Ankylosing Spondylitis - Symptoms

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The symptoms of ankylosing spondylitis can vary greatly from patient to patient. What were your symptoms at the onset of your disease?

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What are ankylosing spondylitis symptoms and signs?

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 with loss of range of motion noticeable over months. Occasionally, the onset is rapid and intense. Lumbar pain (low back pain) and buttock pain are common manifestations of active inflammation in the lumbar spine and sacroiliac joints. The symptoms of pain and stiffness are often worse in the morning or after prolonged periods of inactivity. Motion, heat, and a warm shower often reduces pain and stiffness 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.

Those 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 affected individual 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), which limits 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.

People 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 breastbone (costochondritis) as well as in the tendons where the muscles attach to the bone (tendinitis) and in ligament attachments to bone. Some people 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 upstairs. 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 (iritis), the colored portion of the eye. 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 known as 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 (referred to as heart block). A heart pacemaker may be necessary in these patients to maintain adequate heart rate and output. In others, 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 waste products in the blood by a filtering machine (dialysis).

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See what others are saying

Comment from: seema b., 35-44 Female (Patient) Published: July 31

I have had ankylosing spondylitis since last five years. My shoulder pains, my neck doesn't move, and there is a back pain I can't even sleep.

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Comment from: Tushar_612, 25-34 Male (Patient) Published: September 01

The first symptom of ankylosing spondylitis (AS) I experienced was 3 years ago. I have been differentially diagnosed with AS; awaiting blood work. But somehow I think I have all the symptoms for AS, whether I have HLA-B27 gene or not. Three years ago, I started noticing the pinch in my back. I could not lie flat on my back. The doctor said I had calcium deficiency. Two years ago, I moved to USA from India. Within 7 months I noticed the first major pain in my back and ribs. I also felt the pain in my heels and lower back. I think the change in environment activated my HLA-B27 gene or increased its impact. I remained on Norflex and Ansaid or NSAID for a month and Physical therapy. Last year I had a major flare up again. Never before have I experienced such pain; as if I had been stabbed. I have been living with pain since then. I was told that it is my posture, so have been working with my physical therapist, and last week I went to a chiropractor to get some relief. He saw my x-rays and told me I have AS. At first I was relieved that I can now cure myself, but AS does not have any cure. Not trying to have a negative outlook, but maybe that is what I should expect from myself, a less painful life, if not pain free, and be able to live an active lifestyle.

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