Pfizer's Andrew Koenig, DO, Medical Director of the Inflammation Team, answers frequently asked questions about this inflammatory disease that can cause lower back pain.
Q: What is ankylosing spondylitis?
A: Ankylosing Spondylitis (AS) is the most common form of spondyloarthritis, a type of arthritis that can cause pain and inflammation in and around joints in the spine, hips, chest wall, and anywhere ligaments and tendons join to the bone (such as the heel). AS mainly affects the spine, although other joints can be affected. One of the most common symptoms is lower back pain.
When AS is severe, it can cause some of the vertebrae in the spine to join together, or fuse. When these bones fuse, it can make the spine inflexible and create a hunched over posture and severely limit mobility.
Q: How common is AS and who is most likely to get it?
A: In the United States, AS affects about 0.2-0.5% of the population. Men are about 2 to 3 times more likely to be affected by AS than women, and it usually begins between late teens to age 40. When AS symptoms begin at the age of 16 or younger, it is called juvenile-onset AS.
Q: What causes AS?
A: The exact cause of AS is unknown, but it’s considered to be a systemic, or whole body, “autoimmune” disease—a disease in which the immune system attacks other parts of the body. In the case of AS, the immune system attacks the spine and other areas of the body, causing the joints, tendons, and ligaments to become inflamed, stiff, and painful. Usually, the inflammation begins where the spine meets the pelvis, in a place called the sacroiliac joint.
Q: What are the symptoms of AS?
A: AS affects everyone differently, with some people having back pain and stiffness that comes and goes, while others suffer more severe pain that leads to varying degrees of spinal stiffness as the disease progresses. For almost everyone, AS will cause a cycle of very painful periods of time (flares) followed by periods when the symptoms disappear (remission). Other symptoms include pain and swelling in neck, hips, knees, or ankles; difficulty expanding the chest; and fatigue. Other parts of the body can also be affected.
Ankylosing spondylitis can get worse over time, which is why getting help from a doctor as soon as possible is important. As AS gets worse, the spine gradually becomes more stiff and the bones in the spine may ultimately become fused or attached. This can severely limit a person’s mobility.
Q: How is AS treated?
A: There is no cure for ankylosing spondylitis, but there are several approved treatments that can help manage the symptoms. Options include over-the-counter pain relievers, anti-inflammatory drugs, and prescription medicines. Your doctor may also prescribe an individualized exercise program. These treatments can help manage symptoms of AS, including pain.
Q: How is AS diagnosed?
A: The average time from when a person first noticed symptoms of AS to diagnosis of AS is about 8 years. That’s at least partly because AS can be difficult to diagnose in its early stages. Not only does AS affect people in different ways, it also usually begins very slowly. It can also be mistaken for other forms of arthritis, especially if pain begins in the hips, knees or shoulders. To add to these difficulties, there is currently no single test to identify the disease. Instead, diagnosis is usually based on the expert clinical evaluation of a rheumatologist.
The difficulty in diagnosing AS makes it important that you are prepared to tell your doctor about all of your symptoms. For a clinical diagnosis, your doctor will likely refer you to a rheumatologist and/or:
- Ask about your medical history
- Consider all your symptoms
- Perform a physical examination
- Run some laboratory tests on a sample of your blood
- Send you for x-rays or other diagnostic imaging tests to look for changes in your joints
Q: If I’m diagnosed with AS, is there anything I can do to manage my symptoms?
• Get enough sleep and eat a healthy diet. This may help minimize fatigue that can occur with AS.
• Eat a healthy diet. Eating a diet rich in omega-3 fatty acids may help reduce inflammation.
• Stretch. Stretching may help increase your range of motion and can improve your posture.
• Exercise. Exercise is considered helpful for managing AS symptoms. Exercises can be done on land or in water, but supervised physical therapy is considered to be the most effective. Talk to your doctor before starting any exercise routine or program.
• Avoid high-impact and contact sports. These include activities and sports such as hockey, football, wrestling, basketball, karate, step aerobics, tennis and squash.
• Ask your health care team about canes, walkers and other devices. There are a number of aids available to make functioning easier and more comfortable.