When Ankylosing Spondylitis Spreads to Other Joints

By

Erin Azuse

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Severe hip pain

Ankylosing Spondylitis (AS) is a type of inflammatory arthritis that primarily affects the joints and ligaments of the spine. The term “ankylosing” refers to what can happen in severe cases, where the bones of the spine fuse together and limit movement.

AS is considered a systemic disease. This means even though it usually originates in the spine, inflammation can occur in other joints or anywhere throughout the body. The progression and the severity of the disease can vary greatly from person to person, but proper medical care can make a big difference in managing the symptoms.

How It Starts

AS will often appear near the end of the teenage years or early adulthood. It’s more commonly seen in men than women and has a higher incidence in Caucasians. There is believed to be a genetic component since almost 90% of those who have the disease have the HLA B27 gene, but the exact cause is not known.

In the beginning, the most common complaint is lower back pain and stiffness. Pain may wake you in the middle of the night, and it may feel worse first thing in the morning. Usually after movement or exercise, the pain improves.

Where It Spreads

People with AS experience enesthitis, which is inflammation where the joint capsules, ligaments, or tendons attach to the bone. This causes pain and swelling and may occur in the following areas:

  • Hips: About 1/3 of patients experience hip pain. Discomfort may start in the groin area, but can also be felt as “referred pain” in the knee. The hip joint may become eroded, losing its ability to function.

  • Shoulders: Like the hips, about 1/3 of patients with AS are affected with shoulder pain. However, this is rarely disabling.

  • Ribs: Chest pain can occur from inflammation between the ribs and the spine. Scar tissue can also develop in this area over time, making it difficult to fully expand your chest when you take a breath. Because it’s hard to differentiate this pain from other types of chest pain, such as pain from a heart attack, you should always seek medical attention if it occurs.

  • Jaw: Problems with the jaw occur in about 10% of those with AS. This may make it hard to eat or open your mouth.

  • Heel: The back of the heel near the Achilles tendon or the base of the heel near the plantar fascia, the ligament that attaches your heel bone to your toes, can be affected in people with AS. Walking can be a struggle as a result.

Beyond the joints, other parts of your body may be involved:

  • Eyes: Inflammation of the eye, or iritis, is very common. As many as 40% of AS patients will experience this, resulting in redness, pain, and sensitivity to light.

  • Bowel: Abdominal pain, cramping and diarrhea occur in about 5 to 10% of those with AS due to inflammatory changes in the intestines.

  • Heart and lungs: In rare cases, the heart and lungs may also be affected. For example, certain cardiac conditions such as aoritis, inflammation of the aorta, have been linked to AS.

How It’s Treated

Treatment is aimed at relieving pain and allowing for optimal function.

  • Physical therapy and exercise: Engaging in exercises to promote strength and flexibility can help improve mobility, posture, and pain. Some may be done at home, while others will be performed with the help of a physical therapist. Special breathing exercises can help with chest expansion if you’re experiencing severe inflammation between the ribs and spine. Consult your doctor before starting any exercise program.

  • Heat and cold: Heat can help loosen joints and minimize soreness. Cold can reduce swelling.

  • Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used medication for treating ankylosing spondylitis. Corticosteroid injections, disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine and methotrexate, and biologics such as TNF-inhibitors may be prescribed for more severe cases.

  • Surgery: Occasionally, joint replacement surgery may be required. This is more frequently seen for the hip.

  • Complementary and alternative medicine: Some patients report decreased pain and stiffness after engaging in therapies such as acupuncture, massage, and yoga.

Researchers are continuing to study AS and learn how to best treat it. In the meantime, remember to adhere to your exercise plan, work with your doctor to find most effective medications for you, and keep living your best life.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Mar 7, 2017

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Medical References

  1. Baraliakos X, Braun J. Hip involvement in ankylosing spondylitis. Rheumatology. 2009;49(1):3-4. doi:10.1093/rheumatology/kep298.
  2. Overview of Ankylosing Spondylitis. Spondylitis Association of America. http://www.spondylitis.org/Overview
  3. Spondylitis. Cleveland Clinic. http://my.clevelandclinic.org/health/articles/spondyloarthropathy
  4. Rudawaleit M, Baeten D. Ankylosing Spondylitis and bowel disease. Best Practice Clinical Rheumatology. 2006;20(3)451-471. doi: 10.1016/j.berh.2006.03.010

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