Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine, causing pain and stiffness.

While middle back pain is a common symptom of this condition, there are several other symptoms that can help identify ankylosing spondylitis. Recognizing these symptoms early can lead to prompt diagnosis and treatment, improving the quality of life for individuals affected by this condition.

This article aims to highlight some of the key symptoms of ankylosing spondylitis that go beyond middle back pain.

1. Morning Stiffness

One of the hallmark symptoms of ankylosing spondylitis is morning stiffness, which is characterized by significant pain and stiffness in the spine upon waking up. This stiffness may improve with movement and activity as the day progresses.

Morning stiffness lasting for more than 30 minutes can be a strong indication of ankylosing spondylitis.

2. Pain and Stiffness in Other Joints

While ankylosing spondylitis primarily affects the spine, it can also cause pain and stiffness in other joints such as the hips, shoulders, knees, and ankles. These symptoms may come and go and can vary in intensity.

Joint pain and inflammation that are symmetrical or affect multiple joints on both sides of the body is often associated with ankylosing spondylitis.

3. Fatigue and Loss of Appetite

Ankylosing spondylitis can also lead to symptoms such as fatigue and loss of appetite. This can be attributed to the chronic inflammation affecting the body. Fatigue can be disabling and make it difficult to carry out daily activities.

Loss of appetite may result in unintentional weight loss and nutritional deficiencies.

4. Eye Inflammation

A significant number of individuals with ankylosing spondylitis develop inflammation in the eyes, known as anterior uveitis or iritis. Symptoms may include eye redness, pain, sensitivity to light, and blurred vision.

Prompt medical attention is necessary if eye inflammation is suspected, as it may cause long-term complications if left untreated.

5. Restricted Chest Expansion

Ankylosing spondylitis can affect the rib cage and chest wall, leading to restricted chest expansion. This can cause difficulty in taking deep breaths or experiencing shortness of breath.

Restricted chest expansion is often assessed by measuring the difference in chest circumference during inhalation and exhalation, known as the chest expansion test.

6. Enthesitis

Enthesitis refers to inflammation at the sites where tendons and ligaments attach to the bones, commonly in the heels, elbows, or hips.

This can cause pain and swelling in these areas, making it difficult to perform physical activities such as walking or gripping objects. Enthesitis is a characteristic feature of ankylosing spondylitis.

7. Sacroiliac Joint Pain

The sacroiliac (SI) joints, which connect the spine to the pelvis, are often affected in ankylosing spondylitis. Pain and stiffness in the lower back and buttocks, specifically in the region of the SI joints, is a typical symptom.

The pain may radiate down the legs and be more pronounced after prolonged periods of inactivity.

8. Family History

Genetics play a significant role in the development of ankylosing spondylitis. If you have a first-degree relative such as a parent or sibling with ankylosing spondylitis, your risk of developing the condition increases.

Therefore, a family history of ankylosing spondylitis should raise suspicion and prompt further evaluation if symptoms arise.

9. Disease Progression

Over time, ankylosing spondylitis can lead to progressive involvement of the entire spine. As the disease progresses, it can cause postural changes, such as an increased forward curvature of the spine (kyphosis).

These changes may result in a noticeable stooped posture and loss of flexibility in the spine.

10. Systemic Manifestations

Ankylosing spondylitis is a systemic inflammatory disease, meaning it can affect organs and systems beyond the musculoskeletal system. It can lead to symptoms such as fatigue, fever, and weight loss.

In rare cases, it may also affect the heart, lungs, or kidneys, causing complications that require specialized medical attention.