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spondylitis (say "ang-kill-LOH-sing spawn-duh-LY-tus") is a long-term form of
arthritis that most often occurs in the
spine. It can cause pain and stiffness in the low
back, middle back, buttocks, and neck, and sometimes in other areas such as the
hips, chest wall, or heels. It can also cause swelling and limited motion in
these areas. This disease is more common in men than in women.
There is no cure, but treatment can control symptoms and prevent the
disease from getting worse in most cases. Most people are able to do their
normal daily activities and can still work.
This disease can cause
several other problems. You may have redness and pain in the colored part of
your eye (iritis). You also may have trouble breathing as your
upper body begins to curve and your chest wall begins to stiffen.
The cause is
unknown, but it may run in families. Most people with ankylosing spondylitis
are born with a certain
gene, HLA-B27. But having this gene does not mean that
you will get the disease.
Research suggests that bacterial
infections and your environment may have roles in causing this disease.
This disease causes mild to
severe pain in the low back and buttocks that is often worse in early morning.
Some people have more pain in other areas, such as the hips or heels. The pain
usually gets better slowly as you move around and are active. Ankylosing
spondylitis most often begins anywhere from the teenage years through the 30s.
It gets worse slowly over time as swelling of the ligaments,
tendons, and joints of the spine causes the bones of the spine to
join, or fuse, together. This leads to less range of movement in the neck and low
As the spine fuses and stiffens, the neck and low back lose
their normal curve. The middle back curves outward. This can keep you in a
bent-forward position and may make it hard for you to
As the small joints that connect the ribs and collarbone to
the breastbone get inflamed, you may find that it's harder for you to breathe.
Other parts of the body, such as your eyes and your other joints, may also
swell. Sometimes the disease affects the lungs, the heart valves, the digestive
tract, and the major blood vessel called the aorta.
signs of this disease—dull pain in the low back and buttocks—are common. Your
doctor will ask about your symptoms and if they have become worse over time.
Your doctor will also ask if you have a family history of this joint disease or
others like it.
Your doctor may do several tests if he or she
thinks that you have ankylosing spondylitis. You may have an X-ray, a test for
the HLA-B27 gene, or an
MRI of the
The clearest sign of
the disease is a change in the sacroiliac joints at the base of the low back.
This change can take up to a few years to show up on an X-ray.
Treatment includes exercise and
physical therapy. These will help reduce stiffness so that you can stand up
straighter and move around better. Your doctor will also give you medicine for
pain and swelling.
Because people with ankylosing spondylitis may be at a higher risk for spinal cord injury, it's important that you wear a seat
belt every time you drive or ride in a car.
You will need to get
regular eye exams to check for inflammation in your eye, called iritis. You may
use a device such as a cane to help you walk and to help reduce stress on your
Surgery for the spine is rarely needed. You may want to
think about hip or knee replacements if you have severe arthritis in those
There is no cure for this disease. But early diagnosis and
treatment can help relieve pain and stiffness and allow you to keep doing your
daily activities for as long as possible.
Learning about ankylosing spondylitis:
Living with ankylosing spondylitis:
Ankylosing spondylitis is inflammation
primarily of the joints of the spine. But it can also involve inflammation of
the eye, other joints—especially those in the hips, chest wall, and around the
heels—and, on occasion, the shoulders, wrists, hands, knees, ankles, and feet.
Although it is unusual, ankylosing spondylitis can also cause changes such as
thickening of the major artery (aorta) and the valve in the heart
If the inflammation
continues over time, it will lead to scarring and permanent damage. In some
people the disease is mild and progresses slowly, and symptoms may never become
severe. Other people may have a more aggressive disease process.
Whether ankylosing spondylitis gets worse depends on a number of things
such as how old you were when the disease began, how early it was diagnosed,
and what joints are involved. It's too early to tell yet, but experts hope
that early treatment with newer medicines will slow or minimize the
inflammation, prevent scarring, and limit the progression of the disease.
spondylitis usually starts with dull pain in the low back and back stiffness.
Some people with ankylosing spondylitis have "flares" of increased pain and
stiffness that may last for several weeks before decreasing again.
time, the inflammation continues, it will lead to scarring and permanent
The stiffening of the chest can feel like the discomfort
or "heaviness" of a heart attack. Ankylosing spondylitis can also cause the
heart to work less efficiently.
If you have any symptoms of heart
or lung problems—including heaviness of the chest or pain with deep
breathing—talk to a doctor right away to make sure you don't have any serious
heart or lung problems. For more information on heart and lung problems, see
Heart Attack and Unstable Angina and
Ankylosing spondylitis is one disease in a group of joint diseases called the
"spon-dill-o-ar-THROP-a-thees"). These include
psoriatic arthritis, reactive arthritis (Reiter's syndrome), and enteropathic arthritis (joint
problems linked with
inflammatory bowel disease). Although inflammation of
the spine also occurs in these other conditions, it is less common and less
severe than the inflammation that occurs in ankylosing spondylitis.
Your doctor will use a medical history,
physical exam, and X-ray to diagnose
questions about your medical history, your doctor can evaluate your symptoms.
Most people with ankylosing spondylitis have back pain with four or five of the
Your doctor will want to know whether you have any family
members who have ankylosing spondylitis or a related joint disease. Many people
with ankylosing spondylitis have a family member with the same condition. He or
she may also ask whether you have had ongoing diarrhea, abdominal (belly) pain,
multiple infections of the
cervix (in women) or
urethra (more common in men),
psoriasis, or inflammation of the eye chamber (uveitis). These could be clues to having a condition
other than ankylosing spondylitis.
You will have a physical exam
to see how stiff your back is and whether you can expand your chest normally.
Your doctor will also look for tender areas, especially over the points of the
spine, the pelvis, the areas where your ribs join your breastbone, and your
heels. You may experience chest pain and stiffness with ankylosing
Tests related to ankylosing spondylitis
ankylosing spondylitis focuses on relieving pain and
inflammation, keeping the condition from getting
worse, and enabling you to continue daily activities. Early diagnosis and
treatment may reduce pain, stiffness, inflammation, and deformity.
Talk with your doctor about the best treatment approach for your
condition. A consultation with a
rheumatologist is often recommended, especially to
confirm the diagnosis and lay out a treatment plan. Your
family medicine physician or
internist can treat mild cases. Or you may be referred
to a rheumatologist,
Initial treatment for
ankylosing spondylitis may include:
Talk with your doctor about your job. People who have
ankylosing spondylitis feel better if they stay active and exercise regularly.
So a job that is physically demanding—such as a job that requires lots of heavy
lifting—could increase your symptoms.
If initial treatment does not
sufficiently reduce the pain and inflammation linked with
ankylosing spondylitis, and as your condition
progresses, ongoing treatment may include:
Your doctor will treat complications of ankylosing
spondylitis as they occur. For example,
iritis may be treated with medicines that can help
reduce inflammation of the eye, such as
cases, you may need surgery to replace joints that are severely damaged by the
ankylosing spondylitis. The most common surgery done
hip replacement surgery. Spine surgery is done in a
very small number of people who have ankylosing spondylitis. If there is
loosening of the top two vertebrae in the neck and there are signs of pressure
on the spinal cord such as numbness or clumsiness in the hands or arms, a
surgeon may permanently join (fuse) the two vertebrae together. In very rare
cases, spinal surgery may be done to straighten a part of the spine that has
become severely curved, but the surgery is risky and cannot restore motion.
Because ankylosing spondylitis is a lifelong condition, other
treatment may include
complementary and alternative medicine therapies,
which can reduce symptoms, help manage pain, and improve quality of life.
Complementary and alternative medicine is the term for a wide variety of health
care practices that may be used along with or in place of standard medical
treatment. These therapies may include
Even if your symptoms are
under control, you should see your doctor (often a
rheumatologist) every year to watch for and treat any
complications. People with hip symptoms and perhaps those whose disease started
in their teens may be at risk for a more severe progression of ankylosing
If you have been diagnosed with
ankylosing spondylitis, there are steps that you can
take at home to help reduce pain and stiffness and allow you to continue daily
activities. These steps include:
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
Other Works Consulted
Braun J, et al. (2011). 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Annals of the Rheumatic Diseases, 70(6): 896–904.
Braverman SE (2008). Ankylosing spondylitis. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 2nd ed., pp. 605–608. Philadelphia: Saunders Elsevier.
Inman RD (2012).The spondyloarthropathies. In L Goldman, A Shafer, eds., Goldman's Cecil Medicine, 24th ed., pp. 1690–1697. Philadelphia: Saunders.
Taurog JD (2012). The spondyloarthritides. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 2, pp. 2774–2785. New York: McGraw-Hill.
May 14, 2013
E. Gregory Thompson, MD - Internal Medicine & Richa Dhawan, MD - Rheumatology
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