What is ankylosing spondylitis?
Ankylosing spondylitis (AS) is a condition in which there is inflammation at the places where ligaments (fibrous bands which connect joints) and tendons (the ends of muscles) join onto bone. This is called enthesitis. At the places where there is inflammation, new bone can form. In the most severe cases, this can cause fusion of the spine leading to very severe stiffness which is called ankylosIs or bamboo spine. Some people with ankylosing spondylitis can also develop inflammation and swelling in other joints for example the hips, knees, wrists and ankles.
Who gets ankylosing spondylitis?
Ankylosing spondylitis is more common in men than women and it often starts in young men in their 20s and 30s. Many people with AS wait years for a diagnosis because back pain is very common and is usually put down to normal aches and pains.
Some people with ankylosing spondylitis have a family member with the same condition and sometimes ankylosing spondylitis is associated with other conditions including psoriasis, inflammatory bowel disease such as Crohn’s disease or ulcerative colitis, or a condition called reactive arthritis which can happen after an infection.
What are the symptoms of ankylosing spondylitis?
Most people with ankylosing spondylitis have “inflammatory back pain”. This is back pain which is much worse in the morning or middle of the night, and improves with stretching, exercise or non-steroidal anti-inflammatory drugs such as ibuprofen (NSAIDs).
AS can also cause buttock pain due to inflammation in the sacroiliac joints. This pain is called sacroiliitis and can be severe and make walking difficult. There can also be inflammation and swelling in other joints such as the ankles, knees and hips.
AS is also associated with tendon problems such as Achilles’ tendonitis which can cause heel pain, tennis elbow and a painful condition of the soles of the feet called plantar fasciitis. Some people with AS also develop a condition called iritis or uveitis which is a very painful condition of the eye which also causes blurred vision and redness.
How is ankylosing spondylitis diagnosed?
AS is diagnosed with combination of the history of inflammatory back pain and sometimes joint problems, often in a young man, blood tests to look for raised “inflammatory markers” and the HLA B27 gene. X-rays of the spine and sacroiliac joints can also show changes where ligaments and tendons attach to bone. An MRI scan can also be used to detect early inflammation in the spine and sacroiliac joints.
What are the treatments for ankylosing spondylitis?
There are many different types of treatment for AS and these can be divided into several groups.
- Medical – including pain-killers, non-steroidal anti-inflammatory medicines (NSAIDs), joint injections and disease-modifying drugs (DMARDs) such as methotrexate
- Physical therapies– including stretching exercises, physiotherapy, osteopathy, chiropractic, massage and acupuncture
- Occupational therapy – including splints and devices to help with the activities of daily living
- Self-management – including pain management, exercise and exercises, weight management, dietary modification, relaxation and emotional support, stretching and improving sleep
The treatment of ankylosing spondylitis depends on which parts of the body are affected and how severely. If you have mainly low back pain or spinal pain, stretching is extremely important and you should try to find a way of fitting stretching exercises into your everyday routine. The more stretching you do, the better your pain will be and the more flexible you will be. NSAIDs are usually used for most people with ankylosing spondylitis as they can help a lot with morning stiffness. If you can’t take NSAIDS you may be offered alternative painkillers. Joint injections are sometimes used if you have problems with your sacroiliac joints or have inflammation in one or two other joints. If you have a lot of affected joints, you may be treated with disease modifying drugs such as methotrexate or sulfasalazine which are also used for people with rheumatoid and psoriatic arthritis. Biologic drugs such as anti-TNF drugs including etanercept or adalimumab are also used if AS is severe and has not responded well to NSAIDs.
If AS improves, the drug treatments may be reduced. Flares affecting one or two joints are sometimes treated with joint injections.
What can I do to help myself?
There are lots of ways that you can help yourself deal with the pain of ankylosing spondylitis including stretching, trying to be more active and eating a healthy diet. Read more about self-management.
FAQ about ankylosing spondylitis
Q. I am HLA B27 positive. Does this mean I have AS?
A. No. Although about 97% of people with AS have the B27 gene, so do about 1 in 10 of the UK population, most of whom do not have AS.
Q. Does ankylosing spondylitis run in families and will I pass it on to my children?
A. Ankylosing spondylitis does run in families but the severity between generations can vary a lot. If one of your parents has ankylosing spondylitis, you have a 50% chance of inheriting the B27 gene but this does not mean that you will definitely go on to develop ankylosing spondylitis yourself or that it will be as serious.
Q. Is ankylosing spondylitis connected with any other conditions?
A. Yes, ankylosing spondylitis is associated with several other medical conditions including psoriasis, inflammatory bowel disease such as Crohn’s disease and ulcerative colitis and reactive arthritis which can happen after an infection such as salmonella gastroenteritis.