Symptoms of Ankylosing Spondylitis

Introduction

Ankylosing Spondylitis (AS) is a chronic inflammatory disease that mainly affects the spine and sacroiliac joints. However, its symptoms are not limited to the back; the condition can affect multiple parts of the body, including the hips, shoulders, ribs, and even organs like the eyes.

Recognizing the symptoms early is crucial because early treatment can slow disease progression, prevent joint damage, and improve quality of life.

1. Chronic Back Pain and Stiffness

One of the hallmark symptoms of Ankylosing Spondylitis is persistent back pain and stiffness.

• Pain Location :- It typically starts in the lower back and buttocks.

• Nature of Pain :- The pain is dull, aching, and often bilateral (affecting both sides).

• Timing :- It is usually worse in the early morning or after periods of inactivity (like sitting or lying down for a long time).

Why It Happens:

• Inflammation occurs at the junction where the spine meets the pelvis (sacroiliac joints), causing pain and stiffness.

• Unlike mechanical back pain (like a sprain), AS-related pain improves with exercise and worsens with rest.

2. Morning Stiffness

Another classic feature is prolonged stiffness after waking up.

• Duration :- Morning stiffness often lasts more than 30 minutes.

• Impact :- It may feel like the back is locked or frozen, making simple activities like bending over, twisting, or getting out of bed difficult.

Why It Happens:

• During sleep or inactivity, inflammatory fluids accumulate around the joints, leading to stiffness.

• As movement starts, circulation improves, reducing inflammation and improving flexibility.

3. Reduced Flexibility of Spine

Over time, people with AS notice decreased flexibility in the spine.

• Bending Difficulty :- They find it hard to bend forward, backward, or sideways.

• Postural Changes :- Some individuals develop a forward-stooped posture (kyphosis).

Why It Happens:

• Chronic inflammation leads to the formation of new bone around spinal joints.

• This process, called ankylosis, can fuse vertebrae together, severely limiting movement.

4. Pain in Other Joints

Although AS mainly targets the spine, it can also affect other joints, a condition called peripheral arthritis.

• Commonly Affected Joints :- Hips, shoulders, knees, and ankles.

• Symptoms :- Swelling, warmth, pain, and reduced range of motion.

Why It Happens:

• Inflammation doesn’t limit itself to the spine; it can spread to large joints, especially during flares.

5. Heel Pain

Many patients with Ankylosing Spondylitis experience pain at the back of the heel (Achilles tendon) or under the foot (plantar fascia).

• Common Symptoms :- Tenderness and swelling at the point where tendons or ligaments attach to the bone.

Why It Happens:

• This is known as enthesitis, an inflammation of the sites where tendons and ligaments insert into the bone.

• It’s a key feature distinguishing AS from other types of arthritis.

6. Rib Cage Pain and Chest Tightness

Some people develop pain in the ribs or feel tightness in the chest.

• Breathing Impact :- It can make deep breathing painful or feel restricted.

Why It Happens:

• Inflammation can affect the joints between the ribs and the spine or breastbone.

• As the ribs lose flexibility, lung expansion becomes limited.

7. Fatigue

Extreme tiredness is a very common but often overlooked symptom.

• Nature of Fatigue :- It’s not simply feeling tired; it’s a profound exhaustion that doesn’t get better with rest.

Why It Happens:

• Chronic inflammation releases chemicals (like cytokines) that make the body feel constantly worn out.

• Dealing with ongoing pain and disrupted sleep due to back stiffness also worsens fatigue.

8. Eye Inflammation (Uveitis)

Uveitis or iritis (inflammation of the eye) occurs in about 30–40% of people with AS.

• Symptoms :- Eye redness, pain, blurred vision, and sensitivity to light (photophobia).

• Usually Affects :- One eye at a time.

Why It Happens:

• The immune system’s attack extends beyond the joints to other tissues, including the uveal tract of the eye.

• Prompt treatment is critical to prevent vision loss.

Important Notes on Symptom Progression

• Gradual Onset :- Symptoms usually appear slowly over months or years.

• Symptom Fluctuation :- There can be periods of flare-ups (intense symptoms) and remission (few or no symptoms).

• Severity Varies :- Some people have mild, manageable symptoms, while others may experience severe disability.

Recognizing the signs early and getting a proper diagnosis is critical for slowing disease progression and maintaining mobility and quality of life.

Conclusion

Ankylosing Spondylitis symptoms go beyond just back pain. They affect mobility, vision, digestion, energy levels, and overall health. Understanding the full range of symptoms chronic back pain, morning stiffness, eye inflammation, heel pain, chest tightness, fatigue, gut issues, and joint swelling helps in getting diagnosed faster and starting appropriate treatment early.

If you notice persistent back pain that improves with exercise, morning stiffness lasting over 30 minutes, or any of the other symptoms described here, it’s important to consult a rheumatologist without delay.
Early intervention can change the course of Ankylosing Spondylitis and preserve your quality of life.