Ankylosing spondylitis is a chronic autoimmune disease that currently has no cure. Anyone diagnosed with the condition should be aware of the potential complications that it can present to health.

Certain treatment methods can help reduce these complications, as well as slow the progression of the condition.

This article looks at some of the complications associated with ankylosing spondylitis (AS) and discusses the treatment options available for them.

AS is a type of arthritis. It triggers painful inflammation in the body, most commonly centered in the back and buttocks. Symptoms can spread as the condition progresses, with pain and inflammation commonly felt in the pelvis, hips, heels, and other large joints.

As ankylosing spondylitis progresses, unchecked inflammation can contribute to other complications that can affect a person’s life. The effects of these complications can vary from mild to debilitating, and people should speak with a doctor to understand their options for managing their symptoms.

1. Eye problems

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As ankylosing spondylitis progresses, unchecked inflammation may occur in the eyes, causing painful eyes that may be red or puffy.

Up to 50% of people with AS will develop uveitis or iritis — or inflammation of the eye — at least once.

If inflammation spreads to the eyes, it can cause symptoms such as:

  • eye pain
  • eye redness
  • eye puffiness
  • blurred or impaired vision
  • sensitivity to light
  • floating spots in vision

There are prescription medications used to treat these symptoms. Wearing dark glasses also can help.

A person’s doctor or rheumatologist will often encourage them to visit an ophthalmologist regularly to have their eyes checked.

2. Reduced flexibility

Damage to the back and joints caused by inflammation can restrict movement of the muscles and bones as AS progresses. For some people, this can result in very limited movement in the spine.

This reduced flexibility happens when the bones of the lower back fuse together. The fusing of the bones makes it difficult for a person to move and can even cause the back to get stuck in one position. In rare cases, it may lead to severe disability.

In many cases, people who follow a regular treatment plan that includes stretching and exercise can help keep their bodies more flexible and remain mobile for longer.

3. Fatigue

Fatigue is one of the more common symptoms of AS. It results from the circulation of inflammatory markers in the body called cytokines. Fatigue may get worse because the body uses a lot of its energy to keep this inflammation at bay. The effect can leave a person feeling drained of energy.

Medications that help manage the inflammation of AS may help lighten the load on the immune system and reduce fatigue. These may include biologics, such as TNF or IL-17 inhibitors, or JAK inhibitors. Regular exercise, such as swimming, can also help relieve fatigue and improve a person’s quality of life.

4. Osteoporosis

Osteoporosis is a bone disease that makes the bones less dense than normal. It occurs when the body loses too much bone or makes too little bone. The bones then become weak and are prone to breaks.

This disease can develop in the spines of people with AS, increasing their risk of spinal injury. Medications are often given to help treat those with both AS and osteoporosis symptoms.

According to a study in Current Treatment Options in Rheumatology, over 50% of people with AS have low bone mineral density, which can lead to osteoporosis.

An older study from 2013 found that 25% of people with AS may have osteoporosis.

The severe inflammation caused by AS is thought to contribute to osteoporosis.

Treating AS may also help prevent bone loss. TNF inhibitors may have a positive effect on bone mineral density in people with AS, according to the Current Treatment Options in Rheumatology study.

5. Gastrointestinal disorders

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Inflammation may spread to the intestinal tract causing stomach pain and digestive issues.

In some people who have AS, inflammation can spread from the spine and hips to the intestinal tract. According to research posted to Current Opinion in Rheumatology, up to 50% of people with AS have inflammation in their gut.

Inflammation in the intestinal tract and bowels can contribute to issues such as stomach pain, stomach ulcers, diarrhea, and problems digesting.

AS may increase the risk of inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis. According to the Spondylitis Association of America, 3–4% of people have IBD when they are diagnosed with AS. After 20 years of living with the condition, approximately 10% of people with AS have IBD.

Dietary changes and regular exercise can help manage inflammation. Certain medications, such as biologics, may help treat both AS and IBD.

A person’s doctor may recommend they see a gastroenterologist to help manage IBD or other gastrointestinal issues.

6. Increased risk of heart disease

People with AS may also be at an increased risk of developing heart problems. Cardiovascular issues that AS may contribute to include:

  • aortitis
  • aortic valve disease
  • conduction problems
  • ischemic heart disease
  • cardiomyopathy

Taking preventive measures to reduce the risk of cardiovascular symptoms is important for people with AS.

Regular exercise and eating a well-balanced diet are part of a good AS treatment plan and also help reduce the risk of heart disease. Avoiding tobacco use and maintaining a moderate weight can also help.

7. Social and employment problems

While having AS should not have any direct impact on employment, being unable to work for long periods may make gaining or keeping a job more difficult. The condition can also affect a person’s social and public life as it progresses.

Over time, AS can affect the type of work a person can do, especially physical labor. Some may be unable to work for long periods, while others may not be able to work at all.

It is important for people with AS to learn to sit correctly and keep good posture. As the symptoms often improve with movement, taking regular stretch breaks may also help.

AS can also affect a person’s social life. People experiencing chronic pain may be less likely to visit friends and may find that they are facing symptoms of isolation and depression.

It is important for people to stay active and keep up with a regular treatment plan to help reduce symptoms and promote feelings of well-being as much as possible.

Most of the common complications caused by AS are treatable. There are, however, some very rare complications of AS. These include:

8. Cauda equina syndrome

The inflammation that causes bony overgrowth in AS can lead to an extremely rare condition called cauda equina syndrome. The condition causes bone growth, which leads to pressure and swelling at the end of the spinal cord. This swelling can compact the nerves in the lower back and cause symptoms such as:

  • pain and numbness
  • stinging or tingling sensations in the legs
  • inability to walk
  • incontinence

If it is left untreated, cauda equina syndrome can lead to paralysis and other severe issues. The condition usually requires emergency surgery.

9. Amyloidosis

Caused by the buildup of a protein called amyloid in the organs, amyloidosis can produce symptoms such as weight loss, water retention, and tiredness.

Some people also experience symptoms that resemble nerve damage, such as tingling in the hands and feet. Chemical medications are used to treat the condition.

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A healthcare professional may recommend some light stretching and gentle exercise to help reduce symptoms.

AS presents in a variety of ways, and the condition requires different forms of treatment. Doctors often prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce the inflammation in the body.

If NSAIDs alone are not enough, other medications can be used to help reduce particular symptoms and slow disease progression. These may include:

  • Corticosteroids: Corticosteroids are given as injections directly into a joint to help reduce inflammation and ease pain. Due to the potential side effects, they are not recommended for long-term use.
  • Biologics: These injectable medications target specific parts of the immune system to help prevent inflammation and relieve AS symptoms such as joint pain and stiffness. Types of biologics include TNF inhibitors, IL-17 inhibitors, and IL-12/23 inhibitors.
  • JAK inhibitors: JAK inhibitors are a newer type of AS treatment. They target the JAK family of enzymes, which signal cells to make inflammatory proteins called cytokines. JAK inhibitors are taken orally.

Alongside medical treatments, doctors may suggest that people with AS do some physical activity. Having a workout plan that includes physical therapy, light stretching, and exercises, such as swimming or bicycle riding, may help promote flexibility and reduce symptoms.

Using topical ice or heat packs may also help relieve symptoms.

Ankylosing spondylitis is a complex condition that can cause some serious complications when left unchecked. However, symptoms and complications for many people can be controlled or reduced by following a regular treatment plan.

People should work directly with a doctor or rheumatologist to find a treatment plan that works for them and helps them experience the best quality of life possible.