Ankylosing spondylitis is a type of inflammatory arthritis that affects the spine and the joints where the lower spine connects to the pelvis. It is the most recognized form of a larger group of related conditions called axial spondyloarthritis. At Resurgens Orthopaedics, our spine and arthritis specialists diagnose ankylosing spondylitis and provide the ongoing treatment that helps patients across metro Atlanta keep moving comfortably and protects the spine over the long term.

Axial spondyloarthritis is inflammatory arthritis that centers on the axial skeleton, which includes the spine and the sacroiliac joints that link the lower spine to the pelvis. The trouble starts as inflammation in these joints. When that inflammation continues unchecked, the body responds by building new bone. Over years, that new bone can fill the spaces between the vertebrae and fuse segments of the spine together. As the spine fuses, its natural curves in the lumbar spine and upper back flatten, movement becomes limited and some people develop a stooped, forward-leaning posture. Physicians use the term ankylosing spondylitis once this joint damage is far enough along to show clearly on a standard X-ray.

Spondyloarthritis is not one illness but a family of related diseases, and sorting out which one a patient has shapes the treatment that follows. Ankylosing spondylitis, also called radiographic axial spondyloarthritis, is the type where damage to the sacroiliac joints is visible on an ordinary X-ray. Nonradiographic axial spondyloarthritis brings the same inflammatory symptoms, but the joint damage has not progressed to the point an X-ray can detect, so the diagnosis relies more on MRI, blood work and the overall pattern of symptoms.

The spondyloarthritis diseases also include several forms that reach beyond the spine:

• Psoriatic Arthritis: Joint pain, stiffness and swelling that develop in some people who have the skin condition psoriasis
• Reactive Arthritis: Arthritis that flares in response to a bacterial infection somewhere else in the body, often the intestines or genitals
• Enteropathic Arthritis: Arthritis that appears alongside inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis
• Undifferentiated Spondyloarthritis: The diagnosis when the signs point clearly to inflammatory arthritis but do not yet fit one specific condition

The first and most distinctive sign of ankylosing spondylitis is inflammatory back pain, which does not behave like the everyday mechanical back pain most people have felt at some point. It usually comes on slowly, sits deep in the lower back, buttocks and hips, improves with movement and grows worse after rest or long periods of sitting. Alongside that hallmark pain, common ankylosing spondylitis symptoms include:

• Morning Stiffness: Stiffness that is slow to ease in the morning and gradually loosens through the day
• Night Pain: Back pain that flares in the second half of the night and can interrupt sleep
• Fatigue: Physical and mental tiredness that comes from the body coping with ongoing inflammation
• Tenderness at Attachment Points: Tenderness or swelling where tendons and ligaments attach to bone, often felt in the heels, the rib cage or along the spine
• Reduced Appetite: A drop in appetite during more active periods of the disease

The inflammation is not always confined to the back. It can reach the neck, shoulders, ankles and ribs, and in some patients, it affects the eyes, causing a painful redness called uveitis that needs prompt medical care.

Please Note: Sudden eye pain, redness, blurred vision or sensitivity to light can be a sign of uveitis. Contact an eye specialist promptly, since early treatment helps protect your vision.

The precise cause of ankylosing spondylitis is not fully known, but genetics clearly matter. Most people with the condition carry a gene called HLA-B27, and current thinking is that an outside trigger, possibly an infection, can activate the disease in someone who is genetically susceptible. Carrying the gene is not a verdict, though. Many people who have HLA-B27 never develop ankylosing spondylitis.

Symptoms often begin in early adulthood, which is younger than many people expect for arthritis. A family history of ankylosing spondylitis or a related spondyloarthritis raises the risk, and the condition has long been diagnosed more often in men than in women.

Ankylosing spondylitis develops slowly and looks like more common back problems in its early stages, so an accurate diagnosis takes a thorough, step-by-step evaluation. At Resurgens, your specialist starts with a physical exam that checks your posture, measures how far your spine bends in each direction and looks for tenderness over the sacroiliac joints. That exam often includes a simple measure of how much your chest expands as you breathe in, since limited chest expansion can point to spinal involvement. Your specialist also reviews your symptoms, your medical history and any family history of spondyloarthritis.

No single test confirms the condition, so the diagnosis pulls several pieces together. Imaging does much of the work. X-rays show established damage in the sacroiliac joints, while MRI can catch active inflammation earlier, before any change appears on an X-ray. Blood work adds context. A test for the HLA-B27 gene helps weigh risk, and markers of inflammation such as the erythrocyte sedimentation rate (sed rate) and C-reactive protein (CRP) show whether inflammation is present, though those markers can climb for many reasons and are always read in light of the full picture.

There is no cure for ankylosing spondylitis, but it often responds well to treatment, and many patients stay active and comfortable with the right plan in place. Treatment tends to work best when it begins early, before inflammation has caused permanent fusion or joint damage. At Resurgens, treatment is organized around a clear set of goals: calm the inflammation, control pain, keep the spine mobile and well aligned, protect the joints and other organs from lasting damage and preserve your day-to-day quality of life.

Most plans draw on more than one approach at once. Medication is usually the foundation. It typically starts with anti-inflammatory drugs to relieve pain and stiffness and, for more active disease, moves to targeted biologic medications that block the inflammatory process at its source. Physical therapy carries equal weight. A therapist leads you through exercises that encourage spinal extension, guard your posture, keep the joints flexible and support full, easy breathing, and a steady home routine helps protect those gains between visits. Daily habits matter too. Staying physically active, avoiding tobacco and minding your sitting and sleeping posture all help support your spine. Most people with ankylosing spondylitis do not need surgery, but in select cases it can replace a badly damaged hip joint or correct a pronounced spinal deformity. Your Resurgens specialist shapes the plan around the joints involved and how your disease behaves, then adjusts it as your needs change over time.

Ankylosing spondylitis is easy to brush off early on, because back pain is so ordinary. Catching it early helps protect your spine for the years ahead. See a Resurgens specialist if you have low back, hip or buttock pain that came on gradually over weeks or months, particularly if it is worse in the morning, eases once you start moving or wakes you during the night. Those are the signatures of inflammatory back pain, and they deserve a real evaluation rather than another round of waiting it out. With locations across metro Atlanta, Resurgens makes it easy to see a spine and arthritis specialist close to home.

If back, hip or joint pain from ankylosing spondylitis or axial spondyloarthritis is affecting your life, help is within reach. Book an appointment online today with Resurgens Orthopaedics or call us at (404) 847-9999.

Is ankylosing spondylitis hereditary? It tends to run in families, and most patients carry the HLA-B27 gene, so genetics play a real part. Having the gene or an affected relative raises your risk, but it does not mean you will develop the condition.

What is the difference between ankylosing spondylitis and axial spondyloarthritis? Axial spondyloarthritis is the broad category for inflammatory arthritis of the spine and sacroiliac joints. Ankylosing spondylitis is the form in which the joint damage has advanced enough to be seen on an x-ray.

Can you live a normal life with ankylosing spondylitis? Many people do. With early diagnosis, consistent treatment and regular exercise, most patients manage their symptoms well and stay active.