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).

Return to Ankylosing Spondylitis

See what others are saying

Comment from: MJ, 65-74 Female (Patient) Published: January 08

I suffered pain for a very long time. It wasn't until my late 30's that I was diagnosed with AS (ankylosing spondylitis). Before that though, I was lucky to get 4 hours of sleep a night and would literally have to roll out of bed onto all fours and very slowly roll my spine up into a standing position. My doctor, when told of my symptoms, immediately ordered the blood test and, sure enough, AS was the culprit. I was treated with Naproxen and Tylenol and physiotherapy. this treatment worked, except for a few flare-ups in my back and massage and heat therapy helped. About 20 years ago all treatment that I was on just didn't seem to be working. When my eye became inflamed I didn't know what was happening. I thought I was going blind and the pain was terrible. Thankfully I was sent to an ophthalmologist in time. I was finally referred to a rheumatologist when I just couldn't function very well at all. X-rays were taken and showed some fusion but, being female it wasn't in my spine. Naproxen dosage was hiked up to the maximum with extra strength Tylenol. It helped some. Finally, I was put on Humira injections. I was also on prednisone for 2 years and now, today, I take Humira, methotrexate, Celebrex, Flexeril and Celexa. I have had cataract surgery in both eyes due to iritis flare ups, cortisone shots in my index finger knuckle and my heels. This disease can affect not only the spine. I have had steroid shots in the hip bursa and the shoulder areas; five at one time in my shoulder. The pain was so bad I couldn't stand or sit. I hope this helps someone understand that this disease isn't all in your mind.

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Comment from: MISSjrEWING, 25-34 Female (Patient) Published: April 01

I"m a female who has dealt with ankylosing spondylitis (AS) since 2005. My course has been debilitating to say the very least. I was originally diagnosed with lupus and doctors also thought I had multiple sclerosis (MS). Today I hold my head up high and run off a long laundry list of diagnoses: AS, Sjogren's, fibromyalgia, hiatal hernia, Barrett's esophagus, Collins syndrome, trigeminal neuralgia (suicide disease). I think that"s everything, I have a hard time remembering. My original diagnosis (that I"m not sure if they still carry) are: peripheral neuropathy and sacroiliitis. My rheumatic doctor did an x-ray of my hips and said that it wouldn"t likely turn into AS. He was wrong. I have since had a DEXA scan (I think that"s the name) and it showed in my hips and lower spine. I had that scan about 2 years ago. I now get swelling in the joint of my right foot, severe pain in the heel of my left foot and incredible pain in my right shoulder. The pain in my left buttocks feels like someone has their foot shoved up my backside 24/7. The pain in my ribs and the center of my chest is debilitating at best. As a single mother of 3 life is not easy for me. Sleep is impossible as AS wakes me up in the middle of the night and at any given time one of my other health issues can decide to flare up and then I"m really done for. I walk with a cane and use a wheelchair to get around my house. I wish I had friends or family to aid me but I do not. I do not wish this on my worst enemy. I live in fear of fusion and I try my hardest to stretch and exercise but when my fatigue consumes me I cannot.

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