Back Pain : What are the symptoms of ankylosing spondylitis?

What are the symptoms of ankylosing spondylitis?
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Back pain
The main symptom is back pain. The pain usually starts in the lower back. You may think of it as just mild backache at first. It typically becomes gradually worse over several months. You may have pain over your buttocks, and down the back of your thighs. The buttock pain may be felt sometimes on one side and sometimes on the other side. Coughing or straining may make pain worse. Rest does not make it better. In fact, the pain may wake you from sleep. Instead, exercise and movement usually ease the pain. (This is the opposite to most bouts of common mechanical backache which may alert a doctor to the diagnosis of AS.) The pain tends to be worse first thing in the morning. Lying in bed after waking is often uncomfortable. The pain tends to ease as the day goes on.

The middle (chest part) of the spine may become affected. If this occurs, the joints between the ribs and the spine may also become painful.

Stiffness in the lower spine
The stiffness can be quite severe first thing each morning. It usually improves with activity and exercise, and tends to ease as the day goes on.

Other joint symptoms apart from the spine
Other joints are affected at some stage in about 4 in 10 cases. The most common are: the hips, knees, ankles, and shoulders. Affected joints can become painful, stiff, and swollen.

Inflammation of tendons and ligaments
Tendons and ligaments in various parts of the body (in addition to those attached to the vertebrae of the lower spine) may become inflamed and painful where they attach to bones. Common examples are the Achilles tendon where it attaches to the heel, and where chest muscles attach to the ribs.

Inflammation of part of the eye (uveitis)
This affects about 1 in 3 people with AS from time to time. Tell a doctor urgently if you have AS and develop a painful or red eye. If you develop uveitis, treatment with eye drops should be started as soon as possible after eye symptoms begin. Treatment of uveitis is usually successful. However, if not treated quickly there can be permanent loss of vision in the eye (partial or complete).

General symptoms
Some people with AS feel generally unwell with symptoms of tiredness or depression. Weight loss or anaemia sometimes occur.

Associated diseases
Some other conditions develop more commonly than normal in people who have AS. For example, people with AS have a greater than average chance of developing ulcerative colitis, Crohn's disease, psoriasis, osteoporosis, lung fibrosis, cardiovascular disease (see later) and heart valve problems. Note: most people with AS do not get these conditions - it is just that they are more common in people with AS than would be expected in the general population.