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Ankylosing spondylitis

Published by Bupa's health information team, June 2007.

This factsheet is for people with ankylosing spondylitis, or who would like information about it.

Ankylosing spondylitis is a type of arthritis that mainly affects your spine, especially your lower back, but can also affect your joints. It occurs because inflammation of your joints causes bone to be worn away and your body then attempts to repair this damage. This can lead to stiffness and reduced movement as some of the bones of the spine may fuse together.

What is ankylosing spondylitis?
Symptoms
Causes
Diagnosis
Treatment
Living with ankylosing spondylitis
Further information
Questions and answers
Related topics
Sources

What is ankylosing spondylitis?

Ankylosing means fusing together and spondylitis means inflammation of the bones of the spine. If you have ankylosing spondylitis, the bones in your spine become inflamed where the tendons attach to them. This inflammation leads to the bones being worn down - your body then tries to mend the damage by producing new bone. Usually, the spine bones are separate from each other and don't join directly, but as the new bone grows it can cause them to fuse together.

It can affect any of your joints, but it's most common in your knees, hips, ankles and shoulders.

You can develop ankylosing spondylitis at any time, but it's most likely to start in your early 20s. About one in 1,000 people in the UK have the condition and men are almost three times more likely to get it than women.

Illustration showing how ankylosing spondylitis can affect the spine
How ankylosing spondylitis can affect the spine

Symptoms

Ankylosing spondylitis affects everyone in different ways, but some possible symptoms include:

back pain and stiffness - you will probably find this is worse when you are resting and eases off when you move around
aching in your chest where your tendons attach to your ribs, and pain when you yawn or sneeze
pain in your Achilles tendon
a general feeling of being unwell
weight loss
tiredness
inflammation of your eye - if your eye becomes very bloodshot and painful, you should see your GP straight away as it's important to start treatment as early as possible
problems with your heart and lungs, but these are very rare - they are usually mild and can be treated

You may experience flare-ups when pain and stiffness are worse than at other times. Sometimes, your symptoms may get better or even stop completely. It's likely that you will have less movement in your back as your bones fuse together, and you may develop a stooping, bent-over position.

Associated conditions

Ankylosing spondylitis is one of a group of diseases that also includes psoriatic arthritis, colitic arthritis and reactive arthritis. You may develop any of these conditions before or at the same. Colitic arthritis is related to inflammatory bowel diseases such as Crohn's disease. Sometimes reactive arthritis may be linked to an infection that causes inflammation of your bladder or bowel, and later on this may develop into ankylosing spondylitis.

Causes

The exact reasons why you may develop the condition are not fully understood at present. However, it's likely that it runs in families. Research has shown that 96 percent of people who have the condition carry a genetic marker called HLA-B27. It's thought that this marker is involved in the process of developing ankylosing spondylitis.

Not everyone who has the HLA-B27 marker will develop the condition. If someone with the marker has children, there is a 50 percent chance that they will pass it on to them, but there is still only a small chance that the child will go on to develop ankylosing spondylitis.

Diagnosis

Your GP may be able to diagnose the condition by listening to you describe your symptoms and doing a physical examination. He or she may carry out blood tests to look for signs of inflammation and whether you have HLA-B27. However, this can't provide a definite diagnosis as not everyone with this marker has ankylosing spondylitis.

If your doctor is in any doubt about whether or not you have the condition, he or she may suggest you go for magnetic resonance imaging (MRI) scans of your spine and sacroiliac joint. These may show the early signs of ankylosing spondylitis before they can be seen on an X-ray image.

Treatment

Self-help

It's important that you stay fit, do plenty of exercise and keep a good posture. Exercising may provide relief from the pain and it may also control how bent your spine becomes. Swimming is an ideal activity as it strengthens your muscles without putting weight on your joints. Your GP or physiotherapist may also recommend:

making sure that you keep your back as straight as possible when you are sitting
lying face down (prone) for 20 minutes a day to prevent your spine from becoming set in a bent position
sleeping on a firm bed to stop your back from curving

A physiotherapist will also be able to give you more advice about exercises to help you keep as much movement as possible. These might involve breathing exercises to keep your ribs and chest flexible, and others that target your back, arms and legs.

You may find that heat treatment helps with ankylosing spondylitis. Having hot showers or baths, and using hot water bottles or electric blankets can also ease the pain. You may find an ice pack helps relieve a particularly painful area.

Anti-inflammatory medicines

Painkillers that you would normally take for a headache may give you enough relief. However, if they don't help, your GP may prescribe anti-inflammatory medicines. These are known as non-steroidal anti-inflammatory drugs (NSAIDs). You can buy some NSAIDs, such as ibuprofen (eg Nurofen), from your pharmacist - it's best to speak to your GP or pharmacist before taking these. Other NSAIDs, such as diclofenac (eg Voltarol), have to be prescribed by your GP. NSAIDs will reduce inflammation and pain so that you can continue to exercise.

However, these medicines can have serious side-effects such as stomach pain or bleeding from the stomach. You should see your GP immediately if you experience any pain that feels like indigestion while taking NSAIDs.

You may also be prescribed steroid injections that your GP will inject directly into joints that are very painful.

Disease-modifying medicines

These affect the actual disease process of ankylosing spondylitis. They are used to treat rheumatoid arthritis and don't work as well in the treatment of ankylosing spondylitis. It may take some time before you notice any effect. They can also have serious side-effects so you will need to see your GP regularly for check-ups. Examples of these medicines include methotrexate (eg Maxtrex) and sulfasalazine (eg Salazopyrin).

Biological therapies

Three new medicines called infliximab (Remicade), etanercept (Enbrel) and adalimumab (Humira) have been shown to be successful in treating some forms of arthritis. These are given by injection. They can also have serious side-effects - your GP will explain these to you. These may be suitable if other medication has not helped.

Surgery

It's unlikely that you will need surgery, but if your hip or knee is severely affected your doctor may recommend replacing the damaged joint. You may need to have surgery on your spine or neck to correct a very bent back. However, this is very rare and is usually only done if your stoop is so severe that it prevents you from looking forward.

Living with ankylosing spondylitis

You will probably be able to carry on with your daily life and work as usual. You may need to make some adjustments to your working environment and you might need special equipment to enable you to do your job more easily - the Citizens Advice Bureau can advise you on who to contact about this.

Further information

National Ankylosing Spondylitis Society
020 8948 9117
www.nass.co.uk
Arthritis Research Campaign
0870 850 5000
www.arc.org.uk
Citizens Advice Bureau
www.citizensadvice.org.uk