What is ankylosing spondylitis?

Ankylosing Spondylitis

Ankylosing spondylitis: Overview

Ankylosing spondylitis (say "ang-kill-LOH-sing spawn-duh-LY-tus") is a type of arthritis. It causes pain and stiffness in your neck and back. In some people, it also affects the chest, joints, or eyes.

This problem is different for everyone. You may find that your pain comes and goes. Or maybe you can't move your back or neck very well.

Sometimes the joints in the spine grow together over time. This is called fusion. If this happens, your body may bend forward in a fixed position.

If you do exercises, you will be able to move better and reduce stiffness. Exercises can also help your posture and slow the progress of the disease. You may also want to try physical therapy.

Medicine can also help with pain and stiffness.

Ankylosing spondylitis

Ankylosing spondylitis is a form of joint inflammation (arthritis) that is long-lasting (chronic) and most often affects the spine. Ankylosing spondylitis commonly causes pain and stiffness, with limited motion in the low back, middle back, neck, hips, chest wall, and heels.

Ankylosing spondylitis is a specific disease within a family of diseases called spondyloarthropathies. The cause of the disease is not known. In severe cases the affected joints in the spine fuse together. This causes severe stiffness in the back. Other joints can be stiff and painful, including those in the shoulders, wrists, hands, knees, ankles, and feet. Complications of ankylosing spondylitis may include inflammation of the colored part of the eye (iris), called iritis, or difficulty breathing due to curving of the upper body and stiffening of the chest wall. Inflammation from the condition may also affect the heart valves. In rare cases of severe disease, the artery called the aorta, the lungs, the kidneys, and the digestive tract can also be affected.

Ankylosing spondylitis usually affects people younger than about 35. It can run in families. And it is more common in men than in women.

Although there is no cure, treatment can usually control symptoms and prevent the condition from getting worse. Most people are able to continue to work and do normal daily activities.

What are the symptoms of ankylosing spondylitis?

Symptoms of ankylosing spondylitis include 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.

How is ankylosing spondylitis treated?

Treatment for ankylosing spondylitis focuses on:

  • Relieving pain and stiffness.
  • Reducing inflammation.
  • Keeping the condition from getting worse.
  • Helping you to keep doing your daily activities.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, seem to work best for pain and stiffness. Treatment also includes exercise and physical therapy. They will help reduce stiffness so that you can move around better.

You'll need to get regular eye exams to check for inflammation in your eye, called iritis.

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 you to keep doing your daily activities for as long as possible.

How is ankylosing spondylitis diagnosed?

Your doctor will ask about your symptoms and if they've gotten worse over time. They'll also ask if you have a family history of joint disease.

You may have a physical exam to see how stiff your back is. Your doctor may also want to see whether you can expand your chest normally. Your doctor may also look for tender areas. This may include areas over the points of the spine, the pelvis, the areas where your ribs join your breastbone, and your heels.

Several tests will be done if your doctor thinks that you may have this disease. 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 can you care for yourself when you have ankylosing spondylitis?

There are things you can try that may help you feel better. If your doctor gives you medicine for pain, take it exactly as prescribed. Ask your doctor if it's okay to exercise to keep your joints moving well. Using a cane or walker may reduce pain when you walk.

Posture in Advanced Ankylosing Spondylitis

Normal posture compared to the posture of advanced ankylosing spondylitis

As severe ankylosing spondylitis advances:

  • The head moves forward and the neck becomes stiff.
  • The upper back curves forward (kyphosis).
  • The normal curve in the low back flattens.
  • The hips may become stiff and not straighten completely.
  • People often keep their knees bent a little to make up for the changed curves in their back and stiffness in their hips. This bending of the knees causes the body to shift back a little so it's easier to balance and to see straight ahead.

What is ankylosing spondylitis?

Ankylosing spondylitis (say "ang-kill-LOH-sing spawn-duh-LY-tus") is an inflammatory disease and long-term form of arthritis. It most often occurs in the spine. It can cause pain and stiffness in the low back, middle back, buttocks, and neck, and sometimes in other areas like the hips, chest wall, or heels.

How can you care for yourself when you have ankylosing spondylitis?

  • Take medicines for pain and stiffness exactly as directed.
    • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, seem to work best for ankylosing spondylitis. If you can't take NSAIDs, talk to your doctor about other options. Read and follow all instructions on the label.
  • If your doctor says it is okay, try some exercises to keep your joints moving well.
  • Ask your doctor about other activities and exercise. If your doctor says it is okay, you may want to take yoga or Pilates classes. These can help make your belly, back, and hips strong.
  • You may want to try a cane or walker. These can help reduce pain when you walk.
  • Because people with this condition may be at a higher risk for spinal cord injury, it's important to wear a seat belt every time you drive or ride in a car.
  • Keep good posture. It can help keep your spine straighter. Try to lie on your stomach a few times a day to keep your spine and hips extended. Sleep on a firm mattress. And use a small pillow that supports your neck.
  • Follow your doctor's advice about physical therapy. A physical therapist can move your joints to improve their motion. The therapist can also show you how to stretch your joints. You may also learn exercises to do at home. And you may learn how to use heat or ice to help pain and stiffness.
  • Get regular eye exams. These can check for an eye problem called iritis that may happen with this condition.
  • Do not smoke. People with this condition are at risk for lung infections. And smoking can make it harder to breathe. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

Ankylosing spondylitis: When to call

Call your doctor now or seek immediate medical care if:

  • You have new or worse symptoms in your arms, legs, chest, belly, or buttocks. Symptoms may include:
    • Numbness or tingling.
    • Weakness.
    • Pain.
  • You lose bladder or bowel control.
  • You have bad eye pain and your eyes are red and sensitive to light.

Watch closely for changes in your health, and be sure to contact your doctor if:

  • You are not getting better as expected.

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