What is ankylosing apondylitis? 

What are the symptoms of ankylosing spondylitis?

How is ankylosing spondylitis diagnosed? 

Why is posture important for ankylosing spondylitis?

How is ankylosing spondylitis treated?

Download our Living with ankylosing spondylitis booklet

What is ankylosing spondylitis?

Ankylosing spondylitis is an inflammatory arthritis where the main symptom is back pain and changes can be seen to the sacroiliac joints on x-rays. The sacroiliac joints are between the sacrum and the ilium bones of the pelvis or the spine.

Axial spondyloarthritis (axial SpA) is is an umbrella term for ankylosing spondylitis and non-radiographic axial spondyloarthritis.

Where x-ray changes are not present but inflammation is visible on MRI or you have symptoms, this is called non-radiographic axial spondyloarthritis, and is sometimes considered an early form of ankylosing spondylitis.

"Ankylosing" means fusing together and "spondylitis" means inflammation of the spine which causes stiffness, tenderness and discomfort. Although it mainly affects the spine, AS can also cause pain and/or swelling in the shoulders, hips, knees, heels, chest/ribs, and small joints of the hands and feet. Sometimes the the eyes are also affected. In rare cases, the heart and lungs can be affected too.

The severity of AS symptoms varies greatly, but in severe cases, AS can seriously impact on everyday life and lead to disability.

Over time, AS can cause the spine to become rigid and curved, giving the person a "bent forward" posture. This is known as kyphosis. It's important to note that not everyone with AS will develop kyphosis.

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What are the symptoms of ankylosing spondylitis?

Although the symptoms of AS may vary from person to person, and between women and men, they include;

- Pain and stiffness in the lower back and buttocks, worsening over weeks and months

- Pain and stiffness that is worse in the mornings and during the night, but may be improved by light exercise

- Mild fever

- Loss of appetite

- Pain and tenderness in the ribs, shoulder blades, hips, thighs and heels

- Fatigue

- Mild to moderate anaemia (shortage of red blood cells), which can make people pale, tired and short of breath

- Inflammation of the bowel

- Inflammation of the eyes (iritis or uveitis), making them painful, watery, red and sensitive to bright light

Between 0.1/0.2% of people in Ireland have AS, and it can affect anyone - young or old, male or female, although it is more common in young men. It is also more likely to start early, in the late teens or early twenties.

AS is linked to the genes we inherit but it is not a certainty that a child will inherit the condition if a parent has it. Certain factors can make a person more likely to develop AS, such as a family history of the condition.

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How is ankylosing spondylitis diagnosed?

You doctor or consultant will take a detailed history of your condition. This will include some questions about the type and pattern of your pain and stiffness.

Some questions that may be asked include;

- How long have your symptoms lasted for?

- How does the pain and stiffness feel when you wake up in the morning and how long does it take to subside?

- What happens when you engage in physical activity or exercise?

- How does the pain and stiffness respond to non-steroidal anti-inflammatory drugs (NSAIDs)?

- Questions about your medical and family history will also be required

Are there any special tests that are used to diagnose ankylosing spondylitis?

Your doctor will give you a thorough examination which will include assessing the areas where you are experiencing pain or inflammation, determining how much spinal mobility you have and checking to see how far your chest can expand.

- Your doctor may order some routine blood tests that tell us about your general well-being and about the inflammation in the body

- S/he may order a specific blood test which is called HLA-B27. This is a genetic marker, the presence of which is often associated with AS

- X-rays of the spine are taken to determine whether the joints show signs of damage

- If the x-rays don't show changes caused by AS, in some cases the doctor may order an MRI (Magnetic Resonance Imaging) scan

- The MRI scan can illustrate changes called sacroilitis. You may diagnosed with non-radiographic spondyloarthritis - this means that the changes are not seen on an x-ray but the MRI has detected changes showing active inflammation.

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Importance of posture for ankylosing spondylitis

Posture relates to the position of your body at any time during the day or night. It is important to be aware of your posture and try to correct it not only during exercise times, but also during the day when standing, sitting and walking.

'Neutral spine' refers to the optimal alignment of the spine. In this position, the joints muscles and ligaments of the spine are under the least stress and strain.

Three curves should be present - an inward curve at the neck (cervical spine), a small outward curve at the upper back (thoracic spine) and a small inward curve at the lower back (lumbar spine).

If you perform exercises in a slouched posture, this will cause extra strain on the spine. This could potentially lead to injury and pain when performing exercise.

Postural Cues

- Try to move your spine regularly

- Think tall

- Draw your chin back as if making a double chin

- Bring your shoulders back and down

- Tighten your stomach muscles by bringing the belly button back to the spine and tuck down your tail bone

- Maintain even breathing

For detailed information on posture while;

- sitting

- driving

- in the kitchen

- ironing

- hoovering

- lifting and

- working on a computer

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How is ankylosing spondylitis treated?

Drug treatments for Ankylosing Spondylitis

Many of the drug treatments for AS need to be prescribed by your doctor. Not every medication will work the same for everyone, so open dialogue with your medical team is vital.

The medicines that treat AS fall into two broad groups; those that give pain control and those that are disease modifying. 

1. Pain control treatments 

Within this first group there are two main categories; 

a. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) 

NSAIDs reduce the effects of one or both types of chemicals that can cause inflammation. The signs of inflammation include pain, swelling and loss of function.

b. Steroids

Steroids (called corticosteroids) can be very effective in reducing inflammation. They are hormones that regulate a variety of functions within the body, including immune function.

Corticosteroids are strong medicines that suppress signs of inflammation including pain, swelling and loss of function.

2. Disease Modifying Treatments

Biologic disease modifying anti-rheumatic drugs (DMARDs) are among the most useful AS treatments. DMARDs work by blocking immune system messengers known as cytokines.

For any other information call the Arthritis Ireland Helpline on 0818252846 and request a copy of the Living with Ankylosing Spondylitis booklet.

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