Ankylosing Spondylitis (cont.)
What are the symptoms of ankylosing spondylitis?
The symptoms of ankylosing spondylitis are related
to inflammation of the spine, joints, and other organs. Fatigue is a common symptom associated with active inflammation. Inflammation of the
spine causes pain and stiffness in the low back, upper buttock area, neck, and
the remainder of the spine. The onset of pain and stiffness is usually gradual
and progressively worsens over months. Occasionally, the onset is rapid and
intense. The symptoms of pain and stiffness are often worse in the morning or
after prolonged periods of inactivity. The pain and stiffness are often eased by
motion, heat, and a warm shower in the morning. Because ankylosing spondylitis
often affects adolescents, the onset of low back pain is sometimes incorrectly attributed
to athletic injuries in younger patients.
Patients who have chronic, severe inflammation of
the spine can develop a complete bony fusion of the spine (ankylosis).
Once fused, the pain in the spine disappears, but the patient
has a complete loss of spine mobility. These fused spines are
particularly brittle and vulnerable to breakage (fracture) when
involved in trauma, such as motor-vehicle accidents. A sudden
onset of pain and mobility in the spinal area of these patients
can indicate bone breakage. The lower neck (cervical spine) is
the most common area for such fractures.
Chronic spondylitis and ankylosis cause forward curvature
of the upper torso (thoracic spine), limiting breathing capacity.
Spondylitis can also affect the areas where ribs attach to the upper
spine, further limiting lung capacity. Ankylosing spondylitis
can cause inflammation and scarring of the lungs, causing coughing
and shortness of breath, especially with exercise and infections.
Therefore, breathing difficulty can be a serious complication
of ankylosing spondylitis.
Patients with ankylosing spondylitis can also have arthritis in joints other than the
spine. This feature occurs more commonly in women. Patients may notice pain, stiffness, heat, swelling, warmth, and/or
redness in joints such as the hips, knees, and ankles. Occasionally, the small
joints of the toes can become inflamed or "sausage" shaped. Inflammation can
occur in the cartilage around the breast bone (costochondritis)
as well as in the tendons where the muscles
attach to the bone (tendinitis) and in ligament attachments to bone.
Some patients with this disease
develop Achilles tendinitis, causing pain and stiffness in the
back of the heel, especially when pushing off with the foot while
walking up stairs. Inflammation of the tissues of the bottom of the foot, plantar fasciitis, occurs more frequently in people with ankylosing spondylitis.
Other areas of the body affected by ankylosing
spondylitis include the eyes, heart, and kidneys. Patients with ankylosing
spondylitis can develop inflammation of the iris, called iritis. Iritis is
characterized by redness and pain in the eye, especially when looking at bright
lights. Recurrent attacks of iritis can affect either eye. In addition to the
iris, the ciliary body and choroid of the eye can become inflamed; this is
referred to as uveitis.
Iritis and uveitis can be serious complications of ankylosing spondylitis that
can damage the eye and impair vision and may require an eye specialist's
(ophthalmologist) urgent care. Special treatments for serious eye inflammation
are discussed in the treatment section below. (It should be noted that iritis
and inflammation of the spine can occur in other forms of arthritis such as
reactive arthritis [formerly Reiter's syndrome], psoriatic
arthritis, and the arthritis of inflammatory bowel disease.)
A rare complication of ankylosing spondylitis involves scarring of the heart's
electrical system, causing an abnormally slow heart rate. A heart pacemaker may
be necessary in these patients to maintain adequate heart rate and output. The
part of the aorta closest to the heart can become inflamed, resulting in leakage
of the aortic valve. In this case, patients can develop shortness of breath, dizziness, and heart failure.
Advanced spondylitis can lead to deposits of protein
material called amyloid into the kidneys and result in kidney failure.
Progressive kidney disease can lead to chronic fatigue and nausea
and can require removal of accumulated blood poisons
by a filtering machine (dialysis).
Next: How is ankylosing spondylitis diagnosed? »
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