Understanding Ankylosing Spondylitis
Ankylosing spondylitis (AS) is a chronic, immune-mediated inflammatory arthritis that primarily affects the spine and sacroiliac joints. Ongoing inflammation can cause chronic pain, stiffness, loss of mobility, and in advanced disease, irreversible spinal fusion. AS may also involve peripheral joints and extra-articular organs, including the eyes, chest wall, heart, lungs, and gastrointestinal system.
The Arthritis Center of Nebraska specializes in the diagnosis and comprehensive management of ankylosing spondylitis and related axial spondyloarthritis, with a focus on early intervention to prevent structural damage and long-term disability.
How Ankylosing Spondylitis Affects the Body
AS typically begins with enthesitis, inflammation at tendon and ligament attachment sites, particularly in the spine and pelvis.
Common features include:
- Inflammatory back pain beginning before age 40
- Pain worse with rest and improves with activity
- Prolonged morning stiffness
- Fatigue and reduced spinal flexibility
- Progressive postural changes in advanced disease
Extra-articular involvement may include:
- Peripheral arthritis (hips, shoulders, knees)
- Uveitis (eye inflammation causing pain, redness, blurred vision)
- Chest wall involvement, limiting deep breathing
- Cardiac and pulmonary complications (uncommon but clinically significant)
Disease Course and Importance of Early Treatment
Ankylosing spondylitis is a progressive disease. Without adequate control of inflammation, patients are at risk for:
- Permanent spinal damage and fusion
- Loss of function and quality of life
- Extra-articular complications, including ocular and cardiopulmonary involvement
Early diagnosis and disease-modifying treatment are critical to altering the disease course.
Our Treatment Approach
Effective treatment of ankylosing spondylitis requires more than symptom relief. While NSAIDs and physical therapy may help reduce pain and stiffness, biologic and targeted small-molecule therapies are central to comprehensive disease control.
Management may include:
- Targeted biologic therapies and oral small-molecule agents to suppress inflammatory pathways driving the disease
- NSAIDs for adjunctive symptom control
- Structured exercise and physical therapy to preserve posture and mobility
- Ongoing monitoring to assess disease activity, response, and safety
These advanced therapies are essential to control inflammation, prevent structural damage, and reduce the risk of extra-articular organ involvement.
When to Refer for Suspected Ankylosing Spondylitis
Referral to rheumatology is recommended for patients with:
- Chronic inflammatory back pain beginning before age 40
- Back pain improving with activity but not rest
- Prolonged morning stiffness
- Reduced spinal mobility
- History of uveitis, psoriasis, or inflammatory bowel disease with back pain
- Positive HLA-B27 with compatible clinical features
Early referral allows for timely initiation of disease-modifying therapy, which is critical to preventing irreversible damage.
Why See a Rheumatologist?
Rheumatologists are uniquely trained to:
- Diagnose axial inflammatory arthritis and distinguish it from mechanical back pain
- Initiate and monitor biologic and small-molecule therapies
- Prevent long-term structural and organ damage
- Coordinate multidisciplinary care for extra-articular disease
Who Is at Risk?
Ankylosing spondylitis most commonly begins in late adolescence or early adulthood, typically before age 40, and is more common in men. Risk factors include:
- Family history of ankylosing spondylitis
Presence of the HLA-B27 gene (not diagnostic on its own)