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Ankylosing spondylitis

Published by Bupa's health information team, November 2009.

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 the spine, especially the lower back, but can also affect the joints. It causes stiffness and reduced movement and some of the bones of the spine may eventually fuse together.

About ankylosing spondylitis
Symptoms of ankylosing spondylitis
Complications of ankylosing spondylitis
Causes of ankylosing spondylitis
Diagnosis of ankylosing spondylitis
Treatment of ankylosing spondylitis
Living with ankylosing spondylitis
Questions and answers
Further information
Sources

About ankylosing spondylitis

Ankylosing means fusing together and spondylitis means inflammation of the bones of the spine (vertebrae). If you have ankylosing spondylitis, the bones in your spine become inflamed at the part where they attach to the tendons, and also at the joints between the bones. Your body then tries to mend the damage by producing new bone. As new bone grows, it can eventually cause them to fuse together.

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

You can develop ankylosing spondylitis at any time, but it usually starts between the ages of 15 and 35, with the average age being 24. About one in 200 men and one in 500 women in the UK have the condition.

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

Symptoms of ankylosing spondylitis

Ankylosing spondylitis affects different people in different ways. Symptoms develop gradually, may be mild or severe, and can come and go. They include:

back pain and stiffness - this is worse at night and in the morning, and eases off when you move around
pain and swelling of your hip, knee or other joints
plantar fasciitis - pain under the heel of your foot
aching in your chest, around your ribs
feeling unwell or feverish and having night sweats
weight loss
tiredness

Complications of ankylosing spondylitis

You may get inflammation of your eye, called uveitis. This needs to be treated quickly because it is a very painful condition that can cause damage to the eye, and rarely, blindness. If your eye becomes bloodshot and painful, you should visit your GP straight away.

Some people with ankylosing spondylitis develop problems with their heart and lungs, but these problems are very rare. They are usually mild and can be treated.

Associated conditions

Ankylosing spondylitis is one of a group of diseases that also includes psoriatic arthritis, colitic arthritis and reactive arthritis. These are also sometimes called 'sero-negative arthritis' diseases or the 'spondyloarthropathies'. Some people with ankylosing spondylitis develop psoriasis or colitis later in life. If you do, your diagnosis may be changed to either psoriatic arthritis or colitic arthritis. If you already have psoriasis or colitis, there is only a small chance that you will develop arthritis as well.

Reactive arthritis may develop after a viral or bacterial infection of your bladder or bowel, or a sexually transmitted infection, especially chlamydia.

Causes of ankylosing spondylitis

The exact cause of ankylosing spondylitis is not known. However, it 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 96 percent of people who have ankylosing spondylitis have this gene.

Diagnosis of ankylosing spondylitis

You may have symptoms for years before you're diagnosed with ankylosing spondylitis. Your GP may suspect you have the condition after listening to you describe your symptoms and doing a physical examination.

If your GP thinks you could have ankylosing spondylitis, he or she will refer you to a specialist called a rheumatologist - a doctor who specialises in diagnosing and treating conditions affecting the musculoskeletal system. You may have blood tests, and an X-ray or magnetic resonance imaging (MRI) scans of your spine.

Treatment of ankylosing spondylitis

Self-help

Exercising may provide relief from the pain and help your posture. Swimming is ideal as it strengthens your muscles without putting weight on your joints.

A physiotherapist can give you exercises to do 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, neck, arms and legs.

Your GP or physiotherapist may also recommend:

keeping your back upright when you're sitting
lying face down for 20 minutes a day to prevent your spine becoming set in a bent position
sleeping on a firm bed to stop your back from curving

You may find that a hot shower or bath helps with stiffness in the morning, and using hot water bottles or electric blankets can ease the pain. However, take care not to hold hot water bottles directly against your skin.

Medicines

Painkillers and anti-inflammatories

Your GP or rheumatologist 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), from your pharmacist. Other NSAIDs, such as celecoxib, have to be prescribed by your GP.

These medicines can have side-effects such as stomach pain or bleeding from the stomach. Talk to your GP or pharmacist if you need to take NSAIDs regularly, and see your GP immediately if you experience any pain that feels like indigestion while taking NSAIDs. Always read the patient information leaflet that comes with your medicine.

If you can't take NSAIDs for any reason, your doctor may advise you to take another painkiller, such as paracetamol, instead. Or, he or she may prescribe a medicine called a proton pump inhibitor to take at the same time as an NSAID, to reduce your risk of side-effects.

Your doctor can also prescribe corticosteroid injections, which he or she will inject into joints (such as your knee) if they are very painful and swollen.

Disease-modifying anti-rheumatic drugs (DMARDs)

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

TNF-a inhibitors

If DMARDs have not helped relieve your symptoms, your rheumatologist may recommend a type of medicine called a TNF-a inhibitor. Two of these medicines (etanercept and adalimumab) are available on the NHS for people with ankylosing spondlyitis. They are given by injection.

Bisphosphonates

Bisphosphonates (eg, pamidronate) affect bone metabolism and are usually used to prevent or treat osteoporosis (thin bones). However, they are also sometimes used in the treatment of ankylosing spondylitis. They are also given by injection. Your rheumatologist 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 correct a severe stoop.

Living with ankylosing spondylitis

You will probably be able to carry on with your daily life and work as usual. However, 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. Talk to your occupational health or HR manager for advice, or contact the Citizens Advice Bureau.