To print: Use your web browser's print feature. Close this window after printing. Click here to change your print selections. Ankylosing Spondylitis Table of Contents Topic Overview Symptoms Exams and Tests Treatment Overview Home Treatment Other Places To Get Help Related Information References Credits Appendix Biologics for Ankylosing Spondylitis Hip Replacement Surgery Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Sulfasalazine for Ankylosing Spondylitis Topic Images Spine Ankylosing Spondylitis Posture in Advanced Ankylosing Spondylitis Flexibility and Strengthening Exercises for Ankylosing Spondylitis Cartilage Hip Replacement Surgery Topic Overview What is ankylosing spondylitis? Ankylosing spondylitis (say "ang-kill-LOH-sing spawn-duh-LY- tus") is a long-term form of arthritis that most often occurs in the spine (See figure in appendix) . 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. What causes ankylosing spondylitis? 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. What are the symptoms? 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 (See figure in appendix) , together. This leads to less range of movement in the neck and low back. 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 (See figure in appendix) and may make it hard for you to walk. 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. How is ankylosing spondylitis diagnosed? The early 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 sacroiliac joints. 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. How is it treated? 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 joints. Surgery for the spine is rarely needed. You may want to think about hip or knee replacements if you have severe arthritis in those joints. 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. Frequently Asked Questions Learning about ankylosing What is ankylosing spondylitis? spondylitis: What causes it? What are the symptoms? What are other spondyloarthropathy conditions? Being diagnosed: How is ankylosing spondylitis diagnosed? What is a genetic test? Getting treatment: How is ankylosing spondylitis treated? Can medicines reduce pain and stiffness? What assistive devices or orthotics can help ease movement? Ongoing concerns: What can I do at home to reduce my symptoms? Will I need surgery for ankylosing spondylitis? What is hip replacement surgery? (See [ ] in appendix) Living with ankylosing Can yoga help with my symptoms? spondylitis: Can acupuncture help with my symptoms? What happens over time with ankylosing spondylitis? Symptoms 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 called the aortic valve. 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. Mild or early ankylosing spondylitis Ankylosing 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. Affected bones of the low back, middle back, hips, or neck may become painful, stiff, and limited in motion. Pain tends to increase slowly over a period of weeks or months, and it is often hard to point to exactly where the pain is. Stiffness is usually worse in the morning and usually lasts for more than one hour. Pain is often noticeable in the early morning hours of sleep, such as between 3 a.m. and 6 a.m. Physical activity often helps decrease pain and stiffness. Some people feel tired as the disease progresses. This tiredness comes from the body fighting the inflammatory process that is part of ankylosing spondylitis and also from ongoing stiffness and pain. The colored part of the eye (iris) may become inflamed. Symptoms of iritis include redness and pain in the eye and sensitivity to light. Severe or advanced ankylosing spondylitis If, over time, the inflammation continues, it will lead to scarring and permanent damage. Scarring in the spine causes the joints of the spine to grow together (fuse, or "ankylose"). As the bones fuse (See figure in appendix) , back pain will gradually go away, but the spine will remain very stiff and unable to bend. The fused spine is more likely to break (fracture) if injured, especially the neck (cervical spine). Changes in the spine (See figure in appendix) can cause problems with balance, safety, and mobility. The upper spine can curve forward until eventually the person has a hard time looking straight ahead. Also, as the spine loses its natural curves, it becomes hard to balance while standing and walking, especially if the hips are also affected. Breathing can become difficult as the upper body curves forward and the chest wall stiffens. Severe ankylosing spondylitis can also cause scarring of the lungs (pulmonary fibrosis) and an increased risk of lung infection. This can cause even greater problems in smokers, because their lungs are already more prone to lung infection and scarring. Scarring in the eye from uncontrolled iritis can lead to permanent visual impairment and glaucoma. In rare cases, the heart muscle can become scarred and the heart valves may become inflamed. The heart may be unable to pump properly (heart failure). The main artery leading from the heart (aorta) can also be affected by becoming inflamed and enlarged near where it leaves the heart. Bowel inflammation is sometimes linked with ankylosing spondylitis. The kidneys can be affected by taking medicines over a long period of time. Some people who have ankylosing spondylitis for many years develop cauda equina syndrome from scarring around the nerves at the end of the spinal cord. This condition can cause loss of feeling in the saddle area of the groin and legs. It can also cause problems with bowel and bladder control and sexual activity. Talk to your doctor if you start having problems controlling your bowels or bladder.