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Ankylosing spondylitis

Ankylosing spondylitis is a type of arthritis that mainly affects the joints in your spine. It causes stiffness and can reduce your movement. Some of the bones of your spine may fuse together.

If you have ankylosing spondylitis, the bones in your spine become inflamed at the part where they attach to the tendons. They also get inflamed at the joints between your bones. Your body tries to mend the resulting damage to your joints by producing new bone. As new bone grows, it can eventually cause your spine to fuse together. 

Although it usually starts in your spine, ankylosing spondylitis can affect any of your joints, especially your hips, knees and shoulders.

You can develop ankylosing spondylitis at any time, but it usually starts in your late teenage years or early twenties. Men are three times more likely to be affected than women.

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Image showing how ankylosing spondylitis can affect the spine

Details

  • Symptoms Symptoms of ankylosing spondylitis

    Ankylosing spondylitis affects different people in different ways. You may have symptoms for many years before you’re diagnosed with ankylosing spondylitis because early symptoms are similar to back pain. Symptoms often develop gradually – they may be mild or severe, and can come and go.

    Symptoms of ankylosing spondylitis include the following.

    • Back pain and stiffness that you have had for more than three months. This may be worse in the morning and improve as you move around or exercise.
    • Pain and swelling of your hip, knee or other joints.
    • Aching in your chest or ribs, which makes it difficult to breathe.
    • Tenderness in your heel caused by inflammation where your Achilles tendon joins with your heel bone. Or this may be in the arch of your foot (plantar fasciitis).

    If you have any of these symptoms, see your GP. 

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  • Diagnosis Diagnosis of ankylosing spondylitis

    Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

    If your GP thinks you may have ankylosing spondylitis, he or she will refer you to a rheumatologist. A rheumatologist is a doctor who specialises in diagnosing and treating conditions that affect the musculoskeletal system, particularly the joints and surrounding tissues. Your GP may also refer you to see a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility).

    You may need to have blood tests and an X-ray or MRI scan of your hip or spine.

  • Treatment Treatment of ankylosing spondylitis

    There isn't a cure for ankylosing spondylitis. However, there are a number of treatments that can help to ease your symptoms and improve your quality of life.

    Self-help

    Exercise may provide relief from pain and help to improve and maintain your posture, flexibility and mobility. It’s especially important to exercise your back so that it doesn’t stiffen in a bent position. A physiotherapist can give you exercises to do to help you maintain as much movement as possible. These may involve breathing exercises to keep your ribs and chest flexible. Doing physiotherapy in a pool (known as hydrotherapy) or swimming regularly can be particularly useful. This is because it can help to strengthen your muscles without putting weight through your joints.

    There is little evidence to suggest that changing your diet by not eating certain types of food or eating particular foods will help. However, it’s important to eat a healthy, balanced diet in order to stay a healthy weight. If you’re overweight, this may increase the strain on your back and other joints, and may make your pain worse.

    You may find that a hot shower or bath helps with stiffness in the morning. If you use hot water bottles or electric blankets, it may ease your pain. However, take care not to hold hot items directly against your skin as this may damage it. You may also find it helpful to sleep on a firm, supportive mattress to stop your back from curving, and to use a thin pillow.

    If you find everyday tasks difficult because of the pain from ankylosing spondylitis, you may be able to get help from an occupational therapist. An occupational therapist is a health professional who can give practical assistance to help you manage with everyday tasks and increase your independence.

    Medicines

    Painkillers and anti-inflammatory medicines

    Your doctor will usually advise you to try non-steroidal anti-inflammatory drugs (NSAIDs) first, to help with your pain. NSAIDs will reduce inflammation and pain so that you can keep active. You can buy some NSAIDs, such as ibuprofen (eg Nurofen), over the counter. Other NSAIDs, such as naproxen, have to be prescribed by your doctor. If you take NSAIDs regularly, your doctor may suggest you take a medicine called a proton pump inhibitor as well. This medicine will protect your stomach and reduce the risk of side-effects from NSAIDs.

    If you can’t take NSAIDs for any reason, your doctor may advise you to take another painkiller, such as paracetamol, instead.

    Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    Your doctor may offer you a steroid injection into your joints if they are very painful or swollen.

    Disease-modifying anti-rheumatic drugs (DMARDs)

    Depending on how severe your disease is, your doctor may prescribe disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate or sulfasalazine. These medicines are used for other types of arthritis that are caused by inflammation (for example, rheumatoid arthritis). They work by changing the actual disease process of ankylosing spondylitis and may help reduce the damage to your joints. It may take some time before you notice any effect.

    Tumour necrosis factor (TNF) blockers

    If you have severe ankylosing spondylitis and NSAIDs or DMARDs don’t help relieve your symptoms, your doctor may recommend a biological therapy. These include a type of medicine called a tumour necrosis factor (TNF) blocker, such as etanercept and adalimumab. TNF is a chemical that is made by your cells when you get inflammation. Speak to your doctor about the risks and benefits of taking TNF blockers.

    Bisphosphonates

    Biphosphonates (for example, pamidronate) reduce the breakdown of bone and are used to prevent or treat osteoporosis. However, they are also sometimes used to treat ankylosing spondylitis. Your doctor may prescribe these if he or she thinks these medicines will help you.

    Surgery

    Most people with ankylosing spondylitis don’t need surgery, but if your hip or knee is severely affected, your doctor may recommend replacing the damaged joint. In exceptional circumstances, you may need to have surgery on your spine or neck to try to straighten it.

  • Muscle, bone and joint treatment

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  • Causes Causes of ankylosing spondylitis

    The exact reasons why you may develop ankylosing spondylitis aren't fully understood at present.

    Ankylosing spondylitis can run in families. If you have a gene called HLA-B27, you may be more likely to develop the condition. Research has shown that nine in 10 white people who have ankylosing spondylitis have this gene. The proportion of people with the gene is lower in people from other ethnic groups. You can have a blood test to check if you have it. However, if you do have this gene, it doesn’t mean you will definitely get ankylosing spondylitis – it's likely other factors are involved too.

  • Complications Complications of ankylosing spondylitis

    Complications of ankylosing spondylitis include inflammation of your eye, known as iritis. Your eye may become red, painful and sensitive to light. It's important to treat this quickly as it can cause damage to your eye, and even blindness. If your eye becomes bloodshot and painful or you have problems with your sight, see your optometrist or GP straight away. An optometrist is a registered health professional who examines eyes, tests sight and dispenses glasses and contact lenses.

    If you have ankylosing spondylitis, osteoporosis can develop in your spine. Osteoporosis is a condition that causes your bones to become weak and brittle, which can make them more likely to fracture (break). Also, if you have ankylosing spondylitis, your spine is stiff and less flexible. This can also increase your risk of a fracture if you fall or have an injury.

    Ankylosing spondylitis can increase your chance of developing problems with your heart and lungs, such as heart disease or scarring of your lungs (fibrosis).

  • Living with ankylosing spondylitis Living with ankylosing spondylitis

    You will probably be able to carry on with your daily life and go to work as usual. However, you may need to make some adjustments to your working environment and get special equipment to enable you to do your job more easily. Talk to your occupational health or HR manager for advice, or contact the Citizens Advice Bureau.

  • FAQs FAQs

    What type of exercise should I try to do?

    Answer

    Exercise is crucial for anyone with ankylosing spondylitis. After getting some initial guidance from a physiotherapist, try to do plenty of exercise and stretching every day.

    Explanation

    Exercise is one of the most important things you can do if you have ankylosing spondylitis. If you’re diagnosed with the condition, it’s important that you get advice from a physiotherapist. He or she can help you to set a daily routine of exercises. This may include exercises and stretches designed to keep your muscles strong and increase the range of movement in your joints. The routine will also help with your posture. Even if you only do a small amount of exercise and stretch every day, along with taking your medication, it can greatly help your condition.

    Swimming is a great form of exercise if you have ankylosing spondylitis, as your muscles and joints are exercised while they are supported by water. Your physiotherapist can recommend specific swimming strokes that place the least strain on your neck and other painful joints.

    Cardiovascular exercise that is sufficiently vigorous to get you out of breath can help keep you fit. Your physiotherapist is likely to also recommend other breathing-based exercises to help your condition.

    It's best not to participate in contact sports, such as rugby. Also, be careful if you do high-impact sports, such as tennis, basketball and step aerobics. This is because you’re more likely to fracture (break) a bone doing this type of activity. Activities like Pilates, yoga, tai chi and water aerobics are all excellent exercise for people who have ankylosing spondylitis.

    If you have any further questions about ankylosing spondylitis and exercise, talk to your doctor or ask a physiotherapist for advice.

    Can I do anything to make driving easier?

    Answer

    Yes. Although driving for long periods of time can be difficult if you have ankylosing spondylitis, there are things you can do to help.

    Explanation

    If you have ankylosing spondylitis, you may find that driving can be painful and increases stiffness in your neck or back. If you’re on a long journey, try to take regular breaks to stretch out.

    If you have problems turning your head when you reverse your car, wide rear-view mirrors and parking sensors can help. If you find it painful to use gears, get an automatic car. Use a good head support to help protect your neck because even a minor jolt while driving can be painful if your neck is affected.

    If you feel that ankylosing spondylitis affects your ability to drive, you must inform the Driver and Vehicle Licensing Agency (DVLA).

    Do men and women get the same symptoms?

    Answer

    There can be a different pattern to ankylosing spondylitis in men and women.

    Explanation

    Nearly three times as many men are affected by ankylosing spondylitis as women. Men are more likely to be affected in their spine and pelvis. Ankylosing spondylitis may also affect their ribs, hips and feet.

    Women with ankylosing spondylitis are less likely than men to be severely affected in their spines. The condition is more likely to affect their pelvis, hips, knees, wrists and ankles. Ankylosing spondylitis is often milder in women.

    How will my ankylosing spondylitis progress?

    Answer

    Ankylosing spondylitis varies in the way it progresses. Although there isn't a cure, you can do things that help to prevent the condition from becoming worse.

    Explanation

    It’s difficult to predict exactly how your ankylosing spondylitis will progress. Some people have very few symptoms whereas others are more severely affected. There will be times when pain and stiffness flare up. Over time, your lower back can become stiff and your upper back and neck may also be affected. You may develop a very curved back. Ankylosing spondylitis isn’t usually a life-threatening condition.

    Following a regular exercise programme can help to relieve your symptoms, maintain posture and enable you to carry on with your daily life.

  • Resources Resources

    Further information

    Sources

    • Ankylosing spondylitis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published February 2013
    • Ankylosing spondylitis and undifferentiated spondyloarthropathy. Medscape. www.emedicine.medscape.com, published 5 August 2013
    • Ankylosing spondylitis and related conditions. Arthritis Research UK. www.arthritisresearchuk.org, published April 2013
    • Adalimumab, etanercept and infliximab for ankylosing spondylitis. National Institute for Health and Care Excellence (NICE), May 2008. www.nice.org.uk
    • Iritis and uveitis clinical presentation. Medscape. www.emedicine.medscape.com, published 12 June 2013
    • Osteoporosis – prevention of fragility fractures. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published September 2013
    • Ankylosing spondylitis. Arthritis Care. www.arthritiscare.org.uk, published 30 July 2013
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 17 October 2013
    • Golimumab for the treatment of ankylosing spondylitis. National Institute for Health and Care Excellence (NICE), August 2011. www.nice.org.uk
    • Exercise matters – take charge – take action. National Ankylosing Spondylitis Society. www.nass.co.uk, published September 2012
    • Dagfinrud H, Hagen KB, Kvien TK. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database of Systematic Reviews 2008, Issue 1. doi:10.1002/14651858.CD002822.pub3
    • Driving. National Ankylosing Spondylitis Society. www.nass.co.uk, published October 2011
  • Related information Related information

  • Author information Author information

    Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, December 2013.

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