Ankylosing spondylitis

Ankylosing spondylitis (AS) is a kind of arthritis that mainly affects the joints and ligaments of your spine (backbone).

'Ankylosing' means stiff and 'spondylo' means vertebra. You might have pain at night and feel stiff in the morning.

AS can also affect other large joints, like your hips and shoulders. AS can cause problems in your:

• eyes
• skin
• bowel
• lungs
• fingers and toes

The symptoms of AS usually start between the age of 15 to 40 years. It's more common in males than females.

The symptoms of AS tend to come and go. The symptoms can also vary in severity between people.

The more common symptoms involve pain and stiffness in your spine. The inflammation usually starts in the sacroiliac joints (where your pelvis meets your spine).

Symptoms may include:

• stiffness in your back, neck or buttocks, which may be worse in bed at night
• other joint pain
• pain in tendons and ligaments, such as in your chest wall, soles of your feet, or heels
• sausage like fingers or toes

AS symptoms usually:

• last for longer than 3 months
• include morning stiffness and night pain
• improve with physical activity — and don't improve with rest

Doctors don't fully understand the cause of AS.

Since AS tends to run in families, genetics may play a role. Also, 9 out of 10 people with ankylosing spondylitis have the same gene, called human leucocyte antigen B27 (HLA-B27). But not everyone with this gene gets AS.

Some people have a bacterial infection of their gut shortly before AS symptoms develop.

If you have lower back pain that lasts more than 3 months or other signs that could be ankylosing spondylitis, you should see a doctor. Your doctor can help you get a diagnosis and start treatment.

Your doctor will talk to you about your symptoms and family medical history. They will examine you.

You will probably need to have an x-ray. They may also arrange for you to:

• have blood tests to look for inflammation markers
• have an MRI scan
• see a rheumatologist (doctor who specialises in bone, joint and muscle problems)

At the moment, there's no cure for ankylosing spondylitis, so treatment aims to improve your quality of life. This includes:

• controlling the inflammation
• managing your symptoms — such as pain and stiffness
• improving your physical functioning — so you can take part in social and work activities
• stopping progressive damage to your bones
• lowering your chance of complications

If you have ankylosing spondylitis, your doctor may suggest that you

• stop smoking (if you smoke or vape)
• use non-steroidal anti-inflammatory drugs (NSAIDs) to help with pain

Medicines for ankylosing spondylitis (AS)

If NSAIDs do not work, your doctor may give you other types of medicines to manage the inflammation, pain and stiffness. These can include:

• corticosteroid injections
• so-called 'biological disease-modifying anti-rheumatic drugs' (bDMARDs)

Ask your doctor or pharmacist about the side effects of your medicines. You may need to try a few different medicines to find the best one for you.

Other treatment options

Your doctor might recommend you see a physiotherapist. The physiotherapist will suggest exercises to:

• strengthen your back
• encourage movement in your spine
• reduce pain

It's important to continue with your physiotherapy exercise program for long term control of AS.

As we don't know exactly what causes AS, you can't stop it from occurring.

Because AS is a chronic condition, you might need some support as you adjust to living with it. You may find that your health gradually gets worse.

Here are some things that might help.

• Take the medicines you have been prescribed.
• Follow your management plan if you have one.
• Aim to have a healthy lifestyle.
• See your doctor or specialist regularly.
• Read more about AS and living with back pain.
• Join a support group.
• Get help if having AS is affecting your mental health.

Up to 3 in 10 people with AS get acute uveitis (inflammation of the eye). If this happens, your doctor will refer you to an ophthalmologist (specialist eye doctor).

If you develop a painful watery eye, you should see a doctor immediately.

Some other complications of AS are:

• poor balance
• reduced mobility
• osteoporosis
• heart complications

Over time, your posture may change as the stiffness in your back gets worse.

Arthritis Australia (Opens in new tab) has more information on ankylosing spondylitis, or you can call the Arthritis Information Line on 1800 011 041.

You can visit the Australian Rheumatology Association (Opens in new tab) to find a specialist (Opens in new tab).

You can find information about chronic conditions (Opens in new tab) on the Department of Health and Aged Care website (Opens in new tab).

If you need to find a physiotherapist (Opens in new tab) visit the Australian Physiotherapy Association (Opens in new tab) website or call them on 1300 306 622.

If you're stressed, anxious or depressed, you can call:

• Lifeline (Opens in new tab) on 13 11 14, or text or chat online
• Beyond Blue (Opens in new tab) on 1300 22 4636 or use the webchat support service

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.