Like most aspects of ankylosing spondylitis, a type of arthritis that affects nearly half a million people in the United States, according to the Arthritis Foundation, prognosis is complex and can be difficult to predict. Some people will have no problem with movement and may see their illness stop. But for others, this form of arthritis can progress to disability.
The course of the disease is very variable, says Eric Matteson, MD, professor emeritus of rheumatology at the Mayo Clinic in Rochester, Minnesota. “Some patients have inflammation confined to the sacroiliac joints, which does not significantly impair their mobility,” he says. “Others have severe spinal involvement.”
Ankylosing spondylitis causes inflammation in the sacroiliac joints, where the spine meets the pelvis, Dr. Matteson explains, but in severe cases, the bones in the spine can fuse together and become very rigid.
One thing is true for all cases of ankylosing spondylitis: early treatment is key. Matteson says proper treatment can help slow the progression of the disease.
Here’s how ankylosing spondylitis can occur and what you can do about it.
Symptoms of ankylosing spondylitis
Ankylosing spondylitis usually occurs at a young age, most often between the ages of 17 and 45, according to the American Spondylitis Association (SAA).
Symptoms usually begin with mild back pain and stiffness that gradually develops over weeks or months, according to the SAA. A key sign of ankylosing spondylitis is pain and stiffness that gets worse in the morning or after rest but improves with exercise. Almost everyone with ankylosing spondylitis experiences episodes, which are periods of time when the pain gets worse, followed by a remission, which is when the symptoms subside.
Fatigue can also be a symptom because the body uses energy to deal with inflammation, according to the SAA. Early on, ankylosing spondylitis may cause fever and loss of appetite.
Other than these factors, ankylosing spondylitis can vary widely from person to person. Some experience mild, intermittent pain, while others experience severe, chronic pain. In some people, ankylosing spondylitis also affects other joints where ligaments or tendons attach to bones, such as the hips, knees, feet, and shoulders.
Diagnosis of ankylosing spondylitis
The long-term outlook for people with ankylosing spondylitis can vary greatly. For some, the pain may be intermittent while for others it is chronic. In some cases, ankylosing spondylitis can be debilitating and lead to disability, according to the SAA.
Over time, the inflammation associated with ankylosing spondylitis can cause the vertebrae in the spine to fuse together. In severe cases, when this happens, the spine can curve and cause hunching. This may also affect the ribs and make it difficult for the lungs to work properly.
As ankylosing spondylitis progresses, the inflammation may affect other joints, such as the hips and shoulders, and organs, such as the intestines and eyes. Some people with ankylosing spondylitis may also have Crohn’s disease or ulcerative colitis, and up to 40 percent of people with ankylosing spondylitis will develop eye inflammation, in which the eyes become red and painful, according to the SAA.
Although ankylosing spondylitis is a progressive disease, meaning it tends to get worse as you age, it can also stop progression in some people. Why? Matteson says doctors aren’t sure. However, one study It has been found that men with ankylosing spondylitis tend to experience greater radial progression, erosive damage and joint fusion than women with the condition.
The long-term goal for all people with ankylosing spondylitis is to maintain as much physical activity as possible without changing their daily lives.
Can treatment stop the progression of ankylosing spondylitis?
Getting the right treatment early can affect how the disease presents, Mattison says—treatment can improve symptoms and even slow disease progression. Medications used to treat ankylosing spondylitis include non-steroidal anti-inflammatory drugs, methotrexate, sulfasalazine, and biologics, including tumor necrosis factor (TNF) or interleukin-17 (IL-17) inhibitors. Corticosteroids are sometimes used for a limited time to treat ankylosing spondylitis.
Biologics may help slow the progression of the catcher by targeting specific proteins that promote inflammation in the body. According to the searchPeople with ankylosing spondylitis who have been treated with TNF inhibitors for at least four years show evidence on MRI that disease progression has slowed. TNF inhibitors are also effective in treating inflammation in the digestive tract and eyes often associated with ankylosing spondylitis, according to the SAA.
But medications aren’t the only form of relief for people with ankylosing spondylitis. Physiotherapy is also often part of the treatment plan, as physical activity has been shown to greatly help with symptoms. One study found that exercise significantly improved symptoms and function in people with ankylosing spondylitis.
Whether you smoke may also affect how the disease progresses. According to a study that looked at data from 17 studies involving nearly 5,000 adults with ankylosing spondylitis, the more people smoked, the more likely they were to experience pain and problems with movement. In addition, study participants who smoked more than 10 cigarettes per day had a significantly worse health-related quality of life than people who did not smoke.
Some things may be out of your control when it comes to the course of ankylosing spondylitis, but there are steps you can take to protect your joints. Talk to your doctor about the right treatment plan to improve your prognosis and avoid severe joint damage.
Additional reporting by Blake Miller