The first symptom of ankylosing spondylitis is typically back pain, and other signs and symptoms develop gradually as inflammation begins to affect other areas of the body.
Pain and stiffness in the sacroiliac (SI) joints, thoracic and cervical spine, and peripheral joints appear over time as the condition advances.
In This Article:
Common Ankylosing Spondylitis Symptoms and Signs
Persistent pain and stiffness in the spine and rear pelvis are common symptoms of ankylosing spondylitis. The involvement of peripheral joints and organs causes additional symptoms and discomfort.
Ankylosing spondylitis causes lower back pain, stiffness, and radiating buttock pain.
Ankylosing spondylitis typically begins in the lower back (lumbosacral region) and involves the upper back and neck as the condition progresses. As the condition advances, inflammation begins to affect the peripheral joints and additional areas of the body.
In most people, ankylosing spondylitis causes,,:
- Low back pain and stiffness that is typically worse at night and improves upon wakening
- Radiating buttock pain that affects the lower back and/or thigh
- Neck pain and stiffness that limits neck mobility and is further exacerbated by an unsupported posture
- Peripheral arthritis in the hips, knees, and shoulders
- Dactylitis, a condition caused by inflammation and swelling in the fingers and toes resulting in the appearance of “sausage digits”
- Uveitis, a condition caused by inflammation in the eyes
- Psoriasis, a skin condition characterized by itchy, scaly patches
- Achilles tendon enthesitis, inflammation of the enthesis (the area where ligaments and tendons attach to the bone), that is visible on x-ray and causes heel pain in some patients
Peripheral arthritis and psoriasis are typically more common in women with ankylosing spondylitis.
See Development and Progression of Ankylosing Spondylitis
This list of non-spinal symptoms is not comprehensive; additional symptoms occur depending on disease progression and inflammatory involvement throughout the body.
How Ankylosing Spondylitis Symptoms are Different from Rheumatoid Arthritis
Both ankylosing spondylitis and rheumatoid arthritis are autoimmune conditions characterized by joint inflammation. Several of the signs and symptoms of these conditions overlap, but there are key differences in their underlying mechanisms and clinical presentation.
The following table outlines the primary distinctions between ankylosing spondylitis and rheumatoid arthritis.
| Ankylosing Spondylitis | Rheumatoid Arthritis | |
|---|---|---|
| Genetic variations | Strongly linked to HLA-B27 gene and potential association with HLA-DR1 | Likely impacted by HLA-DR4 and HLA-DR1 |
| Mechanism | Inflammation at the insertion points of tendons and ligaments into bones (enthesis) leads to stiffness and possible fusion of vertebrae | Inflammation of the synovial lining surrounding a joint leads to cartilage and bone damage with potential joint deformity |
| Onset | Younger onset of symptoms and signs, primarily in the low back region of the spine | Onset usually presents in middle-age, beginning with symmetrical hand and wrist involvement |
| Gender | Higher prevalence in men | More prevalent in women |
| Progression | Gradual inflammation along the spine which extends to non-spinal joints, such as hips and shoulders | Typically starts in small joints, such as the fingers, and progresses to involve larger nearby joints, such as the wrists and elbows |
Read more about Rheumatoid Arthritis Symptoms
Tests for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) can be positive in rheumatoid arthritis, whereas HLA-B27 will most likely be positive in ankylosing spondylitis.
