Ankylosing Spondylitis

Ankylosing spondylitis is a type of arthritis that mainly affects the spine, especially the lower back, but can also affect the joints. It causes stiffness and reduced movement and some of the bones of the spine may eventually fuse together.

  • About ankylosing spondylitis
  • Symptoms of ankylosing spondylitis
  • Complications of ankylosing spondylitis
  • Causes of ankylosing spondylitis
  • Diagnosis of ankylosing spondylitis
  • Treatment of ankylosing spondylitis
  • Living with ankylosing spondylitis

About ankylosing spondylitis


Ankylosing means fusing together and spondylitis means inflammation of the bones of the spine (vertebrae). If you have ankylosing spondylitis, the bones in your spine become inflamed at the part where they attach to the tendons, and also at the joints between the bones. Your body then tries to mend the damage by producing new bone. As new bone grows, it can eventually cause them to fuse together.

Although it usually starts in the spine, ankylosing spondylitis can affect any of your joints, especially your knees, hips, ankles and shoulders.

You can develop ankylosing spondylitis at any time, but it usually starts between the ages of 15 and 35, with the average age being 24. About one in 200 men and one in 500 women in the UK have the condition.

Ankylosing Spondylitis
How ankylosing spondylitis can affect the spine

Symptoms of ankylosing spondylitis


Ankylosing spondylitis affects different people in different ways. Symptoms develop gradually, may be mild or severe, and can come and go. They include:

  • back pain and stiffness – this is worse at night and in the morning, and eases off when you move around
  • pain and swelling of your hip, knee or other joints
  • plantar fasciitis – pain under the heel of your foot
  • aching in your chest, around your ribs
  • feeling unwell or feverish and having night sweats
  • weight loss
  • tiredness

Complications of ankylosing spondylitis


You may get inflammation of your eye, called uveitis. This needs to be treated quickly because it is a very painful condition that can cause damage to the eye, and rarely, blindness. If your eye becomes bloodshot and painful, you should visit your GP straight away.

Some people with ankylosing spondylitis develop problems with their heart and lungs, but these problems are very rare. They are usually mild and can be treated.

Associated conditions

Ankylosing spondylitis is one of a group of diseases that also includes psoriatic arthritis, colitic arthritis and reactive arthritis. These are also sometimes called seronegative arthritis diseases or the spondyloarthropathies. Some people with ankylosing spondylitis develop psoriasis or colitis later in life. If you do, your diagnosis may be changed to either psoriatic arthritis or colitic arthritis. If you already have psoriasis or colitis, there is only a small chance that you will develop arthritis as well.

Reactive arthritis may develop after a viral or bacterial infection of your bladder or bowel, or a sexually transmitted infection, especially chlamydia.

Causes of ankylosing spondylitis


The exact cause of ankylosing spondylitis is not known. However, it can run in families. If you have a gene called HLA-B27, you may be more likely to develop the condition – research has shown that 96 percent of people who have ankylosing spondylitis have this gene.

Diagnosis of ankylosing spondylitis


You may have symptoms for years before you’re diagnosed with ankylosing spondylitis. We may conclude the condition after listening to you describe your symptoms and doing a physical examination.

If we think you could have ankylosing spondylitis, we will refer you to a specialist called a rheumatologist – a doctor who specialises in diagnosing and treating conditions affecting the musculoskeletal system. You may have blood tests, and an X-ray or magnetic resonance imaging (MRI) scans of your spine.

Treatment of ankylosing spondylitis


Self-help

Exercising may provide relief from the pain and help your posture. Swimming is ideal as it strengthens your muscles without putting weight on your joints.

A physiotherapist can give you exercises to do to help you keep as much movement as possible. These might involve breathing exercises to keep your ribs and chest flexible, and others that target your back, neck, arms and legs.

Our doctor or physiotherapist may also recommend:

  • keeping your back upright when you’re sitting
  • lying face down for 20 minutes a day to prevent your spine becoming set in a bent position
  • sleeping on a firm bed to stop your back from curving

You may find that a hot shower or bath helps with stiffness in the morning, and using hot water bottles or electric blankets can ease the pain. However, take care not to hold hot water bottles directly against your skin.

Injection

Our doctor can also perform epidural injection to reduce the inflammation.

Surgery

Most people with ankylosing spondylitis don’t need surgery, but if your hip or knee is severely affected, your doctor may recommend replacing the damaged joint. In exceptional circumstances, you may need to have surgery on your spine or neck to correct a severe stoop.

Living with ankylosing spondylitis


You will probably be able to carry on with your daily life and work as usual. However, you may need to make some adjustments to your working environment and you might need special equipment to enable you to do your job more easily. Talk to your occupational health or HR manager for advice.

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