Spine

Key Points

  • AS is an autoimmune disease that causes inflammation in the joints of the spine, sacroiliac joints and where the spine meets the pelvis. It may also impact eyes and other areas.
  • AS is more common in men, and symptoms begin in early adulthood.
  • Symptoms may include pain and stiffness in lower back, buttocks, hips, neck, ribs, shoulders and heels, low grade fever, upset stomach and fatigue.
  • There is no known cure. Medications may be used to manage symptoms, and physical therapy may be prescribed to support posture and breathing.

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.   

Anatomy of the Spine

Explore an interactive model of the spine.

Spine Procedures and Treatments

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