How Do I Know I Have Ankylosing Spondylitis?

You may think your back pain and spasms are the result of an injury, but it could be ankylosing spondylitis (AS). Here’s what to look for to see if you should get tested.

What is ankylosing spondylitis?

AS is a type of arthritis that typically affects the vertebrae in your lower spine. The disease is marked by inflammation of vertebral joints and areas where ligaments and tendons attach to the bone. Repeated damage and healing cause the inflammation to progress, which can result in your vertebrae fusing together.

Other joints can also be affected, including those of your ribs, pelvis, hips, and heels. The inflammation may also affect one or both eyes, causing pain and blurred vision.

Risk factors of AS

AS is an autoimmune disease, and its true cause is unknown. But some risk factors seem to play a role, including:

• Age: Typically, those in their late teens and early to middle adulthood are affected.
• Sex: Males are more likely to have AS.
• Heredity: The presence of a genetic marker called HLA-B27 indicates increased risk of AS.
• Health history: Gastrointestinal or genitourinary infections also increase risk of AS.

It’s important to understand that you can develop AS even if you don’t have these risk factors. And if you have many of these risk factors, you may never develop AS. Some people may just be genetically inclined to contract the disease. However, if you experience frequent bacterial infections in your gastrointestinal tract or genitourinary tract, these infections could trigger a reactive arthritis, leading to development of AS.

Early symptoms of AS

The first symptoms are usually pain and joint stiffness in your lower back and hips, as well as your ribs, shoulders, and back of your heel. This pain and stiffness usually improves with exercise, and then worsens with rest. Symptoms may disappear for some length of time, and then return.

When to call your doctor

You may be wondering if that pain in your lower back is something to be worried about. It’s time to call your doctor if you notice one or more of these symptoms:

• You’ve begun feeling pain and stiffness in your lower back or pelvic area, especially if it’s worse in the morning or at other times of rest.
• Exercise lessens your pain.
• These symptoms have come on gradually, but have lasted for at least three months.
• The pain wakes you up during the night and prevents you from sleeping.
• Nonsteroidal anti-inflammatory drugs, like ibuprofen (Advil) and naproxen (Aleve), help your symptoms.
• You notice pain in your rib cage, and it’s difficult or painful to draw a full breath.
• One or both of your eyes are red, swollen, or painful.
• You notice blurred vision and extreme sensitivity to light.

AS diagnosis

Diagnosing AS can be difficult, as symptoms can mimic those of other disorders. Early on, problems may not even show up on scans.

It’s helpful to keep a journal of your symptoms, because your doctor will probably want to know when and where you have pain, what activities make it worse or better, and when the symptoms started. This can help your doctor to determine the right set of diagnostic tools for you, which may include:

• health questions, covering many of the topics listed in the previous section
• physical exam to pinpoint “hotspots,” or areas of pain and inflammation
• mobility testing, to see how well you’re able to bend and twist
• blood tests, to check for the genetic marker HLA-B27 and for inflammation markers
• X-ray or MRI scan to look for inflammation in your sacroiliac joints

The truth is, you won’t know if you have AS without a full checkup from your doctor. If you’re worried, it’s important to talk to your doctor about all your symptoms and what they could mean. Even though there’s no cure for AS, a range of treatment options can help you feel better and continue to lead a full life.