Back pain is common—but for more than 1.7 million people in the United States, the pain is more than waking up sore and stiff in the morning. This kind of back pain may be caused by a condition called ankylosing spondylitis, a type of arthritis and inflammation that affects the spine.
Ankylosing spondylitis is characterized by inflammation in the spinal joints, particularly around the sacroiliac joints where the spine meets the pelvis. People with this disease experience stiffness and pain in different parts of their back.
Often, the first symptoms of ankylosing spondylitis begin in the lower back and buttocks. It is not a mechanical injury, like a slipped disc or broken bone. Instead, it’s caused by inflammation in the vertebrae and joints. Most people experience back pain and stiffness from ankylosing spondylitis before the age of 45.
Where does the name ankylosing spondylitis come from? When inflammation spreads throughout the spine, including the joints between the vertebrae, it is called spondylitis. As you lose back movement, the bones of the spine fuse together. This is called ankylosis.
If the disease advances, sections of your spine can become fixed or immobile. However, with appropriate treatment, many people can reduce inflammation, manage pain and improve their overall mobility.
Understanding Ankylosing Spondylitis Pain
According to the Spondylitis Association of America, pain from this disease isn’t limited to the sacroiliac joints or low back. Some people may experience pain in their buttocks and low back, while others may experience pain in other joints—including the ribs, shoulders, knees or feet. Pain may last longer than three months and happen on both sides of the body. It may also spread up the spine and into the neck and upper back, as well as into the heels.
People who live with ankylosing spondylitis typically experience flare-ups, or periods of worsening pain, as well as stretches of time without any symptoms. The pain seems to be worse overnight or after sitting still. You may be able to relieve pain and stiffness with physical activity and exercise.
Life with Ankylosing Spondylitis
If you experience back pain that is constant and lasts longer than three months, talk with your health care provider or seek the assistance of a rheumatologist. These specialists are trained to address, diagnose and treat conditions related to the musculoskeletal system. According to the Spondylitis Association of America, ankylosing spondylitis is part of a larger family of diseases called spondyloarthritis that includes two main categories:
- Axial spondyloarthritis, arthritis in the spine and hips
- Peripheral spondyloarthritis, arthritis in joints and tendons
While there aren’t any known causes of ankylosing spondylitis, there are some common characteristics of people who live with this disease. A rheumatologist will likely ask specific questions about personal medical history, the type of pain you experience, family history and other medical conditions. This specialist will consider X-rays to view changes in the sacroiliac joints and blood tests for inflammatory markers to make a diagnosis. However, if the X-ray is normal, the provider can order an MRI or CT scan as a follow-up for additional information.
Who Is More Likely to Get Ankylosing Spondylitis?
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, a set of factors may increase your likelihood of developing ankylosing spondylitis, including:
- Family history and genetics. Certain genetic markers influence risk of developing this disease.
- Sex. Men are at higher risk of developing the disease than women.
- Underlying conditions. People living with inflammatory bowel disease—Crohn’s disease and ulcerative colitis—may be more likely to have ankylosing spondylitis.
Most people develop ankylosing spondylitis in late adolescence or early adulthood.
More Than Just Back Pain
Like other conditions that affect the immune system, ankylosing spondylitis can affect other parts of the body beyond the spine. People may experience inflammation in other joints, pain, and discomfort while breathing if the ribs are affected. They may also experience inflammation of the eyes or uveitis, fatigue, weight loss, rashes, and abdominal pain. People who have ankylosing spondylitis are more likely to be affected by other autoimmune diseases, such as psoriasis and inflammatory bowel disease.
Living with any type of inflammation, whether from ankylosing spondylitis or rheumatoid arthritis, can lead to fatigue and pain. The unforeseen consequences of living with chronic disease appear, too, including depression and anxiety. Beyond a medical provider, people with ankylosing spondylitis may benefit from seeking the support of a therapist or psychologist and a support group—online or in person—as they cope with a chronic disease and learn strategies to manage flare-ups.
Treatment Options
There is no cure for ankylosing spondylitis, nor is there a one-size-fits-all approach to treatment for this disease. However, most treatment regimens include:
- Exercise and staying active
- Good posture practices
- Medication
- Physical therapy
- Reducing joint pain by applying heat or cold to the affected area
After a diagnosis, your physician will recommend the most appropriate treatment plan based on your symptoms. Not every medication strategy works for every patient. It may take time to find the best medication, especially if you live with other autoimmune conditions that affect other organs and systems long-term. In general, medications include the following:
- Nonsteroidal anti-inflammatory drugs for pain relief
- Corticosteroids
- Disease-modifying anti-rheumatic drugs
- Biological therapy
Certain biological therapies may address related conditions, including inflammatory bowel disease.
Your physician and medical team are the best resources for navigating your course of treatment and understanding the benefits and side effects of each medication. If you’re managing ankylosing spondylitis or are a caregiver of someone with this condition, it’s vital to share all other medications and over-the-counter supplements with your health care provider.
Because of the nature of ankylosing spondylitis and its potential impact on other bodily systems, people living with this condition will typically consult with several specialists, including a rheumatologist, dermatologist, gastroenterologist, ophthalmologist and others.
Exercise Is Important
While it may seem daunting if you’re experiencing significant pain and fatigue, exercise can help people with ankylosing spondylitis feel better. Exercise, including stretching, strengthening, and balance, is a vital part of a treatment plan and can improve your mood, help you sleep, and reduce pain. Physical therapists can guide individuals living with ankylosing spondylitis on the best movements and habits to relieve pain.
More to Read
- 7 Steps for Coping With a Chronic Condition
- How Injections for Back Pain Work & When They’re an Option
- Could Sacroiliac Joint Dysfunction Be Causing Your Back and Leg Pain?
- Solutions to Manage Nighttime Back Pain
- How to Relieve Back Pain Without Surgery
Medically reviewed by Bernadette C. Siaton, MD, MEdHP.
