Ankylosing Spondylitis Overview
What is ankylosing spondylitis (AS)?
Also Known as Bechterew’s Disease and Axial Spondyloarthritis, ankylosing spondylitis (AS) is an autoimmune disease that causes inflammation in the joints of the spine and the sacroiliac joints, where the spine meets the pelvis. It can also impact the eyes or other parts of the body. Over time, the inflamed joints can fuse, resulting in a condition known as ankylosis, which reduces the flexibility of the spine. This can cause a hunched posture as well as pain and stiffness in other areas.
Who gets it and when?
AS is more common in men and usually starts in early adulthood (late teens to mid 30s).
Ankylosing Spondylitis Causes and Risk Factors
What are the causes and risk factors of ankylosing spondylitis?
The cause of AS is unknown, but some cases may be genetic, as a family history of this disease increases the risk of developing it. (The gene linked to AS is the HLA-B27 antigen.) Other autoimmune diseases, such as psoriasis, psoriatic arthritis, Chron’s disease and uveitis, may occur with AS.
Ankylosing Spondylitis Signs and Symptoms
What are the signs and symptoms of ankylosing spondylitis?
Symptoms and the speed of progression vary greatly between individuals, but may include:
Pain and stiffness in the lower back or buttocks, which may start on one side and eventually progress to both sides (worse at night and in the morning)
Pain and stiffness that can eventually spread to the hips, upper back, neck, ribs, shoulders and/or heels
- A low-grade fever
- Upset stomach
- Increasing fatigue
Long-term complications in other parts of the body, most commonly the eye complications of iritis and uveitis
Ankylosing Spondylitis Diagnosis
How is ankylosing spondylitis diagnosed?
To diagnose AS, your provider will usually first review your medical history and conduct a physical exam. Diagnostic imaging of the spine and/or pelvis, such as an X-ray and/or MRI, may be ordered. Additionally, lab tests can identify inflammation and the HLA-B27 antigen when appropriate. AS is often diagnosed and managed by a rheumatologist.
Ankylosing Spondylitis Treatment
How is ankylosing spondylitis treated?
There is no known cure for AS, but treatments can slow progression and manage symptoms. They can include:
Medications
Medications may include over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil/Motrin) and naproxen (Aleve, Naprosyn); prescription-level anti-inflammatories/NSAIDs; corticosteroids (prednisone); sulfasalazine; and biologic medications, such as tumor necrosis factor (TNF) inhibitors, IL17A inhibitors and Janus kinase inhibitors.
Physical Therapy
Physical therapy and specific exercises can support posture and breathing. You may also be encouraged to sleep flat on your back.
Surgical Interventions
Surgery is not a typical treatment for AS unless there is a fracture.