Visual Guide to Ankylosing Spondylitis
This type of arthritis causes painful inflammation in the spine. Over time, it may make your vertebrae — the small bones of the spine — fuse together. It can also inflame other joints, like hips and knees, and it can damage your eyes, heart, and other organs. There’s no cure, but treatment and taking care of yourself can often slow it down or prevent it from getting worse.
Three times more men than women get ankylosing spondylitis (AS), typically between ages 16 and 35. It’s more common in people who are white, Asian, or Hispanic. You’re more likely to get it if one of your parents or siblings has it. Most people with the disease have a gene called HLA-B27, though having this gene doesn’t mean you’ll get AS. But you can’t prevent it.
The classic symptom is pain and stiffness in your hips and lower back. It often gets better with exercise and worse with rest, so it may wake you up at night and feel more intense in the morning.
That’s a big word for the pain and swelling AS can cause where your tendons and ligaments connect to bones. You’re likely to feel this at the top of your shinbone, the back or bottom of your heel, or where your ribs connect to your breastbone. When your ribs are affected, you may have trouble breathing or it may hurt when you breathe because you can’t fully expand your chest.
Since AS is a kind of arthritis, joints like your hips, knees, and shoulders can also hurt and swell. AS can lead to weak, brittle bones (osteoporosis). Feeling drained of energy is common, and you may have anemia. You could lose weight because of problems in your gut, such as colitis. AS can cause inflammation that damages your eyes, heart, and lungs, too.
When it’s treated, AS doesn’t typically affect how long you’ll live or limit your abilities too much. Your symptoms may come and go, and often get better and worse. Some people will have more severe problems related to the disease and its effects, such as a hunched-over posture and vertebrae that have grown together, which limit the spine’s movement.
Symptoms usually show up slowly over many months or years. They vary from person to person. You should get checked out if your lower back, hips, or bottom have been hurting more and more for a few months, especially when the pain wakes you at night or feels bad in the morning, or it gets better with exercise and worse when you rest.
Go to an eye doctor right away if your vision is blurry, your eyes are red and hurt, or light bothers you.
AS can take a while to confirm. Your doctor will start by asking when your symptoms began and what they’re like. She’ll check your spine’s flexibility, what positions cause pain, and your breathing. You may get blood tests for inflammation and the HLA-B27 gene, but they can only offer evidence, not say for sure that you have AS. X-rays and MRIs show spine damage, but they may not catch it early.
There’s no cure for AS, but treatment can help you keep doing your usual activities and living your life by easing symptoms and holding off more severe, long-term effects. The earlier you begin, the better.
Rheumatologists are specialists who treat arthritis and other diseases of the bones, joints, and muscles. Depending on your symptoms, you might need to work with other health professionals, too.
You usually start with nonsteroidal anti-inflammatory drugs (NSAIDs) — like aspirin, ibuprofen, and naproxen — to help with pain, stiffness, and swelling. Biologic drugs work on your immune system to interrupt the inflammation process. Other arthritis drugs won’t help your spine, but they may lessen pain and swelling in other joints.
Stay as active as you safely can. It’s one of the best things you can do for AS. It will also help keep your weight in check, so you don’t put extra strain on your back and joints. Eat less bread, rice, and potatoes, and more lean protein, vegetables, and fruits. Make sure to get plenty of calcium and vitamin D for your bones. Avoid smoking: It’s not good for your body in general, but smokers with AS tend to have more spinal damage.
When you walk or sit, don’t slump. Keep your spine straight, shoulders square, and head up.
Choose hard, upright chairs instead of soft, cushy ones. A pillow behind your back can give you support.
Use a firm mattress that has some give. Avoid a lot of pillows. It’s best to sleep on your belly with no pillow, or on your back with one thin pillow. Keep your legs stretched out, rather than curled up.
Treatment for AS often includes an individual, tailored exercise plan to ease pain, build strength, and improve your range of motion. A physical therapist can coach you on posture and sleeping, too. Massage and other bodywork may help with your comfort and flexibility.
In general, use cold packs or ice for swelling, and heat for stiff joints or tight muscles. Tough to move in the morning or when you go to exercise? Try a warm bath or shower and then some gentle stretches. If pain keeps you up at night, try an electric blanket.
You’ll need to adjust your surroundings to encourage good posture. Avoid lifting, stooping, and tasks that are awkward for your body. Use a sit/stand desk so you can change positions throughout the day. Take short breaks often.
If you’re having a hard time, an occupational therapist might be able to help you change your movements and workspace, or show you devices to make it easier to do your job.
For most people with AS, driving won’t be a problem. But if your range of motion is affected and it’s difficult to check to the side and behind you, get extra-wide mirrors for your car so you can see and be safe. Fit your headrest correctly — level with the top of your ears (or higher), with as little distance between it and the back of your head as possible. On longer trips, make regular stops to get out and stretch.
Symptom flare-ups may make it painful, but medications or trying different positions can help. The key is to communicate with your partner. Couples who talk honestly about their needs and fears usually find a way to make it work.
Zelman, MD on July 12, 2017
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Arthritis Foundation: “What Is Ankylosing Spondylitis?” “Ankylosing Spondylitis Symptoms,” “Ankylosing Spondylitis Self-Care.”
Mayo Clinic: “Ankylosing spondylitis: Overview,” “Ankylosing spondylitis: Symptoms and causes,” Ankylosing spondylitis: Diagnosis,” “Ankylosing spondylitis: Treatment,” “Ankylosing spondylitis: Self-management.”
National Health Service: “Ankylosing spondylitis,” “Ankylosing spondylitis – Symptoms,” “Ankylosing spondylitis – Diagnosis,” “Ankylosing spondylitis – Treatment.”
University of Washington, Orthopaedics and Sports Medicine: “Ankylosing Spondylitis.”
Merck Manual, Professional Version: “Ankylosing Spondylitis.”
National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Questions and Answers about Ankylosing Spondylitis.”
UMass Memorial Health Care: “Ankylosing Spondylitis.”
FDA: “Information on Tumor Necrosis Factor (TNF) Blockers (marketed as Remicade, Enbrel, Humira, Cimzia, and Simponi).”
Arthritis Research UK: “Diet and nutrition for ankylosing spondylitis (AS),” “Posture and ankylosing spondylitis (AS),” “Sleep and ankylosing spondylitis (AS),” “Pain management for ankylosing spondylitis (AS),” “Driving and ankylosing spondylitis (AS),” “Sex, pregnancy, children and ankylosing spondylitis (AS).”
Spondylitis Association of America: “The London AS / Low Starch Diet.”
Status Report: “Head restraints will be higher and closer to head under new regulation.”
Journal of the Canadian Chiropractic Association: “Knowledge and application of correct car seat head restraint usage among chiropractic college interns: a cross-sectional study.”
Reviewed by David
Zelman, MD on July 12, 2017
This tool does not provide medical advice. See additional information.
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Visual Guide to Ankylosing Spondylitis
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