Spine Pain

Ankylosing Spondylitis – Causes, Symptoms, and Diagnosis

Ankylosing spondylitis (AS) is an autoimmune disease in which the body’s own immune system causes chronic inflammation to the spinal and sacroiliac joints.


Ankylosing Spondylitis causes

Based on the latest medical research and ankylosing spondylitis information, there is no current cure for AS. This is because the exact mechanism of why the body’s own immune system would want to destroy its own tissue and hence cause chronic inflammation. A possible cause is there is a genetic dysfunction which causes the immune system to wrongly attack healthy spinal tissue.

Another theory is that a pathogen or bacteria called Klebsiella causes confusion and cross-reaction to the immune system. For some reason, the Klebsiella produces an antigen in which the immune system attacks, but it also gets mixed up and confused with normal spinal tissue which causes chronic inflammation. Research in this theory is still ongoing and is still being thoroughly researched.

A genetic association is also a possible cause of AS. Current ankylosing spondylitis information suggests that people who have the HLA-B27 genotype will most likely have this disease. However, it does not guarantee the person will have AS and only 5 per cent of people with HLA-B27 will suffer from AS.


How does Ankylosing Spondylitis affect the body?

In Ankylosing Spondylitis, the immune system attacks its own body. For unknown reason that is still being researched, the immune system attacks the ligaments and spinal joints. When the immune system attacks the ligaments, enthesis (connection of the ligaments to the bone) and spinal joints, it causes the ligaments and spinal joints to be inflamed. The inflammation causes scar tissue to build up in the joints and pain. In the later stages of the AS disease, the scar tissue build up and causes fusion of the joints. The results would be fusion of the spinal and sacroiliac joints. This is called bamboo spine which is clearly shown on a x-ray.


What are the signs and symptoms of AS

The signs and symptoms of AS is dependent on the progression of the disease.

In the early stages, AS causes severe sharp pain the low back worse with movement. It also causes stiffness in the morning, but the person is still flexible and is able to bend and lift.

In the middle or moderate stages, there is moderate chronic pain in the back but with reduced flexibility in the spine. The person will have significant issues bending and have great difficulty walking and turning.

The later stages, the person will have deformity in the spine and is severely restricted in mobility and walking. In some instances, the person is legally diagnosed as physically disabled and cannot walk. Pain will be less, but activities of daily living will be severely limited.

During all the stages of AS, there is fatigue and nausea at times when symptoms are worse. Swelling and redness of the joints is indicative of the inflammation of AS. Vision and lung issues will progressively get worse with the progression of the disease.

How to Diagnose Ankylosing Spondylitis?

Previously a few years ago, there were no tools or medical investigations for an Ankylosing spondylitis diagnosis. It was just recently that scientists have found a way for an Ankylosing spondylitis diagnosis.

Here are the investigations and procedures for an Ankylosing Spondylitis Diagnosis:

History of Symptoms

The initial diagnosis for an Ankylosing spondylitis diagnosis is via a history of the signs and symptoms of the disease. This is initially performed by a general practitioner and is further confirmed by a rheumatologist.

The signs and symptoms of ankylosing spondylitis are:

– Pain in the lower back – initially constant deep ache in the lower spine and buttocks

– Symptoms begin in the mid 30’s

– Pain lasts for more than 3 months

– Symptoms of feeling fatigue and tiredness

– Onset is unknown and comes from no certain incident

– Stiffness at night and especially in the morning

– Movement and heat eases the pain

– Non steroidal anti-inflammatory drugs help ease the pain

– History of eye infection and inflammation

– Family history of AS

Physical examination

A health practitioner or doctor will then do a physical examination to further confirm an ankylosing spondylitis diagnosis.

The physical examination consists of:

– Stiffness and hypo-mobility of the lumbar and sacroiliac joints

– Apophyseal joints are painful on palpation

– Inflammation and pain occurs on both sides of the lumbar and sacroiliac joints

– Thickening around the spinal joints

– Limited lumbar flexion

– Limited rib cage mobility. May seem short of breath at times


A doctor should perform or prescribe an x-ray for every low back problem. In a person who is suffering with possible AS, the early stages of AS shows inflammation and erosion in the lumbar and more particularly in the sacroiliac joint. In the later, severe stages of AS, the joints in the sacroiliac joints and lumbar spinal joints are all fused together. On x-ray, it looks like the spine has turned into bamboo. This is called bamboo spine. This is a stage where all the scar tissue has filled up all the areas in the joint like cement and there is a major restriction in lumbar (low back) flexibility.

Blood tests

In AS patients, C-reactive Protein (CRP) and Erthrocyte Sedimentation Rate (ESR) are elevated in a full blood examination. The CRP and ESR are inflammatory markers in the blood which indicate systemic inflammation. Normally, low back pain does not have any inflammatory markers in the blood. But, because AS is a systemic auto-immune disease, inflammatory markers will show in the general blood circulation.

Genetic Test

Usually by blood test, people who have the variations of the HLA-B gene are indicative of having AS. IL23R and ARTS1 have also been marked as a gene that may cause ankylosing spondylitis. However, having these genes may guarantee one hundred per cent that the person may have AS. In fact, people who have these genes will likely have the chance of contracting Ankylosing Spondylitis by 30 to 70 per cent.


Ankylosing spondylitis information is still being researched and updated continuously. In fact, some researchers state that a cure for AS is very close and in a few years time, people can be cured of this disabling disease.


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