Ankylosing spondylitis is a type of spondyloarthritis, a chronic, inflammatory disorder 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.
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
In people who may have a genetic predisposition, triggers for ankylosing spondylitis may include:
What Are Symptoms of Ankylosing Spondylitis?
Symptoms of ankylosing spondylitis usually start in late adolescence or early adulthood, between ages 17 to 45 and may include:
- Pain and stiffness in the lower back and buttocks
- Comes on gradually over the course of a few weeks or months
- Discomfort may only be felt on one side, or alternate sides at first, then becomes chronic, felt on both sides, lasting 3 months or more
- Pain is usually dull and diffuse
- Usually worse in the mornings and during the night
- May be improved by a warm shower or light exercise.
- Stiffness and pain can spread up the spine and into the neck.
- Pain and tenderness can also spread to the shoulder blades, ribs, hips, thighs, and heels
- Mild fever (early stage)
- Loss of appetite (early stage)
- General discomfort (early stage)
- Stooped posture (advanced stage)
- Irritation of soft tissues (muscles, ligaments, tendons) where they enter the bones (enthesitis), especially in extremities
- Bowel inflammation, which may be associated with Crohn’s disease or ulcerative colitis
- Eye inflammation (uveitis or iritis)
- Painful, watery, and red eyes
- Blurred vision
- Sensitivity to bright light
- Heart disease
- Lung disease
- Kidney disease
- Neurologic disease
- Gastrointestinal disease
- Metabolic bone disease
How Is Ankylosing Spondylitis Diagnosed?
Ankylosing spondylitis is diagnosed with a patient history and physical examination to look for inflammatory back pain and irritation of soft tissues (muscles, ligaments, tendons) where they enter the bones (enthesitis), or arthritis.
Tests used to help confirm the diagnosis of ankylosing spondylitis or rule out other conditions include:
What Is the Treatment for Ankylosing Spondylitis?
Treatment for ankylosing spondylitis is based on the presentation and severity of the condition and may involve a combination of exercise and physical therapy, medication, and surgery.
Physical therapy and exercise used to treat ankylosing spondylitis includes:
- Core strengthening and cardiovascular exercises, isometric strengthening, breathing, stretching, and dynamic movements
- Fall-prevention exercises
- Posture training to help prevent the spine from becoming “frozen”
- Safety measures to minimize accidents caused by limited mobility
- Limit alcohol
- Avoid use of narcotics and sleeping pills or use with caution
- Modify the home to decrease the risk of falls, such as installation of shower or tub grab-bars, use of nightlights, securing loose rugs, and keeping walkways free of clutter
- Always wear seatbelts in a vehicle
- Sleep on a thin pillow to help avoid developing deformities of the neck
- Avoid contact sports and high-impact activities if your spine is inflexible
- Support groups to help patients cope
Medications used to treat ankylosing spondylitis include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and stiffness
- Sulfasalazine (a DMARD) and methotrexate for arthritis symptom relief
- Tumor necrosis factor-α (TNF-α) antagonists such as infliximab (Remicade), etanercept (Enbrel), adalimumab (Humira), certolizumab pegol (Cimzia), and golimumab (Simponi), may help improve symptoms
- Corticosteroid injections for swollen, painful joints or an inflamed tendon or bursa or the sacroiliac joints. (Oral corticosteroids are not used.)
- Opioids (narcotics) for pain
- Anti-interleukin 17 therapy such as secukinumab (Cosentyx) and ixekizumab (Taltz) may be used in place of anti-TNF therapy
Surgery used to treat ankylosing spondylitis may include:
- Total hip replacement for severe, chronic hip pain and limited mobility
- Spinal surgery to fuse the bones in the cervical or upper thoracic spine
- Wedge osteotomy to remove a wedge-shaped piece of bone from a vertebra, followed by realignment of the spine which is braced so it can heal in a better position
- Fracture stabilization