Ankylosing spondylitis - Complications 

Complications of ankylosing spondylitis 

Ankylosing spondylitis (AS) is a complex condition that can affect many parts of your body. It can cause complications in your day-to-day life and lead to additional health conditions.

Some complications associated with AS are outlined below.

Reduced flexibility

Although most people with AS remain fully independent or minimally disabled in the long term, around 4 in every 10 people with the condition will eventually have severely restricted movement in their spine.

This usually only affects the lower back and is the result of the bones in the spine fusing (joining up).

Fusing of the spine can make it difficult to move your back and can mean your posture becomes fixed in one position, although it doesn't lead to severe disability in most cases.

In rare cases, surgery may be recommended to correct severe bends in the spine.

Joint damage

AS can cause joints such as the hips and knees to become inflamed. This can damage the affected joints over time, making them painful and difficult to move.

If a joint becomes particularly damaged, you may need surgery to replace it with an artificial one.

Iritis

Iritis, also known as anterior uveitis, is a condition sometimes associated with AS where the front part of the eye becomes red and swollen. It usually only affects one eye, rather than both.

If you have iritis, your eye may become red, painful and sensitive to light (photophobia). Your vision may also become blurred or cloudy.

You should visit your GP as soon as possible if you have AS and think you may have developed iritis, as the condition can cause the loss of some or all of your vision if not treated promptly.

If your GP thinks you have iritis, they will refer you urgently to an ophthalmologist (a medical doctor who specialises in eye problems) for treatment.

Iritis can usually be treated with corticosteroid eye drops.

Osteoporosis and spinal fractures

Osteoporosis is where the bones become weak and brittle. In AS, osteoporosis can develop in the spine and can increase your risk of fracturing the bones in your backbone. The longer you have the condition, the more this risk increases.

If you do develop osteoporosis, you will usually need to take medication to help strengthen your bones. There are a number of medications that can be used to treat osteoporosis, which can be taken by mouth (orally) as tablets or given by injection.

Read more about treating osteoporosis.

Cardiovascular disease

If you have AS, you may also have an increased risk of developing cardiovascular disease (CVD). CVD is a general term that describes a disease of the heart or blood vessels, such as heart disease and stroke.

Due to this increased risk, it is important to take steps to minimise your chances of developing CVD.

Your rheumatologist (a specialist in treating muscle and joint conditions) can advise about lifestyle changes you should make to minimise your risk of developing a CVD. These changes may include:

You may also be prescribed medication to reduce your blood pressure or blood cholesterol level.

Cauda equina syndrome

Cauda equina syndrome is a very rare complication of AS that occurs when nerves at the bottom of your spine become compressed (compacted).

Cauda equina syndrome causes:

  • pain or numbness in your lower back and buttocks
  • weakness in your legs – which can affect your ability to walk
  • urinary incontinence or bowel incontinence (when you cannot control your bladder or bowels)

See your GP as soon as possible if you have AS and you develop any of these symptoms.

Amyloidosis

In very rare cases, it is possible to develop a condition called amyloidosis as a complication of AS.

Amyloid is a protein produced by cells in your bone marrow (the spongy material found in the centres of some hollow bones). Amyloidosis is a condition where amyloid builds up in organs such as your heart, kidneys and liver.

Amyloidosis can cause a wide range of symptoms, including fatigue, weight loss, fluid retention (oedema), shortness of breath and numbness or tingling in the hands and feet.

Problems with employment

Over time, AS can increasingly affect your ability to work. Some people with the condition may be unable to work at all and others may need changes to their working life, such as working part-time, working from home or avoiding physically demanding work.

When at work, it is important to maintain a good posture when sitting or standing for long periods of time. You should get up, stretch and move around regularly. This could mean adjusting your work station or ensuring you take regular breaks. Read more about how to sit correctly.

The National Ankylosing Spondylitis Society (NASS) has more information on living with Ankylosing Spondylitis, including advice about the condition and employment.

Page last reviewed: 26/06/2014

Next review due: 26/06/2016

Ratings

How helpful is this page?

Average rating

Based on 149 ratings

All ratings

Add your rating

Comments

The 14 comments posted are personal views. Any information they give has not been checked and may not be accurate.

vjsm68 said on 05 February 2014

Hi i am a 46 year old male and the only way i could get diagnosed was to look on the internet listing all my symptoms and cross referencing the answers to see what condition had all the symptoms i had.
After i did this i then went back to my GP and told him what i had and told him i wanted a blood test to check for HLA-B27 which it came back positive and only then did he start to listen to me!
I am currently on the TNF treatment but they are thinking of taking me off all medication now because i am not having any benefit from it and it is a very expensive treatment. My biggest worry is what is going to happen to me i already have very little movement in my neck and my back knees and hips are steadily getting worse.
I am self employed and work as many hours as i can but it too is getting harder and harder.
There has been many days that the pain has been so bad that i have had ideas of just ending it all but i could not do that to my family,i had one child that died and now just my parents and wife but i dont want to be a burden on them either!
life is hard and is not made any easier by living on an island with no where to go and no one to talk to !
anyway i will leave you all in peace with my best wishes and hope you can all get your treatment early so that you can get this condition under control as soon as possible bye and take care dont let your GP's fob you off we know our own bodies best

Report this content as offensive or unsuitable

vjsm68 said on 05 February 2014

Hi i am a 46 year old male and the only way i could get diagnosed was to look on the internet listing all my symptoms and cross referencing the answers to see what condition had all the symptoms i had.
After i did this i then went back to my GP and told him what i had and told him i wanted a blood test to check for HLA-B27 which it came back positive and only then did he start to listen to me!
I am currently on the TNF treatment but they are thinking of taking me off all medication now because i am not having any benefit from it and it is a very expensive treatment. My biggest worry is what is going to happen to me i already have very little movement in my neck and my back knees and hips are steadily getting worse.
I am self employed and work as many hours as i can but it too is getting harder and harder.
There has been many days that the pain has been so bad that i have had ideas of just ending it all but i could not do that to my family,i had one child that died and now just my parents and wife but i dont want to be a burden on them either!
life is hard and is not made any easier by living on an island with no where to go and no one to talk to !
anyway i will leave you all in peace with my best wishes and hope you can all get your treatment early so that you can get this condition under control as soon as possible bye and take care dont let your GP's fob you off we know our own bodies best

Report this content as offensive or unsuitable

pmitc22 said on 07 January 2014

I am 25 years old and have been diagnosed with AS about a month ago. Unfortunately, I've been suffering from this disease for many years (since 17 yoa). Just this last month I have significantly lost my ability to walk. I'm not sure how progressive the disease is for each individual, but my eye sight is being affected as well. Staying mentally strong through the pain and difficulties life has thrown my way, is my main objective. I refuse to be defeated, but keeping this mindset is a challenge of its own. I never expected for my legs to seem to discenegrate and honestly, didn't expect it to happen this fast. Being a mother of two, it is extremely difficult (I'm sure it is for all of us). Has anyone else went "down" so quickly? I'm losing everything and am just waiting for my insurance to approve treatment. Unfortunately, I found out my doctor didn't send in the request as of now and am having to see a new specialist and wait even longer. Seeing all of these comications makes me feel bad because it seems like it is just my luck to deal with them too. Another commentor said you need a good support system and that couldn't be more true. I push myself all day, every day to keep moving and I will crawl if I have to. I don't want people to have to "serve" me, but if this disease continues to aggressively attack my body (mid waist down mostly and neck/shoulders, weak hands, blurred vision, etc.), I feel like I'll have no other choice. Bad things do happen to good people and maybe I'll continue to learn and grow from this lifelong disease. My heart goes out to all of you. May you all find relief and comfort.

Report this content as offensive or unsuitable

hannahbetz23 said on 06 April 2013

I have had AS now for 7 years. im 23 years old and had my trigger episode at 16 from shingles and putting my back out when exercising. i felt paralyzed for a few weeks having to stay in bed and calling the doctor out. he was baffled this is where it started. I have 2 brothers that have it and my dad. we have all just been diagnosed within the last couple of years. it took me 6 years for my diagnosis. But do not be put off by this you have to stay strong and keep going because this is a life long disease and you will need their support. I have only just recently started to really suss how to combat it with a combination of NHS anti tnf injections and herbal remedies, special diet physio/hydro therapy and exercise. I cannot express how this is a life change not just a quick pill. The injections seem like that but they are not! they are just essentially strong pain killers. Your spine will end up fusing and you will not know as the injections hide it! i had awful reactions to entercept hallucinating and having outter body experiences at night when sleeping. this did not happen immediately it was after taking them for 6 months. I now am off them detoxing for 3 months before they put me on the fort nightly ones which my brother is taking. Everyone is effected differently but the most effective which seems to help everyone is a diet of no sugar or starch ! HARD but works a miracle with exercise. my mum is a herbalist and we have tried everything in the book. only now after 6 years have we mastered which ones are good. but everyone is individual.

Report this content as offensive or unsuitable

seo286 said on 26 March 2013

Hannahd85 --- just a quick response to your query in the event you should ever return to this page: I would seriously considering looking into the TNF treatment they are offering. I was diagnosed with AS at 17 years when I was in massive amounts of pain and the MRI's showed a huge amount of bone fusion in my sacroiliac joint (I was told it was a big concern considering my age). I was on pain killers and MTX for about a year and complained that they were interferring to much in my day to day life - I was happy to take them at night to manage to sleep ok, what with all of the tossing and turning/pain at night however I was not ok with how much they messed with my head during the day (it was hard to concentrate at uni). I was put on adalimumab every other week at age 18 then weekly from age 19 until 23. This year the TNF wore off a wee bit so to prevent a massive flare I was switched to 50mg Entanercept weekly for the time being to give a change to my body. Both have worked wonders. I realise there are quite a few side effects (I have definitely experienced them!) but to be honest, you have to make the decision whether you are ok with side effects or if you want to continue living in pain. The TNF blockers have not only seriously reduced my pain levels (not 100% but so much better) but they have also slowed the progression of the disease. Do some research, see what others say about being on them, and then make your own decision. It was an easy one for me although I must say I have a lot of other problems and the TNF has made an impact on all of these in a positive way (Bilateral Iritis, Vasculitis, Ulcerative Colitis, Psoriasis and AS) BUT I have never looked back. Good luck!

Report this content as offensive or unsuitable

Hannahd85 said on 26 March 2013

From the age of 19 Ive suffered with Iritis and a blood test confirmed I was HLAB27 + although initiially all MRIs and Xrays came back clear even though I was in so much pain. So I seemed to just constantly take pain killers. 8 years later I seemed to have had an aggressive onset and now all my MRIs and Xrays show severe deformation of my sacriolatic joints. It seems to be a running trend that GPs turn sufferers away and "fob them off" with pain relief just because the Xrays are not showing the condition, yet I feel intervention when I was a lot younger could have prevented the situation I am in now. It takes time for the bone damage to mature and show up on these tests and by then I feel too much damage has been done. For years ive suffered with my eyes and low back pain but recently its now in my hips and the iritis seems very aggressive (been on drops for 9 months now) and I am constantly visiting Moorfields.Work has become a massive issue and two years into my nursing course Ive been asked to leave as the pain is too much/ the pain killers can make me disorientated. I really believe if some sort of treatment was available when I was 19 I may not be in this position as all the doctors seem to do is prescribe painkillers to "mask" the syptoms resulting in sufferers getting too bad that it is harder to fix...
I have just been offered the ANTI TNF treatment yet im in two minds if I should start this...? im only 27!

Report this content as offensive or unsuitable

Sisra said on 24 March 2013

I was diagnosed with Iritis in 2006, at the same time they found I have HLA B27. I have been back and forth to my GP with my back for the last 6 months, I was sent for blood tests, x rays and an MRI scan all of which the GP said have come back clear. I saw a physio therapist last week who is referring me for more tests. My Dad had HLA B27 and AS and Iritis! Any suggestions on how to get the GP to listen?

Report this content as offensive or unsuitable

Shellyni said on 07 March 2013

Ive been diagnosed for 17 years now - took me 12 years plus to get a doctor to believe me and get diagnosed! I could barely walk with the pain and physios weren't helping. Eventually a physio realised my condition and told me to get a HLAB27 blood test and a referral to a rheumatologist. By this stage I was also getting iritis. I was so relieved someone was actually believing me. X-rays wont show anything in the early years - its only in the last number of years my inflammation has started to show along with the calcification.

Best to get referred to a specialist physio who has had specific traing with arthritis patients and hydro therapy is fantastic. GPs can be very dismissive of this so be very insistent if you think you have this condition.

Reflexology is also a good therapy to get as well.

Good luck!

Report this content as offensive or unsuitable

amfy said on 20 January 2013

I have had the above symptoms of AS for over 4 months now, I have been to the doctors several times, have had blood tests and had an x ray, both of which are clear, I'm at my wits end, I have aged about 10 years through lack of and disrupted sleep every night, I don't know what else to do to convince them, I also have reccurent blisters on the eyeball of my left eye and swelling of the eyelids, which only started at the same time, so am convinced they are linked, but doctors have said all looks ok and probably because I am run down, I wake every morning knowing this is not normal, can anyone suggest how I can get a diagnosis for this.

Report this content as offensive or unsuitable

sharonwy said on 26 September 2012

Hi Steve, I asked the new GP to refer to a rhematologist , hasnt done it yet . Im now on the treadmill of blood tests , and ECG's, I have been having palpatations.GP seems determined to tackle this himself , still cant get past the bloody doctors, on the point of changing surgerys, if I only felt it wouldnt put me back to square one.
Thanks for replying and the advice , I hopeyou are doing ok. sharon.

Report this content as offensive or unsuitable

sharonwy said on 31 August 2012

I believe I may have Ankylosing Spondylitis,having been backwards and forwards , seemingly constantly , to my GP and physio depts .When I put my thoughts to my GP he said that I absolutely do not have it, because my back xray shows no signs, it came back as wear and tear.At first he said there were no tests available,then when I burst into tears he rememberd there were.Although he strongly emphasised these ,even if positive , do not in any way mean I have A.S..When I then asked for a referal for a wheelchair,I find it very painfull standing and walking,and have collapsed several times now , he refused,saying he does not believe I am that bad.I am off work ,I was working when I started this quest ,and am getting worse month on month.The Physio dept haven't helped my condition in any way, and I believe they have seriously misdiagnosed my condition.My life is on hold,I cant work rest or play. Am trying a different GP at my practice,but feel I am back at the begining, and I feel so ill.

Report this content as offensive or unsuitable

RobD said on 18 April 2012

Hi steve Brann,have you seen a rhematologist if you havent it is important that you do.They have expertise in your condition and you may meet the criteria for a type of therapy called Anti- tnf this litterally transformed my life although its not for everyone.It took me 10 years to get diagnosed I was like yourself fobbed off.Try www.nass.co.uk a charity commited to fighting this illness.I am also from Liverpool currently living on the wirral

Report this content as offensive or unsuitable

steve brann said on 04 April 2012

I would like to know of somewhere in merseyside where i can seek advice and help with regards to this illness i have, i try to work full time in a techical and manual job, so working from home or part time, or in a less strenuous job is not happening, and i've been let down big time by my local gp, and all other departments, i am angry and fed up with being fobbed off with eye drops paracetemol,, and "sorry, there's nothing we can do" there must be someone somewhere who could advise me.............. please

Report this content as offensive or unsuitable

Michael_9 said on 10 March 2012

I would have liked some advice on what medication to take.

Report this content as offensive or unsuitable