Ankylosing Spondylitis: Symptoms, Causes & Treatment

Ankylosing spondylitis is a type of chronic inflammatory arthritis that mainly affects the spine and the sacroiliac joints (where the lower spine meets the pelvis). It is an autoimmune disease in which the immune system attacks these joints, causing ongoing inflammation.

The most distinctive feature of this disease is inflammatory back pain, which differs from common mechanical back pain: it begins gradually in young people (often before age forty), is accompanied by severe morning stiffness lasting more than half an hour, improves with movement and activity while worsening with rest and at night and early in the day, and may wake the patient from sleep. The disease may affect other joints such as the hips and shoulders, and sometimes organs outside the joints such as the eyes (iritis).

If left untreated, chronic inflammation may over time lead to new bone formation and fusion of the vertebrae together, making the spine stiff and less flexible and possibly causing a permanent stoop. Early diagnosis is therefore very important, especially since the disease is often diagnosed late and confused with ordinary back pain. Modern treatment — especially biologic therapies along with regular exercise and physiotherapy — is very effective at controlling inflammation and pain and preserving spinal flexibility and the patient's mobility and quality of life.

• Inflammatory back pain beginning gradually in young people.
• Severe morning stiffness over half an hour that improves with movement.
• Pain that worsens with rest and at night and may wake from sleep.
• Hip or shoulder pain and general fatigue.
• Sometimes inflammation, redness, and pain in the eye.

• An autoimmune disease attacking the spine and pelvic joints.
• A strong genetic predisposition linked to the HLA-B27 gene.
• The exact trigger of the disease is uncertain.

• Carrying the HLA-B27 gene.
• A family history of the disease.
• Male sex and symptom onset in youth.

• Clinical assessment of the inflammatory back-pain pattern.
• Imaging (X-ray or MRI) of the sacroiliac joints and spine.
• Blood tests for inflammation markers and the HLA-B27 gene.

Exercise and physiotherapy (essential)

• Regular exercises to preserve spinal flexibility and posture — the cornerstone of treatment.

Medications

• Anti-inflammatories to ease pain and stiffness.
• Biologic therapies that are very effective at controlling inflammation in moderate to severe cases.

This content is educational and does not replace consulting a rheumatologist.

• Vertebral fusion, spinal stiffness, and stooping.
• Recurrent iritis in the eye.
• Limited chest and breathing movement in advanced cases.

• There is no prevention of the disease, but early treatment prevents complications.
• Regular exercise and maintaining correct posture.
• Quitting smoking, which speeds disease deterioration.