What Are the Early Symptoms of Ankylosing Spondylitis?

Low back pain with stiffness is a symptom of ankylosing spondylitis.

Ankylosing spondylitis is a chronic inflammatory disorder that is a type of spondyloarthritis, a rare form of arthritis. It primarily affects the sacroiliac joints between the bones of the pelvis and the axial skeleton, which includes the spinal column, ribcage, neck, and skull bones.

Symptoms of ankylosing spondylitis include the following:

• Low back pain with stiffness
• Stooped posture
  • Symptoms begin before age 40
  • Symptoms are present for more than 3 months
  • Symptoms worsen in the morning or with inactivity
  • Symptoms improve with exercise
• Stooped posture (advanced stage)
• Irritation of soft tissues (muscles, ligaments, tendons) where they enter the bones (enthesitis), especially in extremities
• Arthritis
• Fatigue
• Eye inflammation (uveitis)
• Heart disease
• Lung disease
• Kidney disease
• Neurologic disease
• Gastrointestinal disease
• Metabolic bone disease

The cause of ankylosing spondylitis is unknown, but doctors believe that a combination of genetic and environmental factors plays a role.

Risk factors for ankylosing spondylitis include

• family history of the condition and
• smoking.

Doctors diagnose ankylosing spondylitis based on the presence of inflammatory back pain and irritation of soft tissues (muscles, ligaments, tendons) where they enter the bones (enthesitis) or arthritis.

Medical professionals may order imaging tests to confirm the presence of inflammation and arthritis such as

• X-rays,
• Power Doppler ultrasonography,
• magnetic resonance imaging (MRI), and
• computed tomography (CT).

Treatment for ankylosing spondylitis is based on the presentation and severity of the condition and may include:

• Physical therapy and exercise -- This should include core strengthening and cardiovascular exercises, isometric strengthening, breathing, stretching, and dynamic movements. Tai chi and Pilates may be beneficial for some patients. Patients should perform fall-prevention exercises as part of their exercise program.
• Posture training is important to help prevent the spine from becoming "frozen" in an awkward posture.
• Support groups can help patients cope with the impact the condition has had on their lives.
• Take safety measures because limited mobility may cause accidents.
  • Limit alcohol.
  • Use narcotics and sleeping pills with caution, if at all.
  • Modify the home to decrease the risk of falls, such as installing shower or tub grab-bars, use of nightlights, securing loose rugs, and keeping walkways free of clutter.
  • Always wear seatbelts in a vehicle.
  • Sleep on a thin pillow to help avoid developing deformities of the neck.
  • Avoid contact sports and high-impact activities if your spine is inflexible.

Medications used to treat ankylosing spondylitis include the following:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and stiffness
• Sulfasalazine (a DMARD) and methotrexate (Trexall) for arthritis symptom relief
• Tumor necrosis factor-α (TNF-α) antagonists such as infliximab (Remicade), etanercept (Enbrel), adalimumab (Humira), certolizumab pegol (Cimzia), and golimumab (Simponi), may help improve symptoms.
• Corticosteroid injections for swollen, painful joints or an inflamed tendon or bursa or the sacroiliac joints. (Oral corticosteroids are not used.)
• Opioids (narcotics) for pain
• Anti-interleukin 17 therapy such as secukinumab (Cosentyx) and ixekizumab (Taltz) may be used in place of anti-TNF therapy.

In some cases, surgery may be needed to treat ankylosing spondylitis. Surgical procedures include the following:

• Total hip replacement for severe and persistent hip pain and limited mobility
• Spinal surgery, which involves fusion of the bones in the cervical or upper thoracic spine
• Wedge osteotomy involves the removal of a wedge-shaped piece of bone from a vertebra, followed by realignment of the spine, which is braced so it can heal in a better position.
• Fracture stabilization

The following complications may rarely occur in patients with advanced ankylosing spondylitis:

• Spinal fractures and spinal cord injuries
• Frequent in the neck
• Cauda equina syndrome is a rare neurologic complication. Symptoms result from damage to nerves in the lower back.
• Erectile dysfunction or impotence in men
• Heart valve disease can cause signs and symptoms of heart failure, including leg or ankle swelling (edema) and shortness of breath during exercise or exertion.
• Lung disease

The prognosis for patients with ankylosing spondylitis depends on the severity and progression of the disease. Ankylosing spondylitis in itself does not shorten a person's life expectancy, but some of the complications associated with the condition may. Patients typically require long-term anti-inflammatory therapy.

A poor outcome may occur in patients who have peripheral joint involvement, a young age of onset, an elevated erythrocyte sedimentation rate (ESR), and a poor response to nonsteroidal anti-inflammatory drugs (NSAIDs).