The first symptom of ankylosing spondylitis is typically back pain, and other signs and symptoms develop gradually as inflammation begins to affect other areas of the body.
Pain and stiffness in the sacroiliac (SI) joints, thoracic and cervical spine, and peripheral joints appear over time as the condition advances.1Wenker KJ, Quint JM. Ankylosing Spondylitis. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470173/
In This Article:
Common Ankylosing Spondylitis Symptoms and Signs
Persistent pain and stiffness in the spine and rear pelvis are common symptoms of ankylosing spondylitis. The involvement of peripheral joints and organs causes additional symptoms and discomfort.1Wenker KJ, Quint JM. Ankylosing Spondylitis. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470173/
Ankylosing spondylitis causes lower back pain, stiffness, and radiating buttock pain.
Ankylosing spondylitis typically begins in the lower back (lumbosacral region) and involves the upper back and neck as the condition progresses. As the condition advances, inflammation begins to affect the peripheral joints and additional areas of the body.
In most people, ankylosing spondylitis causes1Wenker KJ, Quint JM. Ankylosing Spondylitis. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470173/,2Spondyloarthritis in over 16s: diagnosis and management. London: National Institute for Health and Care Excellence (NICE); 2017 Jun. (NICE Guideline, No. 65.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK553609/,3Kim TH, Lee JK, Sung HK, Kim BH, Song YS, Sung IH. Radiologic features in symptomatic/asymptomatic heels of patients with ankylosing spondylitis. Int J Rheum Dis. 2019;22(2):222-227. doi:10.1111/1756-185X.13379:
- Low back pain and stiffness that is typically worse at night and improves upon wakening
- Radiating buttock pain that affects the lower back and/or thigh
- Neck pain and stiffness that limits neck mobility and is further exacerbated by an unsupported posture
- Peripheral arthritis in the hips, knees, and shoulders
- Dactylitis, a condition caused by inflammation and swelling in the fingers and toes resulting in the appearance of “sausage digits”
- Uveitis, a condition caused by inflammation in the eyes
- Psoriasis, a skin condition characterized by itchy, scaly patches
- Achilles tendon enthesitis, inflammation of the enthesis (the area where ligaments and tendons attach to the bone), that is visible on x-ray and causes heel pain in some patients
Peripheral arthritis and psoriasis are typically more common in women with ankylosing spondylitis.4Rusman T, van Bentum RE, van der Horst-Bruinsma IE. Sex and gender differences in axial spondyloarthritis: myths and truths. Rheumatology (Oxford). 2020;59(Suppl4):iv38-iv46. doi:10.1093/rheumatology/keaa543
See Development and Progression of Ankylosing Spondylitis
This list of non-spinal symptoms is not comprehensive; additional symptoms occur depending on disease progression and inflammatory involvement throughout the body.
How Ankylosing Spondylitis Symptoms are Different from Rheumatoid Arthritis
Both ankylosing spondylitis and rheumatoid arthritis are autoimmune conditions characterized by joint inflammation. Several of the signs and symptoms of these conditions overlap, but there are key differences in their underlying mechanisms and clinical presentation.5Akhondi H, Varacallo M. Rheumatoid Arthritis and Ankylosing Spondylitis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532288/
The following table outlines the primary distinctions between ankylosing spondylitis and rheumatoid arthritis.
| Ankylosing Spondylitis | Rheumatoid Arthritis | |
|---|---|---|
| Genetic variations | Strongly linked to HLA-B27 gene and potential association with HLA-DR15Akhondi H, Varacallo M. Rheumatoid Arthritis and Ankylosing Spondylitis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532288/ | Likely impacted by HLA-DR4 and HLA-DR15Akhondi H, Varacallo M. Rheumatoid Arthritis and Ankylosing Spondylitis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532288/ |
| Mechanism | Inflammation at the insertion points of tendons and ligaments into bones (enthesis) leads to stiffness and possible fusion of vertebrae1Wenker KJ, Quint JM. Ankylosing Spondylitis. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470173/ | Inflammation of the synovial lining surrounding a joint leads to cartilage and bone damage with potential joint deformity |
| Onset | Younger onset of symptoms and signs, primarily in the low back region of the spine5Akhondi H, Varacallo M. Rheumatoid Arthritis and Ankylosing Spondylitis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532288/ | Onset usually presents in middle-age, beginning with symmetrical hand and wrist involvement5Akhondi H, Varacallo M. Rheumatoid Arthritis and Ankylosing Spondylitis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532288/ |
| Gender | Higher prevalence in men5Akhondi H, Varacallo M. Rheumatoid Arthritis and Ankylosing Spondylitis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532288/ | More prevalent in women5Akhondi H, Varacallo M. Rheumatoid Arthritis and Ankylosing Spondylitis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532288/ |
| Progression | Gradual inflammation along the spine which extends to non-spinal joints, such as hips and shoulders1Wenker KJ, Quint JM. Ankylosing Spondylitis. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470173/ | Typically starts in small joints, such as the fingers, and progresses to involve larger nearby joints, such as the wrists and elbows6Chauhan K, Jandu JS, Brent LH, et al. Rheumatoid Arthritis. [Updated 2023 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441999/ |
Read more about Rheumatoid Arthritis Symptoms
Tests for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) can be positive in rheumatoid arthritis, whereas HLA-B27 will most likely be positive in ankylosing spondylitis.
- 1 Wenker KJ, Quint JM. Ankylosing Spondylitis. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470173/
- 2 Spondyloarthritis in over 16s: diagnosis and management. London: National Institute for Health and Care Excellence (NICE); 2017 Jun. (NICE Guideline, No. 65.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK553609/
- 3 Kim TH, Lee JK, Sung HK, Kim BH, Song YS, Sung IH. Radiologic features in symptomatic/asymptomatic heels of patients with ankylosing spondylitis. Int J Rheum Dis. 2019;22(2):222-227. doi:10.1111/1756-185X.13379
- 4 Rusman T, van Bentum RE, van der Horst-Bruinsma IE. Sex and gender differences in axial spondyloarthritis: myths and truths. Rheumatology (Oxford). 2020;59(Suppl4):iv38-iv46. doi:10.1093/rheumatology/keaa543
- 5 Akhondi H, Varacallo M. Rheumatoid Arthritis and Ankylosing Spondylitis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532288/
- 6 Chauhan K, Jandu JS, Brent LH, et al. Rheumatoid Arthritis. [Updated 2023 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441999/
