Spondylitis (also called ankylosing spondylitis) is a type of arthritis that affects the spine or backbone. Spondylitis may cause back pain and stiffness. The bones of the spine, called vertebrae, may grow or fuse together resulting in a rigid spine. These changes may be mild or severe. Severe disease may lead to poor posture and deformities. Early diagnosis and treatment helps control pain and stiffness, and may reduce or prevent significant deformity.
Who is affected by spondylitis?
Spondylitis affects about three hundred thousand Americans or 0.2% of the adult population. Although it can occur at any age, spondylitis most often affects men in their 20s and 30s. It is less common and generally milder in women. It is more common in Caucasians than in African Americans.
What are the signs and symptoms of spondylitis?
The most common early signs of spondylitis are constant pain and stiffness in the low back, buttocks and hips that continue for more than three months. Spondylitis often starts around the sacroiliac joints where the sacrum (the lowest major part of the spine) joins the ilium of the pelvic bone. Spondylitis can cause an overgrowth of the bones, which may lead to abnormal joining of parts that are normally separate. This is called bony "fusion."
Fusion affecting bones of the neck, back or hips may impair a person's ability to perform routine activities. Fusion of the ribs to the spine or breastbone may limit a person's ability to expand his or her chest when taking a deep breath.
Spondylitis may also affect some of the ligaments and tendons that attach to bones. Tendonitis (inflammation of the tendon) may cause pain and stiffness in the area behind or beneath the heel, such as the Achilles tendon at the back of the ankle.
Spondylitis is a systemic disease, which means symptoms may not be limited to the joints. Patients may also have a fever, fatigue and loss of appetite. Eye inflammation (redness) occurs in about one-fourth of patients with spondylitis. In rare cases, lung and heart problems may also develop.
What causes spondylitis?
Although the cause of spondylitis is unknown, there is a strong genetic or family link. Most, but not all, patients with spondylitis carry a gene called HLA-B27. Although people carrying this gene are at increased risk of developing spondylitis, the majority (over 75%) will never develop the disease.
How is spondylitis diagnosed?
The diagnosis of spondylitis is based on several factors, including:
- Presence of signs and symptoms as noted previously
- Findings on physical examination and X-rays
How is spondylitis treated?
There is no cure for spondylitis, but discomfort can be reduced and function can often be improved. The goals of treatment are to:
- Reduce pain and stiffness
- Maintain a good posture
- Prevent deformity
- Preserve one's ability to perform normal activities
When properly treated, people with spondylitis may lead fairly normal lives. Under ideal circumstances, a team approach to treat spondylitis is desirable. Members of the treatment team typically include the patient, doctor, physical therapist and occupational therapist.
Physical and occupational therapy
Early intervention with physical and occupational therapy is important to maintain function and minimize deformity. The patient should try to maintain normal posture.
Patients with spondylitis are encouraged to sleep on a hard mattress with their back straight. Placing large pillows under the head is discouraged, since it may promote neck fusion in flexion. Similarly, propping the legs up on pillows should be avoided as it may lead to hip and/or knee fusion in a bent position. When sitting, chairs, tables and other work surfaces should be designed to avoid slumping or stooping. Armchairs are preferred over chairs without arms.
Since patients with spondylitis could easily hurt their rigid necks or backs, special care should be taken to avoid sudden impact, such as jumping, or falling.
Exercise
A program of daily exercise will help reduce stiffness, strengthen the muscles around the joints, and prevent or minimize the risk of disability. Deep breathing exercises may help keep the chest cage flexible. Swimming is an excellent form of exercise for patients with spondylitis.
Medications
While a cure for spondylitis is not available, certain drugs help provide relief from pain and stiffness and allow patients to perform their exercises with minimal discomfort. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used drugs for spondylitis treatment. NSAIDs are not related to cortisone (a steroid), although both work by reducing inflammation. A variety of NSAIDs are currently available, and the choice of a particular drug should be discussed with the treating doctor.
In severe cases, other medications may be added to the treatment regimen.
Other treatments
Patients experiencing eye inflammation (red eye) should be evaluated and treated by an ophthalmologist (eye doctor).
Patients are urged to not smoke or chew tobacco products because of the increased risk of lung problems and reduced chest cage expansion. Certainly, all of the other reasons why doctors discourage smoking also apply to spondylitis patients. Artificial joint replacement surgery may be a treatment option for certain patients with advanced joint disease affecting the hips or knees.
Patients are encouraged to discuss coping strategies, work-related issues, sexuality and other important concerns with their health care team.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/18/2003…#4932
