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EspañolAnkylosing spondylitis symptoms: What are the early signs of ankylosing spondylitis?
Overview: What does ankylosing spondylitis feel/look like?
Ankylosing spondylitis is a form of arthritis that primarily affects the spine. Like rheumatoid arthritis, ankylosing spondylitis is an inflammatory disease caused by the immune system. Whereas rheumatoid arthritis mainly affects the joints in the fingers and elsewhere, ankylosing spondylitis causes inflammation in the joints and ligaments of the spine as well as the joint that connects the spine to the hip bone.
Lower back pain and stiffness is the earliest sign and most common symptom of ankylosing spondylitis. Both pain and stiffness are at their worst when waking up or after resting, and both improve with activity. Over time, the spine gradually becomes more rigid and harder to move. Posture is affected, and spinal deformities develop. People with AS may get stuck in a hunched-forward position. Eventually, the new bone begins to grow and fuse in the spine. This condition is called ankylosis. At some point, the fusions make it impossible to move the spine. These are the main symptoms, but AS inflammation can also affect other parts of the body, including the ankles, heels, fingers, eyes, and digestive system.
Key takeaways:
Ankylosing spondylitis is a rare health condition that mostly affects males under the age of 40, though it can affect anyone regardless of age, sex, race, or ethnicity. Find updated arthritis statistics here.
Early signs of ankylosing spondylitis include low back pain, lower back stiffness, hip stiffness, and sometimes neck pain and stiffness.
Serious symptoms of ankylosing spondylitis, such as severe pain, vision changes, or medication side effects, may require immediate medical attention.
Ankylosing spondylitis is caused by a combination of genetics and environmental triggers such as bacterial infections. You may be at risk for developing ankylosing spondylitis symptoms if you are male, under the age of 40, have other autoimmune disorders, or have a family history of ankylosing spondylitis.
Ankylosing spondylitis usually requires a medical diagnosis.
Ankylosing spondylitis generally requires treatment. Ankylosing spondylitis symptoms typically resolve with treatment within variable timelines. Some cases are more treatment-resistant than others.
Treatment of ankylosing spondylitis may include physical therapy, lifestyle changes, nonsteroidal anti-inflammatory drugs (NSAIDs), steroid injections, immune-suppressing drugs, and surgery.
Untreated ankylosing spondylitis could result in complications like chronic pain, reduced flexibility, spinal deformity, disability, spinal fractures, hip dislocation, aortic regurgitation (a dysfunction of the main artery leaving the heart), scarring in the lungs, compression of the nerve bundles in the hips, and an increased risk of cardiovascular disease.
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What are the early signs of ankylosing spondylitis?
The earliest warning signs of ankylosing spondylitis are low back pain and stiffness that are usually worse in the morning or after resting and improve with exercise and activity. These symptoms first appear between the ages of 15 and 30. Early stages of AS may also include symptoms such as hip pain, shoulder pain, butt pain, fever, and fatigue.
RELATED: Lower back pain treatment and medications
Other ankylosing spondylitis symptoms
The primary symptoms of ankylosing spondylitis are lower back pain and stiffness. However, inflammation can affect other parts of the spine and body.
The most common symptoms of ankylosing spondylitis include:
Back pain
Back stiffness
Hip pain and swelling (sacroiliitis)
Shoulder pain
Buttock pain
Fatigue
Feeling sick
Weight loss
The back pain usually worsens during periods of inactivity or rest and will improve with physical activity or applying heat.
Repeated flare-ups over time can eventually lead to bone fusion in the spine and hip-spine joint (sacroiliac joint), producing deformities and movement problems, including:
Spinal rigidity
Difficulty bending over
Stooping, hunched-over posture
Trouble breathing because of postural deformities
Inflammation often affects other joints, causing symptoms such as:
Joint pain
Swelling
Joint tenderness
Finger swelling
Unlike more familiar types of arthritis, ankylosing spondylitis causes inflammation in the ligaments and tendons at their connections to the bone, a condition called enthesitis. Because of enthesitis, people with AS may have other symptoms such as:
Ankle pain (similar to Achilles tendonitis)
Heel pain (similar to plantar fasciitis)
Pain when taking deep breaths in the places where the rib bones connect to the breastbone or spine
Knee pain
Jaw pain
AS inflammatory episodes may include eye inflammation (anterior uveitis or iritis). Symptoms include:
Blurred vision
Light sensitivity
Eye pain
Less commonly, AS can cause inflammation in the large intestine with symptoms similar to Crohn’s disease or ulcerative colitis. Typical symptoms include:
Diarrhea
Bloating
Cramping
Blood in the stool
RELATED: Learn about these 8 common types of arthritis
Ankylosing spondylitis vs. spondyloarthritis symptoms
Ankylosing spondylitis is a type of spondyloarthritis, an inflammatory disease of the backbone. Other spondyloarthritic conditions include psoriatic arthritis (psoriasis-associated arthritis), reactive arthritis, and joint disease associated with inflammatory bowel disease (IBD-associated spondyloarthropathy). Although they share many symptoms, some have unique symptoms. Most of the time, however, symptoms are common in one condition and less common in others. For instance, swelling of the joint between the backbone and the hip, called sacroiliitis, is a defining feature of ankylosing spondylitis. Everyone diagnosed with AS will have swelling in this joint. Only about 20% to 40% of people with other types of spondyloarthritis will have this problem.
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RELATED: Lower back pain treatments and medications
When to see a healthcare provider for ankylosing spondylitis symptoms
See a healthcare provider when experiencing persistent symptoms of AS. Diagnosis will involve a medical history, physical exam, blood tests, and X-rays or MRI scans. While symptoms, history, and blood tests can help narrow the diagnosis, the primary criteria for diagnosing ankylosing spondylitis are the results seen on X-rays or other imaging tests of the spine and the spine/hip joint. Suppose there’s no evidence of backbone joint damage in the imaging tests, but everything else points to ankylosing spondylitis. In that case, the clinician will probably give a diagnosis of non-radiographic axial spondyloarthritis.
AS flare-ups will often require medical care or urgent care. Emergency care is less likely unless there’s severe pain or changes in vision. Some AS medications may have severe side effects requiring emergency treatment, but these are rare.
Complications of ankylosing spondylitis
The most common complications of AS are chronic pain, limited spinal mobility, and postural deformities. Other complications include:
Disability
Hip dislocation
Spinal fractures
Aortic regurgitation—when the main artery leaving the heart spills blood back into the heart
Scarring in the upper lungs
Squeezing of the nerve roots at the base of the spine
Depression
Anxiety
Increased risk of cardiovascular diseases
How to treat ankylosing spondylitis symptoms
Ankylosing spondylitis will require treatment to manage pain, control symptoms, preserve flexibility and range of motion, maintain functional abilities, and prevent serious complications. When treated, most people with AS will have normal lives without severe complications or disability. Most people with AS will see a rheumatologist, a specialist in inflammatory diseases of the muscles and joints, for treatment. However, other medical professionals may be involved, such as a physical therapist, eye doctor, or mental health professional.
Treatment primarily consists of:
Learning and practicing good posture
Exercise
Physical therapy to learn good posture and preserve range of motion
Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief and swelling reduction
Locally injected corticosteroids for pain and other symptoms that do not improve with NSAID treatment
Disease-modifying antirheumatic drugs (DMARDs) to block the immune system and reduce the frequency and severity of flare-ups—a rheumatologist typically starts with biologic drugs called TNF inhibitors such as Humira (adalimumab) and may add or switch to more traditional DMARDs such as methotrexate or sulfasalazine
Spinal surgery in the more severe cases
Other manifestations of the disease, such as eye inflammation, may involve additional treatment options
RELATED: How much does Humira cost? See prices and ways to save
Living with ankylosing spondylitis
Ankylosing spondylitis is a chronic, lifelong medical condition. Symptoms of AS can be controlled and reduced through medications, but lifestyle changes and habits can also have significant effects. Here are some ways to manage AS:
Take prescribed medications as instructed
Follow the advice of doctors, healthcare providers, and rehabilitation therapists
Write down symptoms and their severity in a symptom diary and share it with the treatment team
Identify possible triggers and then avoid them
Exercise
Lose weight
Quit smoking
Avoid secondhand smoke
Eat a healthy diet
Most importantly, see a doctor as soon as possible
Ankylosing spondylitis is not curable, but it can be managed through treatment. Symptoms can be controlled, flare-ups can be managed, complications prevented, and functioning at least partly preserved through the appropriate treatment and lifestyle changes. Get medical help early when experiencing persistent symptoms of AS, such as back pain and stiffness
FAQs about ankylosing spondylitis symptoms
What are the triggers for ankylosing spondylitis?
Healthcare professionals don’t know what causes ankylosing spondylitis. AS is strongly associated with an inherited component of the immune system called the HLA-B27 antigen, but the vast majority of people with this antigen never get AS. Evidence suggests that AS is initially triggered in people with HLA-B27 by an immune system response to a bacterial infection. According to one study, once AS develops, flare-ups are frequent, about once per month. Symptoms can last for a few days to several months. There are no proven triggers, but one study found that the majority of people with AS believed that stress or overexertion triggered their flare-ups.
What labs are elevated with ankylosing spondylitis?
When diagnosing ankylosing spondylitis, healthcare providers will order blood tests that look for evidence of an inflammatory response: erythrocyte sedimentation rate (ESR) and C-reactive protein levels (CRP test). High levels of CRP usually mean that the body is mounting an inflammatory reaction somewhere in the body. In an ESR test, lab technicians measure how fast blood cells float to the bottom of a long, narrow tube. The faster they settle, the more likely the body will have an inflammatory reaction somewhere.
How does ankylosing spondylitis affect the eyes?
Ankylosing spondylitis affects more than just the spine and the joint between the spine and hip. It can also affect other joints and the digestive system, and it frequently causes inflammation at the front of the eye. Symptoms can include red eye, blurry vision, and eye pain. Treatment usually consists of corticosteroid eye drops.
What’s next? Additional resources for people with ankylosing spondylitis symptoms
Test and diagnostics
12 ankylosing spondylitis symptoms you can’t afford to ignore, Global Healthy Living Foundation
Ankylosing spondylitis, NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases
Ankylosing spondylitis, StatPearls
Spondyloarthropathies, American Family Physician
Treatments
2019 update/recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis, Arthritis & Rheumatology
Ankylosing spondylitis, StatPearls
Ankylosing spondylitis: etiology, pathogenesis, and treatments, Bone Research
Spondyloarthritis, American College of Rheumatology (ACR)
Treatment of spondyloarthritis, Spondylitis Association of America
Scientific studies and clinical trials
Definition of disease flare in ankylosing spondylitis: the patient’s perspective, The Journal of Rheumatology
Patient-reported flares in ankylosing spondylitis: a cross-sectional analysis of 234 patients, The Journal of Rheumatology
More information on related health conditions
Arthritis treatments and medications, SingleCare
Degenerative disc disease treatments & medications, SingleCare
Lower back pain treatments and medications, SingleCare
Spondylolisthesis treatments & medications, SingleCare
Ulcerative colitis vs. Crohn’s: causes, symptoms, treatments, & more, SingleCare