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Ankylosing Spondylitis

Overview of Ankylosing Spondylitis

Ankylosing spondylitis is a rare form of progressive arthritis that causes stiffness of the spine and pain. This is a chronic or lifelong condition and is sometimes also referred to as Bechterew disease. The disease typically begins in the lower back and can spread up to the neck. It can also cause damage to the joints in other parts of the body. Over time, this disease can affect your mobility, and in severe cases, it can even leave your spine hunched. (12)

Ankylosing spondylitis causes moderate to severe inflammation of the vertebrae that causes chronic pain and ultimately disability. In more advanced cases of the disease, this inflammation can lead to the formation of new bone on the spine, which leads to deformity. Ankylosing spondylitis can also cause stiffness and pain in other parts of the body, especially the large joints like shoulders, knees, and hips.

Ankylosing Spondylitis

What are the Symptoms of Ankylosing Spondylitis?

The signs and symptoms of ankylosing spondylitis differ from person to person. The symptoms typically range from mild to moderate inflammation that tends to alternate with periods of remission, during which you experience little to no signs of the disease. The most common symptom of ankylosing spondylitis is back pain in the morning and at night. (3)

It is also common to experience pain in your large joints, like the shoulders and the hips. Some of the other signs and symptoms of ankylosing spondylitis may include:

People with ankylosing spondylitis may also experience inflammation in other parts of the body, including:

  • Inflammation of the eyes
  • Inflammation of the bowels
  • Inflammation of the heart valve
  • Achilles tendonitis

Medications and therapy can help relieve the symptoms. Occupational therapy can help people with ankylosing spondylitis. Your doctor is likely to recommend this occupational therapy combined with physical therapy as part of your treatment plan for ankylosing spondylitis. Here’s everything about how occupational therapy can help in ankylosing spondylitis. (4)

What are the Causes & Risk Factors of Ankylosing Spondylitis?

The underlying cause of ankylosing spondylitis is still not known. However, it has been found that the disorder runs in families, making it likely that the condition is genetic. According to estimates, if your siblings or parents have ankylosing spondylitis, you are 10 to 20 times more likely to also have the condition as compared to someone who has no family history of the disease. (5)

Some of the known risk factors of ankylosing spondylitis include:

  • Age: The early symptoms of ankylosing spondylitis have been found to affect younger adults usually. Unlike other arthritic and rheumatic conditions, the symptoms of ankylosing typically appear between the ages of 20 to 40 years of age. (6)
  • Genetics: Having a family history of ankylosing spondylitis increases the risk of having the disease. The presence of the HLA-B27 protein is also a risk factor for ankylosing spondylitis. According to a 2002 study published in the Rheumatology Journal found that over 90 percent of people who were diagnosed with ankylosing spondylitis have this gene that expresses the HLA-B27 protein. (7)
  • Gender and Ethnicity: Ankylosing spondylitis has been found to be three times more common in males, though it is observed in females as well. At the same time, people of Caucasian descent are more likely to have ankylosing spondylitis compared to people of African descent or other ethnicities. (89)

Diagnosing Ankylosing Spondylitis

If your doctor suspects ankylosing spondylitis, you will be referred to a rheumatologist who specializes in arthritis. The first step of diagnosing ankylosing spondylitis is a thorough physical examination. Your doctor will also ask you for a detailed history of your symptoms and pain.

An X-ray will be ordered to determine any erosion on the spine and to also look at any painful joints. However, erosion may not be detected in an X-ray if the disease is in the early stages. Therefore, doctors may recommend an MRI scan in many cases, though the MRI results are usually challenging to interpret in the early stages of the disease.
Your doctor will also order a blood test known as erythrocyte sedimentation rate to determine the presence of inflammation. (10) Another blood test to look for the presence of the protein HLA-B27 may also be done. However, keep in mind that the HLA-B27 test does not mean that you automatically have the disease. It just means that you have the gene that manufactures the HLA-B27 protein. (1112)

However, diagnosing ankylosing spondylitis can be a challenging process and may take time.

What is the Treatment for Ankylosing Spondylitis?

There is no cure for ankylosing spondylitis to date, but there are various treatments that can help manage the symptoms of the condition. Early diagnosis and proper, timely treatment can significantly reduce the severity of your symptoms. Treatment can also help slow down or even stop the progression of the disease as well as potential complications, including bone deformity.

Here are some of the treatments for ankylosing spondylitis.

  1. Medications

    One of the most commonly used medications for managing pain and inflammation in ankylosing spondylitis is non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen and ibuprofen. These are long-acting medications that are generally considered to be safe, though they are known to have a few side effects.

    Your doctor will prescribe stronger medications when the NSAIDs no longer provide you relief. For example, corticosteroids are usually prescribed, but only for the short term. Corticosteroids help ease symptoms and slow down the damage caused to and around the spinal cord since these drugs are used as inflammation fighters.

    Another class of drugs commonly used in ankylosing spondylitis are tumor necrosis factor (TNF) inhibitors. These help block inflammation triggers in the body, thus preventing inflammation and alleviating joint stiffness and pain. TNF inhibitors are used only after the disease has progressed and NSAIDs can no longer manage the symptoms. (13)

    In severe cases, you may be prescribed disease-modifying anti-rheumatic drugs (DMARDs), which are a class of drugs that slow the condition’s progression and prevent worsening of the symptoms. (1415)

  2. Surgery

    If there is a deformity or severe damage to the affected joints like the hip or knee joints, you may require joint replacement surgery. Similarly, on people who have poor posture due to fused bones, an osteotomy might be needed. During an osteotomy, a surgeon cuts and realigns the affected bones in the spinal cord. (16

    There are also many natural remedies for easing the symptoms of ankylosing spondylitis. These include:

    In many cases of ankylosing spondylitis, doctors recommended occupational therapy in combination with the standard treatments. Many people have found that occupational therapy helps them manage their symptoms and alleviate pain and joint stiffness.

What is Occupational Therapy, And How Does It Benefit Ankylosing Spondylitis?

Occupational therapy helps you focus on doing everyday tasks or occupations. These can involve chores or tasks that require you to move around and social activities.

Occupational therapy professionals will come up with a therapy plan that will be based on your individual needs and your mobility. Occupational therapists work with those who have some form of sensory, cognitive, and physical impairment, and they need help to achieve independence and lead a better quality of life. (17)

Many people tend to get confused between physical therapy and occupational therapy. While physical therapy focuses on a range of motion activities to help with the symptoms of ankylosing spondylitis, occupational therapy is designed to help you develop your fine and gross motor skills. Here are some exercises that your occupational therapist may help you with:

  • Playing games
  • Tying your shoes
  • Taking a bath
  • Practicing using assisted devices like holding or balancing equipment
  • Getting dressed
  • Catching or throwing a ball

Your occupational therapist will also set certain goals for you, depending on your treatment. They will then create exercises that are developed to help you meet these goals. After every few months, your therapist will re-evaluate your treatment plan based on your progress and symptoms. (18)

When your doctor suggests occupational therapy as part of your, it is essential that you understand how this type of therapy can benefit your condition. For some people, the progression of ankylosing spondylitis can translate into a loss of independence to doing everyday tasks, especially tasks that involve bending and stretching. Disease progression can also mean that you are no longer able to do the social activities and hobbies that you liked to take part in before.

The goal of occupational therapy for people with ankylosing spondylitis is to increase their independence and ability to do everyday tasks. (19)

The only side effect of occupational therapy is that it might be costly and requires a time commitment.


Ankylosing spondylitis is a progressive disease, which will worsen as time progresses, eventually leading to disability. It is also a chronic condition, and there is no cure for the disease yet. However, regular exercise, medication, occupational therapy, and alternative remedies can help prevent and slow down the progression of the disease. In addition, the techniques and exercises taught during occupational therapy can help you maintain a greater level of independence as you age.

If you are experiencing chronic back pain for some time, it is good to bring it up with your doctor. Remember that leaving ankylosing spondylitis untreated can cause many complications, and it can even cause the bones in the spinal cord to fuse together due to chronic inflammation.


  1. Braun, J. and Sieper, J., 2007. Ankylosing spondylitis. The Lancet, 369(9570), pp.1379-1390.
  2. Sieper, J., Braun, J., Rudwaleit, M., Boonen, A. and Zink, A., 2002. Ankylosing spondylitis: an overview. Annals of the rheumatic diseases, 61(suppl 3), pp.iii8-iii18.
  3. Garrett, S., Jenkinson, T., Kennedy, L.G., Whitelock, H., Gaisford, P. and Calin, A., 1994. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. The Journal of rheumatology, 21(12), pp.2286-2291.
  4. Van Der Linden, S., Brown, M.A., Kenna, T., Maksymowych, W. and Gensler, L., 2020. Ankylosing spondylitis. Kelley & Firestein’s Textbook of Rheumatology 11th Edition. Vol. 2., pp.1319-1343.
  5. Google Books. 2021. Medifocus Guidebook on Ankylosing Spondylitis.
    [online] Available at: < https://books.google.co.in/books?id=2JHZUfd4GhcC&pg=PA24&lpg=PA24&dq=ankylosing+spondylitis+10+to+20+times+parents> [Accessed 8 June 2021].
  6. MSD Manual Professional Edition. 2021. Ankylosing Spondylitis – Musculoskeletal and Connective Tissue Disorders – MSD Manual Professional Edition. [online] Available at: <https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/joint-disorders/ankylosing-spondylitis> [Accessed 8 June 2021].
  7. Cauli, A., Dessole, G., Fiorillo, M.T., Vacca, A., Mameli, A., Bitti, P., Passiu, G., Sorrentino, R. and Mathieu, A., 2002. Increased level of HLA‐B27 expression in ankylosing spondylitis patients compared with healthy HLA‐B27‐positive subjects: a possible further susceptibility factor for the development of disease. Rheumatology, 41(12), pp.1375-1379.
  8. nhs.uk. 2021. Ankylosing spondylitis. [online] Available at: <https://www.nhs.uk/conditions/ankylosing-spondylitis/> [Accessed 8 June 2021].
  9. Jamalyaria, F., Ward, M.M., Assassi, S., Learch, T.J., Lee, M., Gensler, L.S., Brown, M.A., Diekman, L., Tahanan, A., Rahbar, M.H. and Weisman, M.H., 2017. Ethnicity and disease severity in ankylosing spondylitis a cross-sectional analysis of three ethnic groups. Clinical rheumatology, 36(10), pp.2359-2364.
  10. Ruof, J. and Stucki, G., 1999. Validity aspects of erythrocyte sedimentation rate and C-reactive protein in ankylosing spondylitis: a literature review. The Journal of Rheumatology, 26(4), pp.966-970.
  11. Wei, J.C.C., Tsai, W.C., Lin, H.S., Tsai, C.Y. and Chou, C.T., 2004. HLA-B60 and B61 are strongly associated with ankylosing spondylitis in HLA-B27-negative Taiwan Chinese patients. Rheumatology, 43(7), pp.839-842.
  12. Chavan, H., Samant, R., Deshpande, A. and Mankeshwar, R., 2011. Correlation of HLA B27 subtypes with clinical features of ankylosing spondylitis. International journal of rheumatic diseases, 14(4), pp.369-374.
  13. Gorman, J.D., Sack, K.E. and Davis Jr, J.C., 2002. Treatment of ankylosing spondylitis by inhibition of tumor necrosis factor α. New England Journal of Medicine, 346(18), pp.1349-1356.
  14. Chen, J., Veras, M.M., Liu, C. and Lin, J., 2013. Methotrexate for ankylosing spondylitis. Cochrane database of systematic reviews, (2).
  15. Roychowdhury, B., Bintley‐Bagot, S., Bulgen, D.Y., Thompson, R.N., Tunn, E.J. and Moots, R.J., 2002. Is methotrexate effective in ankylosing spondylitis?. Rheumatology, 41(11), pp.1330-1332.
  16. Thomasen, E.I.V.I.N.D., 1985. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clinical orthopaedics and related research, (194), pp.142-152.
  17. Mosey, A.C., 1981. Occupational therapy: Configuration of a profession (Vol. 63, pp. 67-69). New York: Raven Press.
  18. Connolly, D., Fitzpatrick, C. and O’Shea, F., 2019. Disease activity, occupational participation, and quality of life for individuals with and without severe fatigue in ankylosing spondylitis. Occupational therapy international, 2019.
  19. Yigit, S., Sahin, Z., Demir, S.E. and Aytac, D.H., 2013. Home-based exercise therapy in ankylosing spondylitis: short-term prospective study in patients receiving tumor necrosis factor alpha inhibitors. Rheumatology international, 33(1), pp.71-77.

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:December 14, 2022

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