This chronic arthritis mainly affects the spine, but you might notice these other clues, too.
Lower back pain happens to millions of Americans every year, and back pain can be caused by a number of reasons. If your back pain keeps coming back—and it’s not because your mattress is wrong for you—it might be time to investigate if something more serious is causing the problem.
One possible cause of lower back pain is ankylosing spondylitis (AS), an inflammatory arthritis that causes pain and stiffness in the spine. It’s the most common form of arthritis within the spondyloarthritis family, which causes inflammation where ligaments and tendons attach to the bones, according to the American College of Rheumatology. Learn more about what ankylosing spondylitis is here.
“A person who thinks they might have ankylosing spondylitis probably should not ignore the symptoms,” says Themistocles Protopsaltis, MD, spine surgeon at NYU Langone Spine Center. “If possible, you want to start the right type of exercise and medical regimen that might minimize the effect of the disease over the course of your life.”
Early Symptoms of Ankylosing Spondylitis
When inflammation is present in the spine, the vertebrae becomes swollen, stiff, and painful. This especially occurs in the sacroiliac joints—where the spine connects to the pelvic bone.
Symptoms of AS usually appear in teens or early adulthood, according to the Spondylitis Association of America (SAA). Although AS is chronic, symptoms may come and go, depending on the amount of inflammatory activity. Here are some symptoms you may notice, according to Jessica Patel, MD, rheumatologist at The Mount Sinai Hospital.
Chronic pain and stiffness in the lower back, buttocks, and hips, which develops slowly over several weeks or months
Possible pain in the hips, knees, ankles, and hands
Limited mobility and flexibility in the spine
Restriction of chest expansion
Pain and stiffness that worsens when you’re inactive and improves with movement
Back pain during the night or early morning
Stiffness in the morning
Like other inflammatory conditions, AS may involve chronic fatigue due to the intense amount of energy needed for the body to combat inflammation.
How Ankylosing Spondylitis Progresses
The systemic inflammation throughout the body can result in additional or worsening symptoms over time, such as:
Joint pain beyond the spine: Other types of spondyloarthritis may develop, such as peripheral spondyloarthritis, which affects the arms and legs. Other commonly affected joints include the shoulders, ribs, hips, knees, and feet.
Limited mobility: Joint pain and stiffness in the legs and spine can make movement difficult. Foot problems and changes in the heel may also impact mobility.
Increased risk of other inflammatory conditions: People with AS have an increased risk of heart disease, stroke, eye inflammation (uveitis), or inflammatory bowel disease, says Dr. Patel. In fact, about a third of people with AS have eye inflammation at least once, according to SAA.
Ankylosis, or spinal fusion: As the name suggests, this is when the vertebrae fuse together, and the spine becomes stiff, inflexible, and difficult to move. “Pain starts to recede, and the joints start to ossify, or calcify, and fuse together,” says Dr. Protopsaltis. “You can have very little joint pain, but now you have a joint that doesn’t move anymore.”
AS has no cure, but treatment can help manage symptoms and prevent the disease from worsening. The earlier it’s diagnosed, the better you can treat the disease and slow its progression.
“With a combination of medication and lifestyle changes, there can be much relief in pain and stiffness, and [you can] improve the progression of the arthritis itself,” says Dr. Patel.
00:00:00,000 --> 00:00:03,109
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A person who thinks they might have
ankylosing spondylitis probably should not
00:00:07,573 --> 00:00:08,847
ignore the symptoms.
00:00:08,847 --> 00:00:13,757
If possible, you want to start the right
type of exercise and medical regimen
00:00:13,757 --> 00:00:18,530
that might minimize the effect of
the disease over the course of your life.
00:00:18,530 --> 00:00:24,570
00:00:24,570 --> 00:00:29,552
It's really important once you think you
have symptoms of ankylosing spondylitis to
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go and meet with a doctor.
00:00:31,083 --> 00:00:35,499
In terms of the physical exam to
diagnose ankylosing spondylitis,
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your rheumatologist will look for signs
of inflammation in different joint areas,
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such as the lower back, the SI joint,
hips, knees, ankles, even the hands.
00:00:46,203 --> 00:00:51,170
They'll also do a very thorough exam of
the back, looking for flexibility and
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mobility, as well as chest expansion.
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Because oftentimes the ribs
can be involved in ankylosing
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spondylitis as well.
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What time of the day
are your symptoms the worst?
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Is it first thing in the morning?
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Is it at the end of the day?
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Middle of the night?
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These are very important factors when
trying to characterize back pain.
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Is there any family history
of inflammatory arthritis or
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ankylosing spondylitis, or other
rheumatologic diseases in the family?
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Ankylosing spondylitis can also affect
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other organ systems
outside of the skeleton.
00:01:20,538 --> 00:01:22,413
And one of them is the eye.
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It can cause inflammatory eye disease,
such as iritis or uveitis, and
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this often manifests eye pain or
photo sensitivity to light.
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And it can also cause gut inflammation.
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And this is more in terms of in the line
of inflammatory bowel disease or
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ulcerative colitis or Crohn's disease.
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As the disease progresses,
the pain can become more chronic,
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can become more persistent.
00:01:46,301 --> 00:01:51,018
And then things can get to a point
where pain starts to recede and
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the joints start to ossify or
calcify, and fuse together.
00:01:55,471 --> 00:02:00,055
And then, at the very end of the disease,
you can have very little joint pain, but
00:02:00,055 --> 00:02:02,789
now you have a joint that
doesn't move anymore.
00:02:02,789 --> 00:02:07,281
It's very important to take
a proactive role in the treatment of
00:02:07,281 --> 00:02:11,619
such as ankylosing spondylitis.
00:02:11,619 --> 00:02:17,096
With a combination of medication as well
as lifestyle changes, there can be much
00:02:17,096 --> 00:02:22,750
relief in pain and stiffness and improve
the progression of the arthritis itself.
00:02:22,750 --> 00:02:27,347
Low back pain fact sheet. Bethesda, MD: National Institute of Neurological Disorders and Stroke. (Accessed on September 19, 2018 at https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet.)
Moon KH, Kim YT. Medical treatment of ankylosing spondylitis. Hip Pelvis. 2014 Sep;26(3):129-35.
Most common symptoms. Van Nuys, CA: Spondylitis Association of America. (Accessed on September 19, 2018 athttps://www.spondylitis.org/Ankylosing-Spondylitis/Symptoms.)
Overview of ankylosing spondylitis. Van Nuys, CA: Spondylitis Association of America. (Accessed on September 19, 2018 at https://www.spondylitis.org/Ankylosing-Spondylitis.)
Overview of types of spondylitis. Van Nuys, CA: Spondylitis Association of America. (Accessed on September 19, 2018 at https://www.spondylitis.org/Types-of-Spondylitis.)
Spondyloarthritis. American College of Rheumatology, 2013. (Accessed on September 19, 2018 at https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Spondyloarthritis.)
What causes ankylosing spondylitis? Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2016. (Accessed on September 19, 2018 at https://www.niams.nih.gov/health-topics/ankylosing-spondylitis#tab-causes.)
What is ankylosing spondylitis? Atlanta, GA: Arthritis Foundation. (Accessed on September 19, 2018 at https://www.arthritis.org/about-arthritis/types/ankylosing-spondylitis/what-is-ankylosing-spondylitis.php.)