Can Back Pain Be a Symptom of Ankylosing Spondylitis?

Back pain is an extremely common symptom of ankylosing spondylitis (AS). AS is an autoimmune disease that causes increased levels of inflammation in the body, leading to pain. While AS occasionally affects other peripheral areas, the spine and pelvis are the most commonly targeted regions.

This article will discuss how ankylosing spondylitis causes back pain and how this symptom is typically treated.

What Is Back Pain?

The spine consists of 33 individual vertebral bones that are divided into the cervical (neck), thoracic (mid-back), lumbar (low-back), sacral, and coccyx regions. Back pain can occur in any of these segments, making everyday activities like sitting, sleeping, standing, and walking difficult.

Spinal pain often varies in presentation. Some individuals feel dull, achy soreness that can ebb and flow in intensity. Others experience sharp, stabbing pain that can make even gentle twisting or bending movements excruciating.

Other corresponding symptoms may also be present. These can include spinal stiffness, difficulty maintaining a normal posture, muscle spasms, and pain or weakness in the legs. These issues vary greatly from person to person, depending on the region of the spine that is affected and the severity of the issue.

Is Back Pain a Symptom of Ankylosing Spondylitis?

One of the most common symptoms of ankylosing spondylitis is pain and stiffness in the low back or pelvis. Back pain from ankylosing spondylitis usually comes on slowly and can worsen over several weeks or months.

The pain is usually diffuse and may be present on one side of the back or both sides at the same time. Symptoms are usually worse with inactivity or when getting out of bed in the morning and better after you “warm up” with light movement or exercise.

Back pain has several root causes in people with AS, including:

• Spinal joint arthritis
• Ankylosis of the spine
• Soft tissue (ligament and tendon) inflammation

Spinal Joint Arthritis

Each vertebra in your spine connects to the segment above or below it via two facet joints. These structures allow the individual sections of the spine to move smoothly on one another and provide the back movement necessary for daily activities.

Inflammation caused by ankylosing spondylitis usually affects these joints and causes arthritis in the slippery articular cartilage that facilitates motion in these spinal structures. This degeneration typically causes back movements to become painful or restricted.

Ankylosis of the Spine

In more severe cases of AS, advanced spinal arthritis develops and triggers new bone to grow in the affected region. When this occurs, the new bone frequently begins to span from one vertebral segment to the next and can join these sections together.

This is called ankylosis and leaves the affected vertebrae permanently fused to one another. The spinal segments are rendered immobile in these situations, and pain and stiffness frequently develop.

Soft Tissue inflammation

In addition to affecting the facet joints, inflammation from ankylosing spondylitis also frequently targets the soft tissue structures in the back. This can include the spinal ligaments that span between vertebral segments and stabilize these structures.

AS-caused inflammation also frequently targets the muscle tendons that connect to the spine and initiate movement. When soft tissue structures are inflamed, normal back movements can become extremely painful and your range of motion is usually restricted.

Treatments and Management of Back Pain

Medication plays a big role in managing back pain caused by ankylosing spondylitis. Several different types of drugs may be prescribed by your healthcare provider. Common ones include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Motrin or Advil (ibuprofen) are common anti-inflammatory medications used to address spinal pain and stiffness.
• Tumor necrosis factor (TNF) inhibitors: Enbrel (etanercept) and Humira (adalimumab) are injectable biologic medications that help treat spinal arthritis and symptoms in peripheral joints.
• Interleukin-17A (IL-17) inhibitors: These drugs, which include Cosentyx (secukinumab) and Taltz (ixekizumab), disrupt the ability of molecules called cytokines from triggering inflammatory responses in the body.
• Janus kinase (JAK) inhibitors: These include Xeljanz (tofacitinib) and Rinvoq (upadacitinib). They are oral medications that prevent a group of enzymes from triggering inflammatory responses in the body’s cells.

In addition to medication, several other treatments can be helpful. Physical therapy is sometimes used to improve the strength of the core muscles that support and stabilize the spine. Regular aerobic exercise is also useful for alleviating pain and enhancing your available back mobility.

Some medical providers suggest switching to an anti-inflammatory diet, though the evidence supporting this treatment is still mixed.

When to See a Healthcare Provider

Back pain that is severe in nature or gets progressively worse should be evaluated by a healthcare provider. This is especially true if it is accompanied by other symptoms, such as:

• Pain or stiffness in the ribs, shoulders, knees, or feet
• Difficulty or pain when taking a breath
• Vision changes or eye pain
• Fatigue
• Skin rash
• Fever
• Stomach pain, diarrhea, or loss of appetite

Each of these can occur in ankylosing spondylitis and should be reported to a healthcare provider who is skilled in diagnosing this autoimmune disease.  

Summary

Ankylosing spondylitis is an autoimmune disease that primarily targets the spine. It causes inflammation in the vertebrae and frequently leads to back pain. Severe cases can also cause segments of the spine to fuse together and lead to significant mobility deficits.

The back pain associated with ankylosing spondylitis can make many normal tasks difficult. If you are experiencing back pain or have any associated concerns, speak to a healthcare provider about your condition. Medications, physical therapy, and exercise are commonly used to manage this chronic condition.