Ankylosing Spondylitis

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Signs and Symptoms

Symptoms of ankylosing spondylitis usually develop gradually. Early signs include pain, tenderness, and stiffness in the lower back. Symptoms often are more severe upon waking in the morning and with rest, and often improve with activity as the day goes on.

As the disease progresses, pain may become persistent and interfere with sleep. Pain and stiffness in the lower back (lumbar region) eventually ascends to the middle of the back (thoracic region) and then to the neck (cervical region). In some cases, pain and stiffness also develops in the rib cage. Other symptoms include fatigue, fever, and loss of appetite.

Complications
In addition to pain and stiffness in the spine and the sacroiliac joint, approximately 30% of patients with AS experience involvement of the large joints of legs (e.g., hip). The most serious complication related to the spine is spinal fracture, which can lead to spinal cord injury and significant neurological problems.

AS may cause inflammatory eye conditions, such as uveitis and iritis. Symptoms of these conditions include pain, sensitivity to light, blurred vision, and increased tearing. Interestingly, eye inflammation may occur years before the development of AS, aiding in diagnosis of the disease in some cases.

Other complications include the following:

• Anemia (reduced red blood cell count)
• Breathing difficulties (caused by restricted movement of the chest wall due to fusion of the spine or as a result of pulmonary fibrosis [formation of scar tissue in the lungs])
• Cardiovascular conditions, such as aortitis (inflammation of aorta, which is the major artery in the body), heart valve damage, and electrical problems (conduction abnormalities)
• Inflammatory bowel disease (IBD)
• Nerve conditions (e.g., radiculopathy, cauda equina syndrome)
• Prostatitis (inflammation of the prostate gland in men)

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