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Ankylosing Spondylitis: Symptoms, Causes, Risk factors, Treatment, Complications, Prevention

Ankylosing Spondylitis: Symptoms, Causes, Risk factors, Treatment, Complications, Prevention

What is Ankylosing Spondylitis?

Ankylosing spondylitis is a type of arthritis that primarily affects the spine. It leads to severe inflammation of the vertebrae that might eventually lead to chronic pain and disability. In more advanced cases, the inflammation can cause new bone to form on the spine. This may cause deformity.

Ankylosing spondylitis can also cause pain and stiffness in other parts of your body. Other large joints, such as the shoulders, hips, and knees, can be involved as well.

Symptoms of Ankylosing Spondylitis

The symptoms of ankylosing spondylitis vary. It’s often characterized by mild to moderate flare-ups of inflammation that alternate with periods of almost no symptoms.

The most common symptom is back pain in the morning and at night. You may also experience pain in the large joints, such as the hips and shoulders. Other symptoms may include:

  • early morning stiffness
  • poor posture or stooped shoulders
  • loss of appetite
  • low-grade fever
  • weight loss
  • fatigue
  • anemia or low iron
  • reduced lung function

Because ankylosing spondylitis involves inflammation, other parts of your body can be affected as well. People with ankylosing spondylitis may also experience:

  • inflammation of the bowels
  • mild eye inflammation
  • heart valve inflammation
  • Achilles tendonitis

While ankylosing spondylitis is primarily a condition of the spine, it can impact other parts of the body, too.

Causes of Ankylosing Spondylitis

The cause of ankylosing spondylitis is currently unknown.

The disorder does tend to run in families, so genetics probably play a role. If your parents or siblings have ankylosing spondylitis, research estimates you’re 10 to 20 times more likely to have it than someone with no family history.

Risk Factors for Ankylosing Spondylitis

Family History

A family history of ankylosing spondylitis is a risk factor, along with the presence of the HLA-B27 protein. According to a 2002 study, more than 90 percent of people who receive a diagnosis of this condition have the gene that expresses this protein.


Unlike other arthritic and rheumatic disorders, initial symptoms of ankylosing spondylitis often appear in younger adults. Symptoms often appear between ages 20 and 40.


Ankylosing spondylitis is around three times more common in males but is seen in females as well.


This condition is more common in people of Caucasian descent than those of African descent or other ethnicities.

Treatment of Ankylosing Spondylitis

There’s no current cure for ankylosing spondylitis, but treatment can manage pain and prevent disability. Proper, timely treatment can help reduce symptoms. It may also slow or even stop possible complications, such as bone deformity.


Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are often used to help manage pain and inflammation. They’re long-acting drugs and are generally safe with few complications.

When NSAIDs no longer provide enough relief, your doctor may prescribe stronger medications. Corticosteroids are commonly prescribed for the short term. This medication is a powerful inflammation fighter, so it can ease symptoms and slow damage to and around the spine.

Tumor necrosis factor (TNF) inhibitors are drugs that can block inflammation triggers in your body. These drugs act to prevent inflammation, and they may ease joint pain and stiffness. TNF inhibitors are typically used after the condition has progressed and NSAIDs are no longer effective.

Lastly, in severe cases, your doctor may prescribe disease-modifying antirheumatic drugs (DMARDs). These drugs work to slow the process of the disease in the body in order to prevent worsening symptoms.


If you have severe damage or deformity to your knee or hip joints, a joint replacement surgery may be necessary. Likewise, an osteotomy may be performed on people with poor posture caused by fused bones. During this procedure, a surgeon will cut and realign the bones in the spine.

Treatment relies largely on how severe the condition is and how troublesome the symptoms are.

Natural Treatments of Ankylosing Spondylitis

In addition to more traditional medical treatments, some natural remedies may help ease symptoms of ankylosing spondylitis. These treatments may be used alone. They may also be combined with other treatments. Talk with your doctor about which ones are safe to use together and best for you.


Range-of-motion exercises, as well as strength training exercises, may help ease the symptoms of ankylosing spondylitis. Both these exercises can strengthen joints and help them be more flexible. Your doctor may refer you to a physical therapist so you can learn how to do these exercises correctly and safely.


Stretching can make your joints more flexible and improve strength. This can lead to less pain and better range of motion in your joints.

Posture Training

Stiffness in the spine may encourage bad posture. Over time, bones in the spine can fuse together in slouching or slumping positions. You can reduce the risk for this by practicing good posture.

Because this may not come naturally after years of poor posture positions, you may need to encourage better posture with reminders to correct your posture regularly. You can also use support devices, such as chairs or seat cushions.

Heat and Cold Therapy

Heating pads or a warm shower can help ease pain and stiffness in the spine and other affected joints. Ice packs can reduce inflammation in painful or swollen joints.


This alternative treatment may reduce pain and other symptoms of ankylosing spondylitis. It does so by activating natural pain-relieving hormones.

Massage Therapy

In addition to being relaxing and invigorating, massage can help you maintain flexibility and improve range of motion. Be sure to tell your massage therapist that you have ankylosing spondylitis. They can be aware for tender points around your spine.

Many treatments for ankylosing spondylitis are also smart practices for a healthier life.

Diet for Ankylosing Spondylitis

There’s no one-size-fits-all diet for ankylosing spondylitis. A healthy diet that provides plenty of vitamins and minerals through a wide variety of foods is a great place to start. Be sure to include:

  • foods that are rich in omega-3 fatty acids, such as fish, nuts, and some oils
  • a wide variety of fruits and vegetables
  • whole grains, such as quinoa or farro, as well as whole-grain foods
  • foods with active cultures, such as yogurt

Cut down or eliminate foods that are rich in fat, sugar, and sodium. This includes highly processed foods. Boxed, bagged, or canned foods often contain ingredients like preservatives and trans fats. These can make inflammation worse.

Likewise, limit how much alcohol you drink, or avoid it altogether. Alcohol can interfere with medications and may make symptoms worse.

Other foods and supplements may make symptoms of ankylosing spondylitis better or worse.

Exercise for Ankylosing Spondylitis

Daily exercise and posture practice is encouraged to help you maintain flexibility and range of motion. Each of these exercises may help reduce symptoms of ankylosing spondylitis:

  • yoga
  • deep breathing
  • stretching
  • swimming
  • posture practices

These practices may be part of a holistic treatment plan that includes medication and physical therapy.

Diagnosis of Ankylosing Spondylitis

A rheumatologist is often consulted to help diagnose ankylosing spondylitis. This is a doctor who specializes in arthritis.

The first step will be a thorough physical exam. Your doctor will ask you for details about your pain and your history of symptoms.

Your doctor will then use an X-ray to check for erosion on your spine and any painful joints. Erosion may not be detected if the disease is in its early stages. An MRI study may also be done. However, MRI results are often difficult to interpret.

A blood test called an erythrocyte sedimentation rate may be done to gauge the presence of any inflammation. A blood test for the protein HLA-B27 may be done. However, the HLA-B27 test doesn’t mean that you have ankylosing spondylitis. It only that you have the gene that produces this protein.

Diagnosing this type of arthritis can take some time.

Complications of Ankylosing Spondylitis

If ankylosing spondylitis is left untreated, some complications are possible. These include:

  • vertebrae may fuse together because of chronic inflammation
  • inflammation can spread to nearby joints, including hips and shoulders
  • inflammation may spread to ligaments and tendons, which may make flexibility worse
  • difficulty breathing
  • eye irritation
  • heart, lung, or bowel damage
  • compression fractures of the spine

It’s important to seek treatment for lower back pain or chronic joint stiffness.

Prevention of Ankylosing Spondylitis

It’s not known how you can prevent ankylosing spondylitis, because no one knows what causes it in the first place. However, if you have the disease, you can focus on preventing disability by:

  • staying active
  • eating a healthy diet
  • maintaining a normal body weight

These healthy lifestyle approaches, as well as traditional treatments, may help delay or slow the progression of the disease.

Outlook for Ankylosing Spondylitis

Ankylosing spondylitis is a progressive condition. This means it’ll grow worse over time and may lead to disability. It’s also a chronic condition, so there’s not yet a treatment that can cure it.

Medication, exercise, and alternative therapies can help prevent and delay inflammation and damage, but they can’t stop them altogether. Physical therapy, exercise, and medication may help ease symptoms of the condition as it worsens.

Talk with your doctor if you’ve been experiencing chronic back pain. They can help look for a cause, such as ankylosing spondylitis, and help create a treatment plan to ease symptoms and discomfort.

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