Ankylosing Spondylitis

Ankylosing spondylitis is a disease involving inflammation of the spine, joints of the hands and feet, and entheses (where muscle or ligament attaches to bone),^1,a leading to symptoms of pain, swelling and morning stiffness.^2,b The disease also affects other parts of the body, such as the eyes, gut or skin.^a

Ankylosing spondylitis affects up to 2% of the population in Australia.³ The disease typically occurs between the ages of 30 and 50 years, although it can also develop earlier in life.^b Men are more likely than women to have ankylosing spondylitis.

Ankylosing spondylitis is an autoimmune disease, in which the immune system reacts to the body’s own tissues.^c

Ankylosing spondylitis arises from an interaction between genetic and environmental factors.^d

• There is a strong association between ankylosing spondylitis and a gene called HLA-B27.¹
• However, not everyone who carries the HLA-B27 gene will develop the disease, which suggests that environmental factors such as stress might also play a role in the development of the disease.^b

The symptoms of ankylosing spondylitis vary from one person to another.^e

• In the early stages, people with ankylosing spondylitis may have a dull pain deep in the buttock and/or lower back due to inflammation of the lower back joints (termed “sacroilitis”).^2,d
• They may also have morning stiffness, which lasts for a few hours. Morning stiffness tends to improve with activity and worsen after rest.² Due to morning stiffness, people with ankylosing spondylitis can take two or more hours to get going in the morning.^b
• Ankylosing spondylitis can also affect joints outside the spine, including the hips, shoulders and joints in the lower limbs.²
• Inflammation in the entheses (where muscle or ligament attaches to the bone) leads to enthesitis.¹ Enthesitis is marked by pain and swelling, commonly in joints such as the heel. People with ankylosing spondylitis may experience heel pain when walking in the morning after resting the heel overnight.^b

People with severe and prolonged ankylosing spondylitis may also develop symptoms outside the joint that affect the eyes, heart, skin and gut.^f,g

There are many practical things that people with ankylosing spondylitis can to do help their symptoms, such as maintaining a balanced diet and a healthy weight, as well as exercising regularly.^e People with ankylosing spondylitis can continue with their studies, work and home duties, although lifestyle changes to avoid sitting down for long durations or to ensure adequate joint movement through the day may be needed.^e

Be sure to seek the advice of a medical professional on what is best for you before making dietary changes or starting any exercise programme.

The diagnosis of ankylosing spondylitis is based on clinical assessment, imaging studies and blood tests.

• The clinical assessment includes review of a combination of symptoms, such as limited motion of the lower back, persistent lower-back pain, and limited chest expansion.⁴
• Imaging studies, such as magnetic resonance imaging (MRI), computed tomography (CT), and X-rays, are useful for detecting sacroiliitis and other joint abnormalities.¹
• There are no laboratory tests that diagnose ankylosing spondylitis.² However, to support the diagnosis of ankylosing spondylitis, a blood test may be taken to check for the presence of the HLA-B27 gene, particularly in people with inflammatory spinal pain.^f

Patient Organisations:

• Arthritis Australia is a charitable not-for-profit organisation, and is the peak arthritis body in Australia. Resources available through its website include arthritis information sheets, booklets and news. To find a support group near you, please select one of the following:

1. Arthritis Australian Capital Territory (ACT)
2. Arthritis & Osteoporosis New South Wales 
3. Arthritis & Osteoporosis Northern Territory (AONT) 
4. Arthritis Queensland
5. Arthritis South Australia
6. Arthritis & Osteoporosis Tasmania
7. MOVE muscle, bone & joint health (Arthritis & Osteoporosis Victoria)
8. Arthritis & Osteoporosis Western Australia

•  The Australian Rheumatology Association is an association of rheumatologists in Australia that is a specialty society of the Royal Australasian College of Physicians. The Patient’s Home webpage offers people with diseases that affect the joints, muscles, and bones an extentive range of information, including medicine information sheets and consumer information sheets.

For more information about ankylosing spondylitis, please consult a healthcare professional.

1. Ghasemi-rad M, Attaya H, Lesha E, et al. World Journal of Radiology. 2015;7:236-252. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4585948/

2. Sieper J, Braun J, Rudwaleit M, et al. Annals of the Rheumatic Diseases. 2002;61:iii8-iii18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1766729/

3. Arthritis Australia. Ankylosing Spondylitis; Available from http://www.arthritisaustralia.com.au/index.php/component/content/article/51-state-and-territory/state-and-territory/166-ankylosing-spondylitis16.html 

4.Tsui FW TH, Akram A, Haroon N, Inman RD. The Application of Clinical Genetics. 2014;7:105-115.   https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24971029/

a. Paramarta J, Baeten D. Rheumatology. 2013:ket407.

b. Bond D. Nursing Standard. 2013;28:52-59.

c. Bellone M. Autoimmune disease: pathogenesis. John Wiley & Sons: Encyclopedia of Life Sciences. DOI: 10.1038/npg.els.0004000.

d. Keat A. Medicine 2010;38:185-189.

e. Arthritis Australia. Ankylosing Spondylitis: A practical guide to treatments, services and lifestyle choices, 2009.

f. Gouveia EB, Elmann D, Morales MSdÁ. Revista Brasileira de Reumatologia. 2012;52:749-756.

g. Stolwijk C, van Tubergen A, Castillo-Ortiz JD, et al. Annals of the Rheumatic Diseases. 2015;74:65-73.