Ankylosing Spondylitis

What is ankylosing spondylitis?

Ankylosing spondylitis (AS) is a type of arthritis that causes inflammation in certain parts of the spine. Ankylosing means stiff or rigid. Spondyl means spine. Itis refers to inflammation. The disease causes inflammation of the spine and large joints, resulting in stiffness and pain. The disease may damage the joint between the spine and the hipbone. This is called the sacroiliac joint. It may also cause bony bridges to form between vertebrae in the spine, fusing those bones. Bones in the chest may also fuse.

Back view of male torso showing spine and pelvis.

What are the symptoms of ankylosing spondylitis?

Symptoms of AS tend to come and go over time. Symptoms can occur a bit differently in each person. The symptoms may include:

  • Back pain, usually most severe at night during rest
  • Early morning stiffness
  • Stooped posture in response to back pain (bending forward tends to relieve the pain)
  • Straight and stiff spine
  • Inability to take a deep breath, if the joints between the ribs and spine are affected
  • Appetite loss
  • Weight loss
  • Fatigue
  • Fever
  • Anemia
  • Joint pain
  • Mild eye inflammation
  • Organ damage, such as to the heart, lungs, and eyes
  • Skin rashes
  • Digestive illness (such as Crohn's or ulcerative colitis)

Many of these symptoms may be caused by other health problems. Make sure to see your healthcare provider for a diagnosis.

How is ankylosing spondylitis diagnosed?

Diagnosis starts with a health history and physical exam. You may also need tests, such as:

  • X-ray. This test uses a small amount of radiation to create images of internal tissues, bones, and organs onto film.
  • Erythrocyte sedimentation rate (ESR or sed rate). This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood's proteins clump together and become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation. Up to 7 in 10 people with AS have a high ESR.
  • Genetic testing. Genetic testing is done to find if a person carries a copy of an altered gene for a disease. The gene HLA-B27 is found in more than 19 in 20 people with AS.

How is ankylosing spondylitis treated?

Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is. The goal of treatment is to ease pain and stiffness, prevent deformities, and maintain as normal a lifestyle as possible. Treatment may include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), to ease pain and inflammation
  • Tumor-necrosis-factor blockers (biologic medicines), to ease inflammation and swelling
  • Interleukin-17A (IL-17A) inhibitors, to ease inflammation and swelling
  • Disease-modifying anti-rheumatic medicines (DMARDs), such as sulfasalazine, to ease inflammation and control AS
  • Short-term use of corticosteroids, to ease inflammation
  • Short-term use of muscle relaxants and pain relievers, to ease severe pain and muscle spasms
  • Surgery to replace a joint, place rods in the spine, or remove parts of the thickened and hardened bone
  • Maintaining of proper posture
  • Regular exercise, including exercises that strengthen back muscles

Talk with your healthcare provider about the risks, benefits, and possible side effects of all medicines.

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