Ankylosing spondylitis is a type of chronic inflammatory arthritis that primarily affects the joints and ligaments of the spine. Without proper diagnosis and treatment, this condition can result in chronic pain, stiffness, or even permanent changes in spinal mobility. Although this condition most commonly affects the spine, hips, shoulders, ribs, and other joints might also be involved.

Unlike back pain that is caused by muscle strain, poor posture, or age-related wear and tear, ankylosing spondylitis is persistent, often begins at a young age, and improves with movement rather than rest. The good news is that early recognition and treatment can significantly improve quality of life and prevent long-term complications.

Common Symptoms of Ankylosing Spondylitis

Unlike back pain caused by injury or overuse, inflammatory back pain often has distinct characteristics.

Common symptoms include:

• Chronic lower back pain lasting longer than three months
• Morning stiffness that lasts 30 minutes or more
• Pain that improves with physical activity but worsens with rest
• Joint pain in hips, knees, ankles, or shoulders
• Tendon pain and inflammation, especially in the heel (Achilles tendon) and bottom of the feet (plantar fasciitis)
• Pain that wakes you during the second half of the night
• Reduced flexibility in the spine
• Fatigue
• Neck pain as the disease progresses

Symptoms often begin before the age of 45 and may develop gradually over months or years.

Who is at Risk of Developing Ankylosing Spondylitis?

Several factors can increase the likelihood of developing ankylosing spondylitis. A family history of ankylosing spondylitis or the presence of the HLA-B27 genetic marker might increase your risk. In fact, 80-90 percent of people with ankylosing spondylitis carry the HLA-B27 gene. Personal or family history of psoriasis, inflammatory bowel disease, or recurrent eye inflammation (uveitis) also increases your chances. 

Having these risk factors does not guarantee that you will develop the disease. However, they may help a rheumatologist diagnose you sooner when symptoms are present.

How is Ankylosing Spondylitis Diagnosed?

Unfortunately, there is no single test for ankylosing spondylitis. Instead, medical professionals rely on a combination of symptom review, imaging, and testing. A rheumatologist will likely first conduct a physical examination and review your medical history and symptoms. Next, they might run blood tests that look for markers of inflammation. Genetic testing for the HLA-B27 genetic marker can also be helpful. In some cases, imaging such as x-rays or MRI scans might help detect inflammation or structural changes. MRI technology can often identify inflammation before permanent damage appears on X-rays, which allows for earlier diagnosis.

Treatment Options for Ankylosing Spondylitis

There is currently no cure for ankylosing spondylitis. However, modern treatments and lifestyle changes can effectively control inflammation, reduce pain, preserve mobility, and improve quality of life.

Your rheumatologist will create a treatment plan individualized to the severity of your disease and your needs. Your plan will likely include a combination of medications and physical therapy recommendations. For medication, your plan might include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Biologic medications that target specific inflammatory pathways
• Targeted synthetic medications
• Corticosteroid injections for certain joints when appropriate

Besides medication, regular exercise is one of the most important aspects of managing ankylosing spondylitis. Stretching, strengthening exercises, and posture training can help maintain spinal flexibility and reduce stiffness. Many patients also benefit from working with a physical therapist to develop a personalized exercise program.

Finally, certain lifestyle changes can also support treatment success. Stay physically active. Practice good posture. Avoid smoking. Maintain a healthy weight. Prioritize good quality sleep. These habits can improve overall function and reduce stress on affected joints.

When Should You See a Rheumatologist for Back Pain?

While back pain is a common issue for many people, certain additional factors should prompt an evaluation with a rheumatologist. If you begin to show symptoms and have a family history of ankylosing spondylitis or related autoimmune diseases, schedule an evaluation. You should also see a rheumatologist if you have back pain lasting longer than three months or that is worse after resting. Morning stiffness that improves with activity is usually a sign of inflammatory disease. Persistent back pain before the age of 45 is also a sign to have a rheumatologist evaluate you. 

Early intervention offers the best opportunity to control inflammation and maintain long-term mobility.

Why Ankylosing Spondylitis is Often Misdiagnosed

At Advanced Rheumatology of Houston, we find that many of our patients previously assumed that persistent back pain was simply part of aging or the result of an active lifestyle. Because early X-rays may appear normal and symptoms can mimic more common conditions, ankylosing spondylitis is sometimes overlooked for years.

Delayed diagnosis can allow inflammation to continue unchecked, increasing the risk of spinal damage and disability. Seeing a rheumatologist when inflammatory back pain is suspected can help lead to an earlier diagnosis and more effective treatment.

One of those treatments could include new medication currently being studied. You might be eligible for no-cost treatment by participating in an ankylosing spondylitis study. Candidates must: 

• Have been diagnosed with ankylosing spondylitis
• Be 18 or older
• Currently have back pain or stiffness
• Live in the Houston or greater The Woodlands area
• Not be enrolled in another clinical study

Contact us for further information or to schedule an appointment.

FAQs

Q: Can ankylosing spondylitis affect parts of the body besides the spine?

• A: Yes. Ankylosing spondylitis can affect the hips, shoulders, ribs, knees, and heels. Some people also experience inflammation of the eyes, inflammatory bowel disease, psoriasis, or cardiovascular complications.

Q: Can ankylosing spondylitis cause permanent damage?

• A: Unfortunately, yes. Without treatment, chronic inflammation may lead to fusion of the spinal bones, reduced mobility, and permanent postural changes. At its most severe, it can even cause new bone to form in the spine. Early diagnosis and treatment can significantly reduce the risk of long-term complications.

Q: Does ankylosing spondylitis get worse over time?

• A: The disease varies from person to person. Some individuals experience only mild symptoms, while others have more progressive disease. With modern therapies and regular monitoring, many people successfully manage their symptoms and maintain active lifestyles.

Q: Is ankylosing spondylitis considered an autoimmune disease? 

• A: Not exactly. Ankylosing spondylitis is generally classified as an immune-mediated inflammatory disease. While it shares features with autoimmune conditions, researchers believe it involves a complex interaction between genetics and the immune system.

Q: Can diet cure ankylosing spondylitis?

• A: No diet has been proven to cure ankylosing spondylitis. However, eating a balanced diet rich in fruits, vegetables, lean proteins, whole grains, and healthy fats may support overall health. This type of balanced eating also helps maintain a healthy weight, which reduces stress on the joints.

Q: What treatments are available for ankylosing spondylitis?

• A: Treatment may include anti-inflammatory medications, biologic therapies, targeted medications, physical therapy, exercise programs, and lifestyle modifications. Your rheumatologist will develop a personalized treatment plan based on your symptoms and disease activity.