Ankylosing spondylitis

 

Alternative Names

Spondylitis; Spondyloarthropathy

Definition

Ankylosing spondylitis is a long-term type of arthritis. It most commonly affects the bones and joints at the base of the spine where it connects with the pelvis.

These joints become swollen and inflamed. Over time, the affected spinal bones join together.

Causes

The cause of ankylosing spondylitis is unknown. Genes seem to play a role.

The disease most often begins between ages 20 and 40, but it may begin before age 10. It affects more males than females.

 

Symptoms

The disease starts with low back pain that comes and goes. Low back pain is present most of the time as the condition progresses.

  • Pain and stiffness are worse at night, in the morning, or when you are less active. The discomfort may wake you from sleep.
  • The pain often gets better with activity or exercise.
  • Back pain may begin in the sacroiliac joints (between the pelvis and spine). Over time, it may involve all or part of the spine.
  • Your lower spine becomes less flexible. Over time, you may stand in a hunched forward position.

Other parts of your body that may be stiff and painful include:

  • The joints between your ribs and breastbone, so that you cannot expand your chest fully
  • Swelling and pain in the joints of the shoulders, knees and ankles
  • Swelling of the eye

Fatigue is also a common symptom.

Less common symptoms include:

  • Loss of appetite
  • Slight fever
  • Weight loss

Exams and Tests

Tests may include:

  • CBC
  • ESR (a measure of inflammation)
  • HLA-B27 antigen (which detects the gene linked to ankylosing spondylitis)
  • X-rays of the spine and pelvis
  • MRI of the spine

Treatment

Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain.

  • Some NSAIDs can be bought over-the-counter (OTC), such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
  • Other NSAIDs are prescribed by your health care provider.
  • Talk to your health care provider or pharmacist before using any over-the-counter NSAID.

You may also need stronger medicines to control pain and swelling, such as:

  • Corticosteroid therapy (such as prednisone)
  • Sulfasalazine
  • Methotrexate 
  • TNF-inhibitors (such as etanercept, adalimumab, infliximab, golimumab)

Surgery may be done if pain or joint damage is severe.

Exercises can help improve posture and breathing. Lying flat on your back at night can help you keep a normal posture.

Outlook (Prognosis)

The course of the disease is hard to predict. Symptoms may come and go at any time. Most people are able to function unless they have a lot of damage to the hips.

Rarely, people may have problems with:

  • Abnormal heart rhythm
  • Scarring or thickening of the lung tissue
  • The aortic heart valve
  • Inflammation in the large intestine (colitis)

When to Contact a Medical Professional

Call your health care provider if:

  • You have symptoms of ankylosing spondylitis
  • You have ankylosing spondylitis and develop new symptoms during treatment

References

Inman RD. The spondyloarthropathies. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 273.

Sidiropoulos PI, Hatemi G, Song IH, et al. Evidence-based recommendations for the management of ankylosing spondylitis: systematic literature search of the 3E Initiative in Rheumatology involving a broad panel of experts and practising rheumatologists. Rheumatology (Oxford). 2008. 47(3):355-61.

Yu D, Lories R, Inman RD. Pathogenesis of ankylosing spondylitis and reactive arthritis. In: Firestein GS, Budd RC, Gabriel SE, et al, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 74.

Review Date: 4/20/2013
Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

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