Ankylosing Spondylitis

Topic Overview

What is ankylosing spondylitis?

Ankylosing spondylitis (say "AN-kill-ose-ing spon-dill-EYE-tis") is a form of arthritis that is long-lasting (chronic) and most often affects the spine. It can cause pain, stiffness, swelling, and limited motion in the low back, middle back, and neck, and sometimes areas such as the hips, chest wall, and heels. Ankylosing spondylitis is more common in men than women.

Although there is no cure, treatment can usually control symptoms and prevent the condition from getting worse. Most people are able to do normal daily activities and continue to work. Complications of ankylosing spondylitis may include inflammation of the colored part of the eye (iris), called iritis, or trouble breathing due to curving of the upper body and stiffening of the chest wall.

What causes ankylosing spondylitis?

The cause of ankylosing spondylitis is unknown, but a tendency to develop the condition may be genetic (passed down from parents to children). Most people with this condition are born with a particular gene, HLA-B27.¹ But having the HLA-B27 gene does not mean that you will develop ankylosing spondylitis. Current research suggests that both the environment and bacterial infections may also have roles in triggering ankylosing spondylitis.¹

What are the symptoms of ankylosing spondylitis?

Ankylosing spondylitis causes mild to severe back and buttock pain that is often worse in the early morning hours. This pain usually gets better with activity. It most often begins in the teens through the 30s and develops gradually.

In time, continued inflammation of the ligaments, tendons, joint capsules (soft tissues surrounding the joint), and joints of the spine will cause the spine to fuse together (ankylose), leading to less motion in the neck and low back. As the spine fuses, or stiffens, the neck and low back lose their normal curve, the mid-back curves outward (kyphosis), and a fixed bent-forward position can result, leading to significant disability. Inflammation of the small joints joining the ribs and collarbone to the breastbone can cause less expansion of the chest wall with breathing. The inflammation of ankylosing spondylitis can affect other parts of the body, most commonly other joints and the eyes, but sometimes the lungs, heart valves, and the major blood vessel called the aorta.

How is it diagnosed?

If your doctor suspects ankylosing spondylitis based on your history and symptoms, he or she can use a blood test for the HLA-B27 gene, an X-ray, or MRI of the sacroiliac joints to help make the diagnosis. The early signs of ankylosing spondylitis—dull low back and buttock pain and stiffness—are fairly common. If you have these symptoms for a period of time and they slowly increase, your doctor will ask about your pattern of symptoms and whether you have a family history of ankylosing spondylitis or similar joint disease.

Pain that moves around the low back area and changes in intensity, and morning stiffness that gets better once you start moving around or take a warm shower, are common symptoms of ankylosing spondylitis. (Pain occasionally starts in other areas, such as the hips or heels.) The clearest sign, however, is a change in the sacroiliac joints at the base of the low back. This change in the sacroiliac joints can take up to a few years to show on X-ray, which means doctors are often hesitant to give a diagnosis of ankylosing spondylitis until you have had symptoms for a long time.

What is the treatment for ankylosing spondylitis?

Treatment includes exercise and physical therapy to help reduce stiffness and maintain good posture and mobility, and medicine for pain and inflammation. It is important to get regular eye exams to check for problems in the eye (iritis) that may occur with this condition. You may use an assistive device, such as a cane, that can help to reduce joint stress and inflammation.

Surgery for the spine is rarely needed. Hip or knee replacements are sometimes considered if there is severe arthritis of those joints.

While there is no cure for ankylosing spondylitis, early diagnosis and treatment can help relieve pain and stiffness and maintain mobility, allowing you to continue with your daily activities as much as possible.

Frequently Asked Questions

Learning about ankylosing spondylitis:	What is ankylosing spondylitis? What causes ankylosing spondylitis? What are the symptoms of ankylosing spondylitis? Who develops ankylosing spondylitis? What are other spondyloarthropathy conditions?
Being diagnosed:	How is ankylosing spondylitis diagnosed? What is a genetic test?
Getting treatment:	How is ankylosing spondylitis treated? Can medicines reduce pain and stiffness? What assistive devices or orthotics can help ease movement?
Ongoing concerns:	What can I do at home to reduce my symptoms? Will I need surgery for ankylosing spondylitis? What is hip replacement surgery?
Living with ankylosing spondylitis:	Can yoga help with symptoms of ankylosing spondylitis? Can acupuncture help with symptoms of ankylosing spondylitis? What happens over time with ankylosing spondylitis?

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Author:	Shannon Erstad, MBA/MPH	Last Updated: May 18, 2007
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Stanford M. Shoor, MD - Rheumatology
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