud H.Restrictive pulmonary function is more prevalent in patients with ankylosing spondylitis than in matched population controls and is associated with impaired spinal mobility: a comparative study.Arthritis Res Ther. 2012;14(1):R19. doi:10.1186/ar3699Akassou A, Bakri Y.Does HLA-B27 status influence ankylosing spondylitis phenotype?.Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544117751627. doi:10.1177/1179544117751627Ghasemi-Rad M, Attaya H, Lesha E, et al.Ankylosing spondylitis: A state of the art factual backbone.World J Radiol. 2015;7(9):236-252. doi:10.4329/wjr.v7.i9.236Poddubnyy D.Classification vs diagnostic criteria: the challenge of diagnosing axial spondyloarthritis.Rheumatology (Oxford). 2020;59(Suppl4):iv6-iv17. doi:10.1093/rheumatology/keaa250National Institute of Arthritis and Musculoskeletal and Skin Diseases.Ankylosing spondylitis.Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE.Gender differences in axial spondyloarthritis: Women are not so lucky.Curr Rheumatol Rep. 2018;20(6):35. Published 2018 May 12. doi:10.1007/s11926-018-0744-2Zakaryan A, Ginosyan K.Perioperative management of patients With ankylosing spondylitis undergoing spine surgery.Front Pharmacol. 2020;11:1017. doi:10.3389/fphar.2020.01017
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Doherty T, Pilcher J, Njegovan N, et al.AB0564 A review of ankylosing spondylitis complications and associations.Annals of the Rheumatic Diseases;2013;72:A961-A962. doi:10.1136/annrheumdis-2013-eular.2886Li Y, Zhang S, Zhu J, Du X, Huang F.Sleep disturbances are associated with increased pain, disease activity, depression, and anxiety in ankylosing spondylitis: a case-control study.Arthritis Res Ther. 2012;14(5):R215. doi:10.1186/ar4054Berdal G, Halvorsen S, van der Heijde D, Mowe M, Dagfinrud H.Restrictive pulmonary function is more prevalent in patients with ankylosing spondylitis than in matched population controls and is associated with impaired spinal mobility: a comparative study.Arthritis Res Ther. 2012;14(1):R19. doi:10.1186/ar3699Akassou A, Bakri Y.Does HLA-B27 status influence ankylosing spondylitis phenotype?.Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544117751627. doi:10.1177/1179544117751627Ghasemi-Rad M, Attaya H, Lesha E, et al.Ankylosing spondylitis: A state of the art factual backbone.World J Radiol. 2015;7(9):236-252. doi:10.4329/wjr.v7.i9.236Poddubnyy D.Classification vs diagnostic criteria: the challenge of diagnosing axial spondyloarthritis.Rheumatology (Oxford). 2020;59(Suppl4):iv6-iv17. doi:10.1093/rheumatology/keaa250National Institute of Arthritis and Musculoskeletal and Skin Diseases.Ankylosing spondylitis.Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE.Gender differences in axial spondyloarthritis: Women are not so lucky.Curr Rheumatol Rep. 2018;20(6):35. Published 2018 May 12. doi:10.1007/s11926-018-0744-2Zakaryan A, Ginosyan K.Perioperative management of patients With ankylosing spondylitis undergoing spine surgery.Front Pharmacol. 2020;11:1017. doi:10.3389/fphar.2020.01017
Doherty T, Pilcher J, Njegovan N, et al.AB0564 A review of ankylosing spondylitis complications and associations.Annals of the Rheumatic Diseases;2013;72:A961-A962. doi:10.1136/annrheumdis-2013-eular.2886
Li Y, Zhang S, Zhu J, Du X, Huang F.Sleep disturbances are associated with increased pain, disease activity, depression, and anxiety in ankylosing spondylitis: a case-control study.Arthritis Res Ther. 2012;14(5):R215. doi:10.1186/ar4054
Berdal G, Halvorsen S, van der Heijde D, Mowe M, Dagfinrud H.Restrictive pulmonary function is more prevalent in patients with ankylosing spondylitis than in matched population controls and is associated with impaired spinal mobility: a comparative study.Arthritis Res Ther. 2012;14(1):R19. doi:10.1186/ar3699
Akassou A, Bakri Y.Does HLA-B27 status influence ankylosing spondylitis phenotype?.Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544117751627. doi:10.1177/1179544117751627
Ghasemi-Rad M, Attaya H, Lesha E, et al.Ankylosing spondylitis: A state of the art factual backbone.World J Radiol. 2015;7(9):236-252. doi:10.4329/wjr.v7.i9.236
Poddubnyy D.Classification vs diagnostic criteria: the challenge of diagnosing axial spondyloarthritis.Rheumatology (Oxford). 2020;59(Suppl4):iv6-iv17. doi:10.1093/rheumatology/keaa250
National Institute of Arthritis and Musculoskeletal and Skin Diseases.Ankylosing spondylitis.
Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE.Gender differences in axial spondyloarthritis: Women are not so lucky.Curr Rheumatol Rep. 2018;20(6):35. Published 2018 May 12. doi:10.1007/s11926-018-0744-2
Zakaryan A, Ginosyan K.Perioperative management of patients With ankylosing spondylitis undergoing spine surgery.Front Pharmacol. 2020;11:1017. doi:10.3389/fphar.2020.01017
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