This is the first phase of ankylosing spondylitis. It happens when nr-axSpA gradually gets worse and affects the sacroiliac joints and the bones of the spine. Your doctor will be able to see noticeable changes in these joints on an X-ray.
Early symptoms of ankylosing spondylitis might include back pain and stiffness in the lower back and hips, especially in the morning and after periods of inactivity. Neck pain and fatigue also are common. Over time, symptoms might worsen, improve or stop at irregular intervals.
AS often slowly moves up from the base of your spine to your neck. Imaging tests like MRIs can show how serious it is based on how much of your spine is affected. The changes in your spine can be hard for doctors to spot in the first few years, then become more visible.
NSAIDs are often the first line of defense against ankylosing spondylitis pain. NSAIDs is a broad category of medications that includes: Over the counter NSAIDs, such as aspirin, ibuprofen, and naproxen.
Grade 1 – Suspicious. Grade 2 – Minimal sacroiliitis. Grade 3 – Moderate sacroiliitis. Grade 4 – Ankylosis.
Symptoms of ankylosing spondylitis vary from person to person. Some people have mild episodes of pain that come and go, while others will have chronic, severe pain. The symptoms of ankylosing spondylitis, whether mild or severe, may worsen in “flares” and improve during periods of remission.
This progression can take 10 years or more to happen. And not everyone with nr-axSpA will progress to AS. Another method of measuring progression is looking at inflammatory blood markers. Many people with active inflammatory axSpA have more signs of inflammation in their blood.
Ankylosing spondylitis is a chronic, inflammatory disorder and a rare form of arthritis. Triggers for ankylosing spondylitis include infections (gastrointestinal infections, urinary tract infections [UTIs], and respiratory infections), heavy physical activity, work stress, emotional stress, and pregnancy.
Second Stage AS
As ankylosing spondylitis symptoms worsen (increased pain and stiffness), the disease may start to involve other parts of the body. For example, systemic inflammation can affect the eyes and your vision could become impacted.
Some people with AS are able to remain fully independent or minimally disabled in the long term. However, some people eventually become severely disabled as a result of the bones in their spine fusing in a fixed position and damage to other joints, such as the hips or knees.
If you have ankylosing spondylitis, you may have pain and stiffness at night, in the morning, or when you're not active. The pain may begin in the joints between your pelvis and spine and then move along your spine. Your pain may get better with movement or exercise.
The symptoms may come and go, and improve or get worse, over many years. AS usually first starts to develop between 18 and 40 years of age.
At this time, no single test diagnoses ankylosing spondylitis. Your doctor may order a blood test to check for the HLA-B27 gene, which is present in most people with the disease. You may have the HLA-B27 gene and never develop ankylosing spondylitis, but it can give doctors more information when making a diagnosis.
According to the Spondylitis Association of America, people typically develop AS between 17 and 45 years of age. Most people develop AS in their 20s and 30s. In a 2022 study, the average age of onset worldwide was 26.
More than 90% of people with ankylosing spondylitis have a particular genetic marker called HLA-B27, which can be found on their white blood cells. This marker does not appear to be the only cause, however, as 80% of people with this genetic marker never develop an inflammatory disease.
Ankylosing spondylitis causes chronic pain that can come and go. You might experience periods of flares and stiffness, and other times when you don't feel pain as acutely. The symptoms may ease up or disappear for a period of time, but they ultimately return.
Almost all people with ankylosing spondylitis can expect to lead normal and productive lives. Despite the chronic nature of the illness, only a few people with ankylosing spondylitis will become severely disabled.
"Fatigue from inflammation in ankylosing spondylitis can feel like you have the flu. You can ache all over," says Rochelle Rosian, MD, the director of regional rheumatology at the Cleveland Clinic in Ohio. “That's because inflammation affects your whole body, not just your joints.”
Don't do movements that cause pain
Carefully consider high-impact exercises, such as running, or jarring and twisting sports, such as tennis, squash, and racquetball. These could increase pain in the spine, hips, and knees.