Most symptoms of ankylosing spondylitis present with lower back pain first, but in women and children it is not unusual that the first presentation would be joint pains in arms or legs. Sometimes it might even present with an acute eye inflammation (acute iritis or anterior uveitis).
Recurrent back pains, which mostly occur at nights, and morning stiffness are common. This improves with moving about (Ref. 2). Inflammation in the sacroiliac joints (sacroiliitis)manifests itself by buttock pains either only on one side or on both. This is worse with rest and tends to get worse with weight bearing. This can be confused with irradiating pain from a disc herniation and when a CT scan of the spine is normal, the ankylosing spondylitis might be missed.
There might be chronic inflammatory changes followed by bone spur formation deep inside the sole of the feet (plantar fasciitis) or at the insertion of the Achilles tendons at the calcaneous bones. These lesions are called “enthesis lesions” (Ref. 1) and this shows up on X-rays.
Eye lesions such as conjunctivitis happen in about 33% of Reiter’s syndrome. In about 4% of patients with any spondyloarthropathy (including ankylosing spondylitis) an acute inflammation of the iris occurs. This condition is called “anterior uveitis” by the eye specialist and has the potential to reoccur. The more it reoccurs, the more difficult it is to treat and can in a few patients can become the cause of blindness.
The costovertebral joints, which allow the ribs to move up and down with breathing, tend to become stiff and as a result the chest expansion becomes limited with ankylosing spondylitis.
As long as the person is not excessively overweight, the diaphragm can compensate to a certain extent, but the overall exercise tolerance is decreased. As over the years the spinal connections via the facet joints and the interspinal ligaments become stiff and immobile, the spine becomes forward bent permanently, which is called “kyphosis“.
More rare systemic symptoms from ankylosing spondylitis are nerve compressions (sciatica, radiculitis) and heart problems (leaky aortic valve, irregular heart beats, pericarditis). Also rare is a lung fibrosis condition, which affects the upper lungs and can sometimes be misdiagnosed on X-rays as “tuberculosis”, when in reality it is not. However, this can be complicated by a fungal superinfection (“aspergillosis”) (Ref. 2, p. 446).
References:
1.The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 51.
2. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders
3. ABC of rheumatology, second edition, edited by Michael L. Snaith,M.D., BMJ Books, 1999.
4. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
5. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
