Patient education: Ankylosing spondylitis (The Basics)

What is ankylosing spondylitis? — 

This is a disease that causes pain and stiffness in the back, neck, and sometimes hips and heels. It begins with inflammation around the bones in the spine or in some joints. Later, it can sometimes cause the bones in the spine to fuse together.

Ankylosing spondylitis is part of a group of diseases called "spondyloarthritis."

What are the symptoms of ankylosing spondylitis? — 

The most common symptom is pain in the low back. This pain usually:

●Starts in early adulthood, usually before age 45 years

●Starts slowly

●Lasts for longer than 3 months

●Is worse after resting, like first thing in the morning

●Feels better with movement

The back might also become less flexible. This can make it harder to do certain things, like bending forward to put on socks or shoes. It can also lead to a "hunchback" posture over time.

Other symptoms might include pain or arthritis in other joints, especially in the morning.

In some cases, ankylosing spondylitis can lead to other problems, such as:

●Inflammation of part of the eye – This is called "iritis" or "uveitis." It causes eye pain and blurry vision.

●Damage to the spinal cord – Ankylosing spondylitis makes it more likely the bones in the neck or back will break. This can sometimes happen even from a very small fall or accident. If these bones break, the spinal cord can get injured.

●Problems with the heart valves

●Breathing problems – Some people have stiffness between the ribs and spine. This can make it harder to breathe deeply and to exercise.

●Inflammation of the inside of the intestines – This usually does not cause any obvious symptoms.

Is there a test for ankylosing spondylitis? — 

No. But your doctor or nurse should be able to tell if you have it by learning about your symptoms, doing an exam, and using imaging tests, like X-rays. Imaging tests create pictures of your bones and joints. You might get blood tests, too.

How is ankylosing spondylitis treated? — 

Treatment depends on your symptoms and how severe your condition is. The goals of treatment are to:

●Relieve symptoms

●Help you do your normal activities

●Keep your condition from causing other problems

Exercise is an important part of treating ankylosing spondylitis. Some people work with a physical therapist (exercise expert) to learn the best way to exercise. You might do stretches and gentle exercises to strengthen your muscles.

It is especially important to work on your posture. That's because ankylosing spondylitis can cause the head to tilt forward in a "hunchback" posture. Special exercises can help prevent this.

Many people with ankylosing spondylitis also take 1 or more medicines. These might include:

●NSAIDs – This is a large group of medicines that includes ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand names: Aleve, Naprosyn). They can help relieve pain.

●Other medicines – There are other medicines that can help treat symptoms and keep ankylosing spondylitis from getting worse. Your doctor or nurse will decide which ones are best for you.

If you smoke, your doctor or nurse will talk to you about quitting. This can help slow damage to the spine from ankylosing spondylitis. If you are having trouble quitting, there are treatments that can help.

Surgery can help some people with severe ankylosing spondylitis.

What can I do on my own? — 

You can lower the chance your condition will cause problems if you:

●Get regular physical activity – This can help prevent some of the stiffness caused by ankylosing spondylitis. Follow your doctor's instructions for exercising and stretching.

●Eat and drink foods with a lot of calcium and vitamin D (figure 1) – This can help keep your bones from getting weak. If your doctor or nurse thinks you are not getting enough calcium and vitamin D through diet, they might suggest taking supplements. Talk to your doctor about how much you should get.

●Use a thin pillow – Sleeping on a thick pillow can cause neck problems in people with ankylosing spondylitis.

What will my life be like? — 

Ankylosing spondylitis can make it hard to do simple things, such as get dressed, get up from a sitting position, and look from side to side. You might need help from family or friends.

You can also buy certain devices to help with your daily activities. These might include:

●A walker or cane to help prevent falls

●Tools to help you put on your socks and shoes, like a shoehorn with a long handle or sock aid

Your doctor, nurse, or physical therapist might be able to suggest tools that can help and where to get them. Many are available at the pharmacy.

If the bones in your spine have fused together, you could be at risk of a serious neck or back injury. To reduce the chance you will get hurt:

●Remove loose rugs, electrical cords, and any clutter that could make you trip.

●Do not drink a lot of alcohol or take sleeping pills.

●Avoid contact sports and other activities that might cause injury.

●Always wear a seatbelt while riding in a car.

It can be scary to find out you have ankylosing spondylitis. It might help to talk to a counselor or go to a support group. Your doctor or nurse might be able to suggest local or online options. It might also help to tell trusted friends or family.

What if I want to get pregnant? — 

It is possible to have a safe, healthy pregnancy with ankylosing spondylitis. But talk to your doctor or nurse before you start trying. This is because:

●Some of the medicines used to treat ankylosing spondylitis are not safe for a developing fetus. You might need to switch medicines before you get pregnant.

●There are things you should do to help prevent problems during pregnancy.

When should I call the doctor? — 

Call your doctor or nurse if your:

●Eyes hurt

●Vision gets worse

●Pain or stiffness gets worse

More on this topic

Patient education: Reactive arthritis (The Basics)
Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (The Basics)
Patient education: Quitting smoking for adults (The Basics)
Patient education: Physical activity for people with arthritis (The Basics)
Patient education: Calcium and vitamin D for bone health (The Basics)

Patient education: Axial spondyloarthritis, including ankylosing spondylitis (Beyond the Basics)
Patient education: Reactive arthritis (Beyond the Basics)
Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)
Patient education: Disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (Beyond the Basics)
Patient education: Quitting smoking (Beyond the Basics)
Patient education: Calcium and vitamin D for bone health (Beyond the Basics)