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Ankylosing Spondylitis FAQs

Reviewed by William C. Shiel Jr., MD, FACP, FACR

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Q:What is ankylosing spondylitis?

A:Ankylosing spondylitis belongs to a group of arthritis conditions that tend to cause chronic inflammation of the spine.

Ankylosing spondylitis is also a systemic disease, meaning it can affect other tissues throughout the body.

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Q:What are symptoms at the onset of ankylosing spondylitis?

A:Ankylosing spondylitis symptoms usually begin with back pain and stiffness.

The onset of pain and stiffness is usually gradual and progressively worsens with loss of range of motion that becomes noticeable over a period of months. The symptoms of pain and stiffness are often worse in the morning or after prolonged periods of inactivity.

The symptoms of ankylosing spondylitis are typically related to inflammation of the spine. Inflammation of the spine most commonly affects the low back and causes pain and stiffness in the low back and upper buttock area.

Some people with ankylosing spondylitis have "flares" of increased pain and stiffness that may last for several weeks before decreasing again.

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Q:Ankylosing spondylitis can, over time, cause the joints of the spine to fuse completely together. True or False?

A:True.

Those who have chronic, severe inflammation of the spine can develop a complete bony fusion of the spine. Over time, chronic inflammation of the spine (spondylitis) can lead to a complete cementing together (fusion) of the vertebrae, a process referred to as ankylosis. Once completely fused, the pain in the spine disappears, but the affected individual has a complete loss of spine mobility in the affected area.

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Q:Men are more commonly affected by ankylosing spondylitis. True or False?

A:True.

Ankylosing spondylitis is 2 to 3 times more common in men than in women. In women, joints away from the spine are more frequently affected than in men. Ankylosing spondylitis affects all age groups, including children. The most common age of onset of symptoms is in the second and third decades of life.

The tendency to develop ankylosing spondylitis is believed to be genetically inherited, and the majority (nearly 90%) of Caucasian people with ankylosing spondylitis is born with a gene known as the HLA-B27 gene.

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Q:What is a serious complication of ankylosing spondylitis?

A:Difficulty breathing.

Reduced ability to expand the chest can be a complication of ankylosing spondylitis. This is because ankylosing spondylitis can cause inflammation and limited range of motion of the spine as well as the joints where the ribs attach to the spine. This leads to limited ability to expand the chest wall, which is essential for optimal breathing.

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Q:Surgery is the standard treatment for ankylosing spondylitis. True or False?

A:False.

The treatment of ankylosing spondylitis typically involves the use of medications to reduce inflammation and to stop progression of the disease.

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Q:There is no way to prevent ankylosing spondylitis. True or False?

A:True.

There are no known ways to prevent ankylosing spondylitis. As mentioned earlier, the condition is partly due to genetics. Ankylosing spondylitis can run in families and can be expressed to greater or lesser degrees in various family members.

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Q:What does ankylosing spondylitis have in common with psoriasis and Crohn's disease?

A:They are all autoimmune disorders.

An autoimmune disease is an illness that occurs when the body tissues are attacked by its own immune system. The immune system is a complex organization within the body that is designed normally to "seek and destroy" invaders of the body, including infectious agents. Patients with autoimmune diseases frequently have unusual antibodies circulating in their blood that target their own body tissues. Ankylosing spondylitis can sometimes be seen in patients with psoriasis, psoriatic arthritis, and inflammatory bowel disease (ulcerative colitis and Crohn's disease).

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Q:What other disease or condition commonly accompanies ankylosing spondylitis?

A:Inflammation of the eye.

Other areas of the body affected by ankylosing spondylitis include the eyes, heart, and kidneys. Specifically, patients with ankylosing spondylitis can develop inflammation of the iris (iritis), the colored portion of the eye. Iritis is characterized by redness and pain in the eye, especially when looking at bright lights.

Recurrent attacks of iritis can affect either eye. In addition to the iris, the ciliary body and choroid of the eye can become inflamed; this is referred to as uveitis. Iritis and uveitis can be serious complications of ankylosing spondylitis that can damage the eye and impair vision and may require an eye specialist's (ophthalmologist) urgent care.

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Q:What type of doctor is an expert at diagnosing and treating ankylosing spondylitis?

A:A rheumatologist.

The diagnosis of ankylosing spondylitis is often made by a rheumatologist, a doctor who is specially trained to diagnose and treat arthritis and related conditions of the musculoskeletal system.

Because ankylosing spondylitis can affect different parts of the body, a person with the disorder may be required to see several different types of doctors for treatment. In addition to a rheumatologist, there are many different specialists who treat ankylosing spondylitis.

These may include:
- an ophthalmologist, who treats eye disease;
- a gastroenterologist, who treats bowel disease;
- a physiatrist, a medical doctor who specializes in physical medicine and rehabilitation;
- a physical therapist or rehabilitation specialist, who supervises stretching and exercise regimens.

Often, it is helpful to the doctors and the patient for one doctor to manage the overall treatment plan.

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Q:What type of diet has been shown to be helpful for people with ankylosing spondylitis?

A:Neither fat-free, gluten-free, nor vegetarian diets have been shown to be helpful for people with ankylosing spondylitis.

A healthy diet and exercise are good for everyone but may be especially helpful if you have ankylosing spondylitis. In people with rheumatoid arthritis, another inflammatory joint disease, a diet high in omega-3 fatty acids (found in cold-water fish, flax seeds, and walnuts) has been shown to help in reducing joint inflammation. Although the usefulness of omega-3 fatty acids is not as well studied in people with ankylosing spondylitis, there is some evidence that omega-3 supplements could reduce disease activity in people with ankylosing spondylitis.

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Q:Many people with ankylosing spondylitis find it helpful to exercise. True or False?

A:True.

Exercise can be an essential part of the management of ankylosing spondylitis. Many people with ankylosing spondylitis find it helpful to exercise in water.

Staying active is probably the best thing to do to relieve symptoms of ankylosing spondylitis, as regular exercise can help relieve pain, improve posture, and maintain flexibility. Exercise and stretching, when done carefully and increased gradually, may help painful, stiff joints. People with ankylosing spondylitis may benefit from the following:

- Strengthening exercises performed with weights or done by tightening muscles without moving the joints, build the muscles around painful joints to better support them. Exercises that don't require joint movement can be done even when your joints are painful and inflamed.
- Range-of-motion exercises improve movement and flexibility and reduce stiffness in the affected joint. If the spine is painful and/or inflamed, exercises to stretch and extend the back can be helpful in preventing long-term disability.

Note: Before beginning an exercise program, it's important to speak with a health professional who can recommend appropriate exercises.

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