Ankylosing spondylitis symptoms vary widely. Pain is always a symptom but the location and quality of pain can be different from person to person. Pain is typically accompanied by other symptoms, such as fatigue or eye irritation.

Pain and Ankylosing Spondylitis

Many people report pain with stiffness that appears over many months. Pain most often occurs in the:

  • Low back
  • Alternating buttocks
  • Hip(s)
  • Thigh(s)—this is radiating pain that typically does not go past the knee

This pain results from inflammation of the lower spine and/or sacroiliac [sak-roh-il-ee-ak] joints. The sacroilioac joints, sometimes called the iliosacral [ill-ee-oh-say-kral] joints, are where the sacral bone—a triangle shaped bone located at the bottom of the spine—attaches to the ilium bones of the pelvis.

See Possible Causes of Sacroiliitis and SI Joint Pain

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Inflammation of the sacroiliac joint is called sacroiliitis. People with sacroiliitis may notice pain when sitting down or standing up, when climbing stairs, or after a run or strenuous walk.

See Sacroiliac Joint Pain and Inflammation

People with ankylosing spondylitis may also report these pain-related symptoms:

Neck pain. The neck may be painful and/or stiff. Turning the head may be difficult, making certain activities, such as driving, more challenging. While anyone with ankylosing spondylitis can experience neck pain, women tend to report it more frequently than men.

Peripheral joint pain. About half of patients with ankylosing spondylitis develop inflammation of joints in the arms and legs. Peripheral pain and stiffness is most commonly experienced in the:

  • Knee
  • Shoulder
  • Ankle
  • Achilles tendon
  • Plantar fascia (causing pain at the bottom of the heel)

Children with ankylosing spondylitis often report pain in their heels and/or knees, not the low back.

See Juvenile Idiopathic Arthritis and Other Rheumatologic Diseases in Children

Pain and stiffness that improves with exercise. Unlike back pain from other causes, pain from ankylosing is worse during periods of rest or inactivity. Exercise typically helps reduce pain.

See Exercising with Arthritis

Morning stiffness. Affected joints may feel stiff after getting out of bed, and may improve with movement or a warm shower.

Pain that interrupts sleep. Many people report that pain wakes them up, often in the second half of the night.

Tenderness. Many people report tenderness over the area of inflammation. For example, pressing the skin over the base of the spine may be uncomfortable or painful.

Painful flares. Almost everyone with ankylosing spondylitis reports experiencing painful flares—periods of time when symptoms are noticeably worse. Flares can occur suddenly and cause pain and stiffness all over the body. Flares may last days or weeks and are followed by periods of relative relief.

Eye redness and pain. Between 30% and 40% of people with ankylosing spondylitis experience an inflammatory eye condition called uveitis at least once21 (though it is often recurrent). Uveitis, sometimes called iritis, can cause eye redness, eye discomfort, sensitivity to light, and impaired vision. This condition warrants immediate attention by an ophthalmologist.

NSAIDs relieve pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibubrofen and naproxen, usually provide some pain relief to people with ankylosing spondylitis.

See Pain Medications for Arthritis Pain Relief

The location, type, and intensity of pain can vary widely in ankylosing spondylitis.

Other Symptoms Associated with Ankylosing Spondylitis

Ankylosing spondylitis is a systemic disease—it affects the whole body—and pain is not the only symptom. Other symptoms include:

Unexplained fatigue. This body-wide fatigue can be overwhelming and last for days, regardless of how much sleep a person gets.

Fever. A persistent low-grade fever may occur as a result of the body-wide inflammation.

General feeling of illness. Some people report feeling unwell or “not quite right.”

Weight loss and/or loss of appetite. The inflammation may cause people to lose their appetite and lose weight, similar to when having a cold or flu.

Swollen fingers or toes. Dactylitis, the medical name for swollen fingers or toes, can be a sign of ankylosing spondylitis or another type of a spondyloarthritis.

See Understanding the Different Names and Classifications for Spondyloarthritis (SpA)

Vascular disease. Experts estimate people with ankylosing spondylitis are 36% more likely to die from vascular disease than the general population.22 Vascular disease includes:

  • Cardiovascular disease, which affects the heart and increases the risk of heart attacks.
  • Cerebrovascular disease, which affects the brain and increases the risk of stroke.

Pulmonary disease. Anyklosing spondylitis can affect the rib cage and the lungs making breathing difficult or uncomfortable.

See 5 Unusual Ankylosing Spondylitis Symptoms

People with ankylosing spondylitis may experience none, one, or all of these symptoms. Symptoms may come and go and tend to lessen with treatment.

Complications of Severe Ankylosing Spondylitis

People with advanced cases of ankylosing spondylitis may develop a hunched posture, experience bone fractures, or other complications that are explained on the next page. People who receive treatment for ankylosing spondylitis rarely experience these symptoms.

References:

  1. Rosenbaum JT. Uveitis in spondyloarthritis including psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease. Clin Rheumatol 2015;34: 999-1002.
  2. Haroon NN, Paterson JM, Li P, Inman RD, Haroon N. Patients With Ankylosing Spondylitis Have Increased Cardiovascular and Cerebrovascular Mortality: A Population-Based Study. Ann Intern Med. 2015;163(6):409-16.
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