Ankylosing spondylitis

Recognizing the Signs and Symptoms of Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic autoimmune condition primarily affecting the spine, though it can also affect other joints. Understanding its signs and symptoms is crucial for early detection and effective management. This guide aims to provide a clear and empathetic overview of the symptoms associated with AS, helping you recognize potential indicators of the condition.

What Is Ankylosing Spondylitis?

Ankylosing spondylitis is a type of inflammatory arthritis that primarily affects the spine, but it can also affect other joints and areas of the body. It’s a chronic condition, meaning it persists over a long period of time, often for a person’s entire life. (Source)

The condition is characterized by inflammation in the vertebrae — the small bones that make up the spine. This inflammation can lead to severe, chronic pain and discomfort. Over time, the inflammation may cause the vertebrae to fuse together, resulting in a rigid spine. (Source)

Early Signs and Primary Symptoms

It’s important to note that the symptoms of AS can vary greatly from person to person. Some people may have mild symptoms, while others may experience severe pain and disability. The onset of symptoms can also vary, with some people experiencing sudden onset while others may have gradual onset of symptoms.

Back Pain and Stiffness

Back pain and stiffness are hallmark symptoms of ankylosing spondylitis. They typically originate in the sacroiliac joints, where the spine connects to the pelvis, before progressing up the spine. The pain is often described as a dull ache that is worse in the morning or after periods of inactivity, improving with movement or exercise. (Source)

Unlike typical back pain, AS-related discomfort tends to occur in the second half of the night, often waking the individual. This is due to the inflammatory nature of the disease. The stiffness associated with AS can last more than 30 minutes in the morning and improves with activity. (Source)

Other Joint Stiffness

Another early sign of AS is pain or stiffness in the buttocks, hips, or shoulders. This can be due to inflammation in the sacroiliac joints (where the spine connects to the pelvis) or other peripheral joints. (Source)

Inflammation of Tendons and Ligaments

AS can also cause enthesitis, which is inflammation where tendons or ligaments attach to bones. This can lead to pain and tenderness in areas such as the back of the heel (Achilles tendinitis) or under the heel (plantar fasciitis). (Source)

Other Associated Symptoms

Ankylosing spondylitis can also cause symptoms outside the joints, known as extra-articular symptoms. These can include:

  • fatigue
  • eye inflammation (uveitis)
  • skin problems (psoriasis)
  • inflammatory bowel disease
  • weight loss

These symptoms may appear at any stage of the disease, and their presence can indicate a more systemic involvement. (Source)

Recognizing Atypical Presentations

Ankylosing spondylitis typically presents with symptoms such as chronic back pain, stiffness, and reduced flexibility in the spine. However, there are instances where AS may manifest in atypical ways, making it more challenging to diagnose. (Source)

These atypical presentations highlight the importance of a comprehensive and holistic approach to diagnosing and managing AS. It’s crucial for health care professionals to consider all potential symptoms and manifestations of the disease, and for patients to report any new or changing symptoms promptly.

Atypical Joint Involvement

While the spine is most commonly affected in AS, the disease can also affect other joints, including the hips, shoulders, knees, and even smaller joints like those in the hands and feet. This atypical presentation can sometimes lead to misdiagnosis, as these symptoms may be mistaken for other forms of arthritis. (Source)

Cardiovascular Involvement

Ankylosing spondylitis can also affect the cardiovascular system, leading to conditions such as aortitis, which is inflammation of the aorta, and heart valve disease. These manifestations are less common but can have serious implications if not detected and managed promptly. (Source)

Gastrointestinal Symptoms

Some individuals with AS may present with symptoms related to the gastrointestinal system due to the co-occurrence of inflammatory bowel disease. These symptoms can include abdominal pain, diarrhea, and weight loss. (Source)

Fatigue

Ankylosing spondylitis can also present with fatigue as a prominent symptom. While fatigue is common in many chronic illnesses, it can be particularly debilitating in AS and can significantly affect a person’s quality of life. (Source)

Age and Gender Variations

Ankylosing spondylitis can affect individuals of any age, but it most commonly begins between the ages of 17 and 45. However, it’s not uncommon for symptoms to start in childhood, known as juvenile AS, or later in life. The onset of AS tends to be earlier in men than in women. (Source)

Regarding gender variations, AS is more prevalent in men than in women. The reasons for this disparity are not entirely clear, but it may be related to genetic, hormonal, or environmental factors. Men with AS also tend to experience more severe symptoms and a more aggressive disease course than women. However, research suggests women often go longer without an accurate diagnosis, allowing the disease to progress and worsen. (Source)

Progression of Symptoms

Ankylosing spondylitis is a progressive condition, meaning its symptoms typically worsen over time. However, the rate and pattern of progression can vary widely from person to person. Some individuals may experience rapid progression of symptoms, while others may have periods of relative stability interspersed with flare-ups. (Source)

As the disease progresses, inflammation may spread up the spine, leading to chronic pain and stiffness in the neck and chest. This can limit mobility and make it difficult to perform daily activities. In some cases, inflammation can also affect the rib cage, potentially leading to breathing difficulties.

Over time, chronic inflammation can lead to the formation of new bone in the spine, causing the vertebrae to fuse together. This process, known as ankylosis, can result in a hunched-forward posture if the spine fuses in a bent position. This is a late stage symptom of AS and signifies severe progression of the disease.

The progression of AS is unpredictable and can be influenced by various factors, including genetic predisposition, lifestyle factors, and the effectiveness of treatment. Regular monitoring and early intervention can help manage symptoms and potentially slow the progression of the disease.

Importance of Early Detection

Early diagnosis and treatment can help manage symptoms of AS and prevent or slow spinal damage. This involves recognizing the early signs and symptoms and understanding the risk factors. 

If you are diagnosed with AS, you should have regular check-ups to monitor the progression of the disease and adjust treatment plans as necessary. This proactive approach can help prevent further damage and maintain a higher quality of life.

The Bottom Line

Understanding the signs and symptoms of ankylosing spondylitis is key to early diagnosis and effective management. If you’re experiencing persistent back pain, stiffness, or other related symptoms, it’s important to consult a health care professional for a thorough evaluation. The effects of ankylosing spondylitis vary from person to person, and a personalized approach to care is essential for managing this condition.

References

Baraliakos, X., Listing, J., Haibel, H., Sieper, J., & Braun, J. (2013). ​​Vertebral erosions associated with spinal inflammation in patients with ankylosing spondylitis identified by magnetic resonance imaging: Changes after 2 years of tumor necrosis factor inhibitor therapy. Journal of Rheumatology, 40(11), 1891–1896. https://doi.org/10.3899/jrheum.120533

Better Health Channel. (n.d.). Ankylosing spondylitis. State Government of Victoria, Australia, Department of Health. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ankylosing-spondylitis

Children’s Hospital of Philadelphia. (n.d.). Juvenile ankylosing spondylitis. https://www.chop.edu/conditions-diseases/juvenile-ankylosing-spondylitis

de Winter, J. J., van Mens, L. J., van der Heijde, D., Landewé, R., & Baeten, D. L. (2016). Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: A meta-analysis. Arthritis Research & Therapy, 18(1), 196. https://doi.org/10.1186/s13075-016-1093-z

Gies, A. (2022, December 27). Ankylosing spondylitis progression: What to expect. My Spondylitis Team. https://www.myspondylitisteam.com/resources/the-progression-of-ankylosing-spondylitis

Johns Hopkins Medicine. (n.d.). Ankylosing spondylitis. https://www.hopkinsmedicine.org/health/conditions-and-diseases/ankylosing-spondylitis

Lindström, U., Bremander, A., Haglund, E., Bergman, S., Petersson, I. F., & Jacobsson, L. T. H. (2016) Back pain and health status in patients with clinically diagnosed ankylosing spondylitis, psoriatic arthritis and other spondyloarthritis: A cross-sectional population-based study. BMC Musculoskeletal Disorders, 17, 106. https://doi.org/10.1186/s12891-016-0960-8

Mader, R. (1999). Atypical clinical presentation of ankylosing spondylitis. Seminars in Arthritis and Rheumatism, 29(3), 191–196. https://doi.org/10.1016/s0049-0172(99)80030-4

McVeigh, C. M., & Cairns, A. P. (2006). Diagnosis and management of ankylosing spondylitis. BMJ, 333(7568), 581–585. https://doi.org/10.1136/bmj.38954.689583.DE

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (n.d.). Ankylosing spondylitis. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niams.nih.gov/health-topics/ankylosing-spondylitis

NHS. (n.d.). Symptoms, ankylosing spondylitis. https://www.nhs.uk/conditions/ankylosing-spondylitis/symptoms/

Rudwaleit, M., & Baeten, D. (2006). Ankylosing spondylitis and bowel disease. Best Practice & Research. Clinical Rheumatology, 20(3), 451–471. https://doi.org/10.1016/j.berh.2006.03.010

Rusman, T., van Vollenhoven, R. F., & van der Horst-Bruinsma, I. E. (2018). Gender differences in axial spondyloarthritis: Women are not so lucky. Current Rheumatology Reports, 20(6), 35. https://doi.org/10.1007/s11926-018-0744-2

Spondylitis Association of America. (n.d.). Fatigue in spondyloarthritis. https://spondylitis.org/about-spondylitis/possible-complications/fatigue-in-spondyloarthritis/

Spondylitis Association of America. (n.d.). Overview of ankylosing spondylitis. https://spondylitis.org/about-spondylitis/overview-of-spondyloarthritis/ankylosing-spondylitis/

Weisman, M. (n.d.). Enthesitis: A closer look. Spondylitis Association of America. https://spondylitis.org/spondylitis-plus/enthesitis-a-closer-look/

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