Whether it’s a dull ache or a sharp stab, back pain is among
the most common of all medical problems. In any three-month period, about
one-fourth of U.S. adults suffer through at least one day of back pain.
Many people lump all back aches and pains together as a “bad
back.” But there are actually many causes for back pain, including muscle spasms,
ruptured disks, back sprains, osteoarthritis, infections, and tumors. One possible
cause that rarely gets the attention it deserves is ankylosing spondylitis
(AS), a form of arthritis that’s associated with long-term inflammation of the
joints in the spine.
If you’ve never heard of AS, you’re certainly not alone. Yet
it’s more prevalent than you might think. AS is head of a family of
diseases—also including psoriatic arthritis and reactive arthritis—that cause inflammation
in the spine and joints. As many as 2.4 million U.S. adults have one of these
diseases, according to the National Arthritis Data Workgroup. So maybe it’s
time you got to know AS better.
AS mainly affects the spine and sacroiliac joints (places where
the spine joins the pelvis). Inflammation in these areas can cause back and hip
pain and stiffness. Eventually, long-lasting inflammation may lead some bones
of the spine, called vertebrae, to fuse together. This makes the spine less
flexible and may lead to a stooped-over posture.
At times, AS also affects other joints, such as those of the
knees, ankles, and feet. Inflammation in joints where the ribs attach to the
spine may stiffen the ribcage. This limits how much the chest can expand, restricting
how much air the lungs can hold.
Occasionally, AS affects other organs, too. Some people develop
inflammation of the eyes or bowel. Less often, the largest artery in the body,
called the aorta, may become inflamed and enlarged. As a result, heart function
may be impaired.
How the Disease
AS is a progressive disease, which means that it tends to
get worse as time goes by. Typically, it starts with pain in the low back and
hips. Unlike many kinds of back pain, however, the discomfort of AS is most
severe after a rest or upon rising in the morning. Exercise often helps it feel
Typically, the pain comes on slowly. Once the disease is
established, the symptoms may go through good and bad periods. But as the years
pass, the inflammation tends to move up the spine. It gradually causes greater
pain and more restricted movement.
The symptoms of AS vary from person to person. Here’s a look
at how they might progress:
lower spine stiffens and fuses: You can’t get close to touching your
fingers to the floor when bending over from a standing position.
and stiffness increase: You may have trouble sleeping and be bothered by
ribs are affected: You may find it difficult to take a deep breath.
disease spreads higher up your spine: You may develop a stooped-shoulder
disease reaches your upper spine: You may find it hard to extend and turn
inflammation affects your hips, knees, and ankles: You may have pain and
inflammation affects your feet: You may have pain at your heel or the bottom
of your foot.
affects your bowel: You may develop abdominal cramps and diarrhea,
sometimes with blood or mucus in the stool.
affects your eyes: You may suddenly develop eye pain, sensitivity to light,
and blurred vision. See your doctor immediately for these symptoms. Without
prompt treatment, eye inflammation can lead to permanent vision loss.
Why Treatment Is
There’s still no cure for AS. But treatment can ease its
symptoms and may possibly keep the disease from getting worse. For most people,
treatment involves taking medication, doing exercises and stretches, and
practicing good posture. For severe joint damage, surgery is sometimes an
If you’re bothered by long-term pain and stiffness in your low
back and hips, don’t just write it off to having a bum back or not being 20
anymore. See your doctor. If it turns out to be AS, early treatment can make
you feel more comfortable now, and it might prevent some serious problems in