Ankylosing Spondylitis: Night Back Pain, Stiffness and When to Be Seen

What it involves

MedlinePlus explains that ankylosing spondylitis, or AS, is a type of arthritis of the spine. It causes inflammation between the vertebrae and in the joints between the spine and pelvis, leading to stiffness and difficulty moving and bending. Over time it can fuse the vertebrae, limiting movement and causing a hunched posture.

Who this is for

• Adults with lower back or hip pain and stiffness that is worse at night or after sitting a long time.
• Younger adults whose back pain began before age 45 and keeps returning.
• People with Crohn's disease, ulcerative colitis or psoriasis who also have back stiffness.
• Anyone with a family member who has ankylosing spondylitis and a sore back of their own.

What to expect

• Questions about when the pain began, when it is worst, morning stiffness, family history and eye or bowel symptoms
• An exam of the spine, hips and joints, including how well you bend and breathe deeply
• Blood work, which the practice offers, as part of the evaluation
• A referral for imaging or to a rheumatologist when the picture points to inflammatory arthritis

What it can feel like

The most common symptom, according to MedlinePlus, is pain and stiffness in the lower back or hips. It is usually worse during the night or after sitting for a long time, which is the opposite of many strains that ease with rest. AS affects people differently, so some have symptoms that come and go while others have severe, ongoing pain. Over time it can move to other areas of the spine or body. Common strains are covered in the low back pain guide and the hip pain guide.

Symptoms outside the spine

MedlinePlus lists pain, stiffness and inflammation of other joints, difficulty taking a deep breath when the joints connecting the ribs are affected, changes in vision, fatigue, loss of appetite and weight loss. Skin rashes such as psoriasis and belly pain with loose stools can also occur. Vision changes are discussed in the blurry vision guide, and shortness of breath in the shortness of breath guide. Mention eye redness or bowel symptoms at your visit, since they help a provider see the larger pattern.

Who is more likely to get it

MedlinePlus says ankylosing spondylitis usually starts before age 45, with early symptoms often beginning between 15 and 30. It is more common and more severe in men. Having a family member with AS raises the chance, as do other conditions such as Crohn's disease, ulcerative colitis or psoriasis. No one knows exactly what causes it, but genes and the environment likely play a role. The psoriatic arthritis guide and the Crohn's and colitis guide describe those related conditions.

How it is told apart from other back problems

A pinched nerve or herniated disc usually causes pain that spreads down a leg, as the sciatica guide and the herniated disc guide explain. A narrowed spinal canal tends to hurt with walking, covered in the spinal stenosis guide. Inflammatory arthritis of the spine instead brings morning or night stiffness that eases with movement. A provider weighs your age, the timing of the pain and your exam. Neck stiffness alone is covered in the neck pain guide.

How it is diagnosed

MedlinePlus says there is no single test for ankylosing spondylitis. Your provider asks about your medical history and symptoms, asks whether relatives have had AS, performs a physical exam, and may order blood tests or imaging studies. The practice offers blood work, while imaging and specialist care are arranged by referral. Because AS can affect other parts of the body, MedlinePlus notes you will likely work with a team of health care professionals for tests, diagnosis and care. A rheumatologist is the usual specialist.

Treatment and when to be seen

There is no cure, but MedlinePlus says treatment may relieve symptoms, maintain posture and slow the disease. It usually includes medicine and physical therapy to improve mobility, and surgery may be needed if AS is severe. Exercise, tracking symptoms, managing stress, a healthy diet, assistive devices as needed, and quitting smoking can help. See a provider when back stiffness lasts more than a few weeks. Go to the ER for new leg weakness, numbness in the groin or loss of bladder or bowel control.

Sources

• MedlinePlus: Ankylosing Spondylitis