Complications of Ankylosing Spondylitis

Ankylosing spondylitis (AS) typically affects the spine and causes back pain and stiffness. It can impact other joints and organs as it progresses, leading to complications such as inflammatory bowel disease (IBD) and uveitis (eye inflammation).

When left untreated, AS can significantly impact your quality of life. Chronic pain due to AS can affect your mental health, leading to depression and anxiety. Some people with AS may not be able to work because of pain or immobility, which can lead to socioeconomic hardship.

This article discusses AS complications and discusses ways to identify and manage complications.

Secondary Complications of Ankylosing Spondylitis

Ankylosing spondylitis causes inflammation leading to pain and stiffness in the back. As it progresses, AS can affect other areas of the body and cause secondary complications.

Bowel

Ankylosing spondylitis can cause inflammation of the intestines. Approximately 5% to 10% of people with AS are also affected by IBD, which includes ulcerative colitis and Crohn's disease. These conditions can cause abdominal pain, diarrhea, blood in stool, fatigue, decreased appetite, and weight loss.

Depending on the severity of the inflammation, treatments include:

• Medications
• Exercise
• Physical therapy
• Surgery
  

Eye

Approximately 50% of people affected by AS experience eye pain, redness, sensitivity to light, blurry vision, and excessive tear production. These symptoms are known as uveitis. Providers typically treat uveitis with corticosteroid eyedrops, which help decrease inflammation.

In Women

For many years, ankylosing spondylitis was considered a disease exclusive to men. Over time, researchers found that the disease also impacts women.

One study found that women with AS experience more delays in diagnosis and more misdiagnoses than men. It also noted that, compared to men, women in the study reported more symptoms affecting body areas outside of the joints, including enthesitis (inflammation of connective tissue that attaches ligaments to bones), psoriasis (condition of the skin causing red, scaly patches), and inflammatory bowel disease.

Pregnancy

Symptoms of AS tend to remain stable throughout pregnancy. However, there are potential risks associated with labor and delivery. Limited hip, neck, and back mobility caused by stiffness from AS create challenges with specific laboring techniques and medication administration. A vaginal delivery is possible, but it does require additional planning.

Enthesitis

Entheses are areas in the body where joint capsules, ligaments, and tendons attach to bone. Enthesitis occurs when those connections become inflamed, causing pain, tenderness, and swelling and impacting mobility. Although enthesitis can happen anywhere in the body, common sites are the back, pelvis, chest, and heels.

Back and Spine

As the body works to heal the inflammation from enthesitis due to AS, it can cause scarring and create areas of fusion restricting movement. This buildup of scar tissue decreases mobility and increases the risk of fractures and kyphosis, a spine curvature.

Hips and Shoulders

Approximately one-third of people diagnosed with AS have hip and shoulder pain. It typically seen in younger people with AS. Hip mobility decreases over time and may radiate to the thighs or knees. Shoulder pain is generally mild.

Chest

Adults affected with AS commonly experience chest pain, called costochondritis that can mimic pain similar to a heart attack. Over time, the inflammation of the connections between the ribs, spine, and breastbone can create scarring, which limits chest expansion and affects breathing.

If you are experiencing chest pain with AS, seek medical care to determine the cause of the pain.

Jaw

Approximately 15% of people with ankylosing spondylitis have inflammation in the jaw joints. Jaw inflammation can limit the ability of the mouth to open and chew food thoroughly, impacting eating.

Cauda Equina Syndrome

Cauda equina syndrome is a rare medical emergency that occurs in people with AS when the bundle of nerves at the base of the spine is compressed. It can cause problems with bowel and bladder function, sexual dysfunction, and pain and weakness in the legs.

Lungs

Ankylosing spondylitis affects the lungs in two primary ways. It causes inflammation and scarring of the ribs, spine, and breastbone, which prevents the chest from fully expanding.

The lungs can become scarred or fibrotic, affecting your ability to recover from an upper respiratory infection. Tobacco use is especially discouraged for people with AS due to its impact on lung function.

How to Prevent AS Complications

The cause of AS is unknown, making prevention challenging. Early identification and collaboration with a healthcare provider to develop a solid treatment plan is key to managing AS symptoms and reducing the risk of complications.

People affected by AS report less pain and fewer visits to their healthcare providers when they are active in their treatment plan. Some of the ways that people with AS can improve function and prevent complications is to engage in the following lifestyle modifications:

• Exercise regularly.
• Maintain good posture.
• Manage stress.
• Eat a healthy, balanced diet.
• Avoid tobacco products.

If a Complication Is Suspected

Routine visits with your healthcare provider can help identify possible AS complications early, making treatment more effective and ensuring timely referrals to specialists when necessary. Various medical tests, such as laboratory and radiology testing, assist with identifying changes associated with ankylosing spondylitis.

Summary

Spinal pain and inflammation are the most common symptoms of ankylosing spondylitis. However, AS can cause inflammation in other body areas, leading to complications. It is important to have a consistent and collaborative partnership with your healthcare provider to manage AS and minimize adverse effects.

A Word From Verywell

Living with AS can feel overwhelming some days. Developing unexplained symptoms can create additional stress and leave you feeling defeated. Knowing that AS is associated with certain complications can help you identify potential problems early and get the support you need to manage your symptoms.