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Ankylosing spondylitis

Spondylitis; Spondyloarthritis; HLA - Spondylitis

Ankylosing spondylitis (AS) is a chronic form of arthritis. It mostly affects the bones and joints at the base of the spine where it connects with the pelvis. These joints can become swollen and inflamed. Over time, the affected spinal bones may join together.

Images

Skeletal spine
Cervical spondylosis

Causes

AS is the main member of a family of similar forms of arthritis called spondyloarthritis. Other members include psoriatic arthritis, arthritis of inflammatory bowel disease and reactive arthritis. The family of arthritis appears to be quite common and affects up to 1 in 100 people.

The cause of AS is unknown. Genes seem to play a role. Most people with AS are positive for the HLA-B27 gene.

The disease often begins between ages 20 and 40, but it may begin before age 10. It affects more males than females.

Symptoms

AS starts with low back pain that comes and goes. Low back pain becomes present most of the time as the condition progresses.

Other parts of your body that may be affected include:

Fatigue is also a common symptom.

Less common symptoms include:

AS may occur with other conditions, such as:

Exams and Tests

Tests may include:

Treatment

Your health care provider may prescribe medicines such as NSAIDs to reduce swelling and pain.

You may also need stronger medicines to control pain and swelling, such as:

Surgery, such as hip replacement, may be done if pain or joint damage is severe.

Exercises can help improve posture and breathing. Lying flat on your back at night can help you keep a normal posture.

Outlook (Prognosis)

The course of the disease is hard to predict. Over time, signs and symptoms of AS flareup (relapse) and quiet down (remission). Most people are able to function well unless they have a lot of damage to the hips or the spine. Joining a support group of others with the same problem may often help.

Treatment with NSAIDS often reduces the pain and swelling. Treatment with TNF inhibitors early in the disease appears to slow progression of the spine arthritis.

Rarely, people with ankylosing spondylitis may have problems with:

When to Contact a Medical Professional

Contact your provider if:

Related Information

Arthritis
Peripheral
Aortic stenosis
Uveitis
Idiopathic pulmonary fibrosis

References

Gardocki RJ, Park AL. Degenerative disorders of the thoracic and lumbar spine. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 39.

Inman RD. The spondyloarthropathies. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 249.

van der Linden S, Brown M, Gensler LS, Kenna T, Maksymowych WP, Taylor WJ. Ankylosing spondylitis and other forms of axial spondyloarthritis. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelly's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 80.

Ward MM, Deodhar A, Gensler LS, et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Care Res (Hoboken). 2019;71(10):1285-1299. PMID: 31436026 pubmed.ncbi.nlm.nih.gov/31436026/.

Werner BC, Feuchtbaum E, Shen FH, Samartzis D. Ankylosing spondylitis of the cervical spine. In: Shen FH, Samartzis D, Fessler RG, eds. Textbook of the Cervical Spine. Philadelphia, PA: Elsevier Saunders; 2015:chap 28.

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Review Date: 5/31/2020  

Reviewed By: Diane M. Horowitz, MD, Rheumatology and Internal Medicine, Northwell Health, Great Neck, NY. Review provided by VeriMed Healthcare Network. Internal review and update on 08/26/2021 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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