Ankylosing Spondylitis - Symptoms
Ankylosing spondylitis is inflammation
primarily of the joints of the spine. But it can also involve inflammation of
the eye, other joints-especially those in the hips, chest wall, and around the
heels-and, on occasion, the shoulders, wrists, hands, knees, ankles, and feet.
Although it is unusual, ankylosing spondylitis can also cause changes such as
thickening of the major artery (aorta) and the valve in the heart
If the inflammation
continues over time, it will lead to scarring and permanent damage. In some
people the disease is mild and progresses slowly, and symptoms may never become
severe. Other people may have a more aggressive disease process.
Whether ankylosing spondylitis gets worse depends on a number of things
such as how old you were when the disease began, how early it was diagnosed,
and what joints are involved. It's too early to tell yet, but experts hope
that early treatment with newer medicines will slow or minimize the
inflammation, prevent scarring, and limit the progression of the disease.
Mild or early ankylosing spondylitis
spondylitis usually starts with dull pain in the low back and back stiffness.
Some people with ankylosing spondylitis have "flares" of increased pain and
stiffness that may last for several weeks before decreasing again.
- Affected bones of the low back, middle back,
hips, or neck may become painful, stiff, and limited in motion. Pain tends to
increase slowly over a period of weeks or months, and it is often hard to point
to exactly where the pain is. Stiffness is usually worse in the morning and
usually lasts for more than one hour. Pain is often noticeable in the early
morning hours of sleep, such as between 3 a.m. and 6 a.m. Physical activity
often helps decrease pain and stiffness.
- Some people feel tired as
the disease progresses. This tiredness comes from the body fighting the
inflammatory process that is part of ankylosing spondylitis and also from
ongoing stiffness and pain.
- The colored part of the eye (iris) may become inflamed. This inflammation, called
iritis, occurs in about 25 to 30 out of 100 people who have
ankylosing spondylitis.1 Symptoms of iritis include
redness and pain in the eye and sensitivity to light.
Severe or advanced ankylosing spondylitis
time, the inflammation continues, it will lead to scarring and permanent
- Scarring in the
spine causes the joints of the spine to grow together
(fuse, or "ankylose").
- As the
bones fuse , back pain will gradually go away, but the spine will remain very
stiff and unable to bend. The fused spine is more likely to break (fracture) if
injured, especially the neck (cervical spine).
- Changes in the spine can cause problems with balance, safety, and mobility. The upper
spine can curve forward until eventually the person has a hard time looking
straight ahead. Also, as the spine loses its natural curves, it becomes hard to
balance while standing and walking, especially if the hips are also
- Breathing can become difficult as the upper
body curves forward and the chest wall stiffens. Severe ankylosing spondylitis
can also cause scarring of the lungs (pulmonary fibrosis) and an increased risk of lung infection. This can cause even
greater problems in smokers, because their lungs are already more prone to lung
infection and scarring.
- Scarring in the eye can lead to permanent
visual impairment and glaucoma.
- In rare cases, the heart muscle
can become scarred and the heart valves may become
inflamed. The heart may be unable to pump properly
(heart failure). The main artery leading from the heart
(aorta) can also be affected by becoming inflamed and
enlarged near where it leaves the heart.
- Bowel inflammation is
sometimes linked with ankylosing spondylitis.
- The kidneys can be
affected by taking
medicines over a long period of time.
- Some people who have
ankylosing spondylitis for many years develop
cauda equina syndrome from scarring around the nerves
at the end of the spinal cord. This condition can cause loss of feeling in the
saddle area of the groin and legs. It can also cause problems with bowel and
bladder control and sexual activity. Talk to your doctor if you start having
problems controlling your bowels or bladder.