Can Ankylosing Spondylitis Be Diagnosed with X-rays?

Reviewed on 4/8/2022
Woman with ankylosing spondylitis grabbing her back in pain
Many tests are used to diagnose ankylosing spondylitis, including a patient history, physical examination, X-rays of the spine and pelvis, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, Power Doppler ultrasonography, and other blood tests.

Ankylosing spondylitis is a chronic, inflammatory autoimmune disease that is a rare form of arthritis. It primarily affects the sacroiliac joints between the bones of the pelvis, and the axial skeleton, which includes the spinal column, ribcage, neck, and skull bones. 

Ankylosing spondylitis is diagnosed with a patient history and physical examination in which a doctor checks for inflammatory back pain and irritation of soft tissues (muscles, ligaments, tendons) where they enter the bones (enthesitis), or arthritis.

X-rays of the spine and pelvis are one of the first-line tests used to check for bone changes (bony erosions, fusion, or calcification of the spine and sacroiliac joints) that can help confirm a diagnosis of ankylosing spondylitis. However, these changes often do not show up on X-rays early in the disease. 

Other imaging tests used to help diagnose ankylosing spondylitis may include:

Blood tests used to help confirm the diagnosis of ankylosing spondylitis or rule out other conditions include: 

What Are Symptoms of Ankylosing Spondylitis?

Pain and stiffness in the lower back and buttocks are characteristic symptoms of ankylosing spondylitis, which usually starts in late adolescence or early adulthood. 

In addition to pain and stiffness, early-stage ankylosing spondylitis symptoms may include: 

  • General discomfort 
  • Loss of appetite 
  • Mild fever 

Other symptoms of ankylosing spondylitis may include: 

  • Irritation of soft tissues (muscles, ligaments, tendons) where they enter the bones (enthesitis), most often in extremities
  • Arthritis
  • Fatigue
  • Bowel inflammation
  • Anemia 
  • Eye inflammation (uveitis or iritis)
    • Blurred vision
    • Painful, watery, and red eyes
    • Sensitivity to bright light
  • Stooped posture (advanced stage)

What Causes Ankylosing Spondylitis?

The cause of ankylosing spondylitis is unknown. A combination of genetic and environmental factors is believed to play a role.

Risk factors for ankylosing spondylitis include: 

  • Family history of the condition
  • Smoking 

In people who may have a genetic predisposition, triggers for ankylosing spondylitis may include: 

What Is the Treatment for Ankylosing Spondylitis?

Treatment for ankylosing spondylitis usually involves a combination of exercise and physical therapy, healthy lifestyle changes, and medication. Surgery may be needed in severe cases. 

Physical therapy and exercise used to treat ankylosing spondylitis includes:

  • Exercises
    • Cardiovascular exercise
    • Core strengthening
    • Stretching
    • Dynamic movements
    • Fall-prevention exercises 
    • Isometric strengthening
    • Breathing exercises 
  • Posture training to help prevent the spine from becoming “frozen” 

Lifestyle modifications to help manage ankylosing spondylitis include: 

  • Safety measures to minimize accidents caused by limited mobility 
    • Wear seatbelts in motor vehicles
    • Limit alcohol
    • Modify the home to decrease the risk of falls
    • Sleep on a thin pillow to help avoid developing deformities of the neck
    • Avoid contact sports and high-impact activities if the spine is inflexible
    • Avoid or limit use of narcotics and sleeping pills 
  • Eat a healthy diet with anti-inflammatory foods
    • Consume foods such as fruits, vegetables, whole grains, fatty fish, and extra virgin olive oil  
    • Limit red meat, sugar, and processed foods
  • Don’t smoke
  • Pace yourself and take breaks when needed
  • Support groups 

Medications used to treat ankylosing spondylitis include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used medications for or pain and stiffness
  • Biologics may be used if NSAIDs don’t work well
    • Tumor necrosis factor-α (TNF-α) antagonists 
    • Anti-interleukin 17 therapy 
  • Sulfasalazine (a DMARD) and methotrexate for arthritis symptom relief
  • Corticosteroid injections for swollen, painful joints 
  • Opioids (narcotics) to treat pain

Surgery is rarely used to treat ankylosing spondylitis and most patients will not require surgical intervention. When surgery is needed, it may include:

  • Joint replacement to help with severe pain or joint damage 
  • Fracture stabilization 
  • Spinal surgery 
Reviewed on 4/8/2022
Image Source: iStock Images