Is Ankylosing Spondylitis Easy to Diagnose?

Reviewed on 3/30/2022
Woman holding back and head in pain
Ankylosing spondylitis can be difficult to diagnose because it develops slowly and there is no single definitive test for it.

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 can be difficult to diagnose because the condition develops slowly and there is no single definitive test that can confirm the diagnosis. A diagnosis of ankylosing spondylitis starts 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. 

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:

  • Exercise
  • 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 
    • Modify the home to decrease the risk of falls
    • Wear seat belts in motor vehicles
    • 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
    • Limit alcohol
    • Avoid or limit the use of narcotics and sleeping pills 
  • Eat a healthy diet with anti-inflammatory 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) for pain and stiffness
  • Biologics may be used if NSAIDs don’t work well
  • 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 3/30/2022
Image Source: iStock Images