Ankylosing Spondylitis: Treatment and Social Security Disability FAQs

What Exactly Is Ankylosing Spondylitis?

Ankylosing spondylitis is an autoimmune disorder, a systemic rheumatic disease, and a chronic inflammatory form of arthritis of the spine and sacroiliac joints. Ankylosing spondylitis is characterized by:

• Exacerbations of acute painful episodes and remissions.
• Involvement of the joints at the base of the spine.
• Back pain and stiffness in the back, often occurring during the night and often lasting for periods in the morning after waking up.

How Many People Get Ankylosing Spondylitis?

The incidence of ankylosing spondylitis varies around the world, but there seems to be a high correlation between the incidence of ankylosing spondylitis and having a particular gene (HLA-B27). There is also a high correspondence between being disagnosed with the illness when other family members are also known to have the condition.

In North America, mainly Canada and the United States, about 1% of the population is diagnosed with ankylosing spondylitis, with two to three times as many men as women becoming diagnosed. Ankylosing spondylitis also seems to be a "younger person's" disease as it is often diagnosed between the ages of 15 and 30, with onset somewhat uncommon after age 40. In northern Scandinavia, however, nearly 2% of the population may have this condition.

What Kind Of Doctor Treats Ankylosing Spondylitis?

If you have ankylosing spondylitis, your initial treatment may be provided by an internist (general practitioner) or by an orthopedist. However, you will probably be referred for treatment by a rheumatologist. Rheumatologists treat various arthritic and autoimmune problems.

Can Ankylosing Spondylitis Cause Poor Posture?

Yes, individuals with ankylosing spondylitis often alter their posture by leaning forward to reduce and minimize the discomfort they feel. However, this can only exacerbate the symptoms of AS. For this reason, individuals with ankylosing spondylitis should attempt to be mindful of their sitting and standing posture. Those with AS are sometimes advised to engage in therapeutic stretching exercises and exercises designed to strengthen the muscles of the back, which can promote better posture.

Is Ankylosing Spondylitis a Genetic Disorder?

It seems that the predisposition to developing ankylosing spondylitis may be genetic and inherited. The HLA-B27 tissue type is found in approximately 6% of the general population, but occurs in more than 90% of the population that has ankylosing spondylitis. However, having this component in your genetic makeup does not definitively mean that you will get ankylosing spondylitis, simply that you are more likely to develop the condition.

What Can Happen in a Severe Case of Ankylosing Spondylitis?

In severe cases of ankylosing spondylitis, the inflammation that is caused by AS can lead to fusion of the spinal vertebrae, thus limiting the mobility of the individual. Additionally, severe instances of ankylosing spondylitis can result in permanent damage to certain weight-bearing joints (such as the hip joints and knee joints), which may result in the need for joint replacement. It is for this reason that diagnosis of AS is so important, and proper and continued treatment of ankylosing spondylitis is equally important. By detecting AS early and by treating the inflammation that results in joint destruction and vertebrae fusion, the painful and limiting effects of ankylosing spondylitis can be minimized (though the existing effects, such as existing joint damage, may never be reversed).

What Should You Do If You Have Ankylosing Spondylitis?

Above all else, if you have been diagnosed with ankylosing spondylitis, stay current with your medical treatment and remain completely compliant with the medication regimen that your physician has recommended. You should consider physical therapy if it has been recommended. However, throughout the normal course of a day, you can do things to protect your joints and spine. If you are faced with a demanding physical task, try to section it into increments to reduce the stress on your joints, particularly your weight bearing joints (hips, knees, ankles). If you are siting in a chair for long periods, be aware of how you sit to avoid a position that is stooped. Lastly, consider whether or not your mattress is firm enough to provide the kind of support you need in order to reinforce good alignment of the spine.

Can Ankylosing Spondylitis Affect Connective Tissue Such as Tendons And Ligaments?

Yes, ankylosing spondylitis, in addition to affecting certain joints (mainly the joints of the lower back and the sacroiliac joint), AS can cause inflammation of the ligaments and tendons that provide support to the joints.

What Are Some Treatment Options for Ankylosing Spondylitis?

Treatment options for individuals with ankylosing spondylitis will generally include the use of medications that are designed to fight inflammation and suppress immune function. Physical therapy may also be useful for some individuals in an effort to increase back mobility and gain improvements in posture. For some individuals with ankylosing spondylitis, however, surgical intervention may be necessary for severely affected joints or for cardiac-related problems.

How Is Ankylosing Spondylitis Diagnosed?

There are a number of different tools to aid in the diagnosis of ankylosing spondylitis. A patient may be given a blood test called an ESR, or erythrocyte sedimentation rate, which can indicate the presence of inflammation in the body. Urinalysis may be done to check for kidney-related abnormalities and to rule out back pain that may be produced by a kidney condition versus ankylosing spondylitis. X-rays or bone scans may be conducted to visualize degenerative changes to vertebrae and various joints as a result of prolonged inflammation. Testing may also be done to check for the presence of the gene HLA-B27, since there is a high correlation between those who have ankylosing spondylitis and those who possess the gene. Finally, physical examination and the examination of a patient's family medical history can aid in the proper diagnosis of ankylosing spondylitis.

Can a Diagnosis Of Ankylosing Spondylitis Be Missed?

Yes, a diagnosis of this condition can be missed. Anklyosing spondylitis typically causes pain in the lower back (the lumbar spine) and pain in the sacroiliac joints (within the buttocks). However, it can also cause pain and destructive damage as a result of inflammation in other areas such as the middle back (the thoracic spine), and the neck (the cervical spine).

Additionally, pain and joint damage may occur in the shoulder joints and in weight-bearing joints such as the hips and knees. Because ankylosing spondylitis involves so many different areas, its effects may be mistakenly assigned to other medical conditions.

However, there are other factors that may contribute to a missed diagnosis of ankylosing spondylitis:

• Ankylosing spondylitis tends to appear in younger individuals (those under the age of 30, with a low incidence in individuals over the age of 40) and in three times as many males as females. For this reason, the complaints of pain voiced by patients with AS may be mistakenly attributed to mechanical back pain, or to an unexplained injury.
• Some of the symptoms of ankylosing spondylitis, such as iritis and spine inflammation, are known to occur in other conditions, such as reiter's syndrome (another member of the spondylarthropathies group, also known as reactive arthritis) and arthritis associated with IBD, or inflammatory bowel disease.
• While x-rays may show the degenerative changes that are brought on by ankylosing spondylitis, in its early stages there may be no such changes to visualize, though the condition will certainly cause pain.
• Though urinalysis and sedimentation rate testing may point to the presence of ankylosing spondylitis, there is still no single test that can definitively diagnose ankylosing spondylitis. 

Is There a Cure For Ankylosing Spondylitis?

Unfortunately, there is no cure for ankylosing spondylitis. Minimizing the effects of ankylosing spondylitis is dependent on diagnosing the condition as early as possible (a goal which can be problematic since AS can be mistaken for other medical conditions) and, likewise, treating the condition properly as early as possible.

Can I Get Disability Benefits due to Ankylosing Spondylitis?

Yes, if AS is limiting your funcitoning so much that you can't work, you shuld be able to get disabiity benefits. For more information, see our article on disability benefits for AS.