11 Possible Complications of Ankylosing Spondylitis

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Ankylosing spondylitis

Ankylosing spondylitis (AS) is an incurable inflammatory disease of unknown origin that typically affects the spine and low back. Because ankylosing spondylitis is progressive and systemic, it can also impact many different parts of the body, including joints and organs. Here are 11 possible complications of the disease.


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Costochondritis

Costochondritis, also called Tietze's syndrome, is inflammation of rib cartilage where ribs attach to the breastbone. Common symptoms are difficulty breathing and pain and tenderness in the chest area that can mimic symptoms of heart attack and heart disease. The condition is often treated with rest, ice or heat, and anti-inflammatories. For patients with ankylosing spondylitis, costochondritis can be a recurring condition.


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Uveitis and iritis

Uveitis is characterized by inflammation in the uvea, the part of the eye between the sclera and retina. Iritis, a form of uveitis close to the front of the eye, is common in ankylosing spondylitis. Any form of uveitis can cause permanent damage, including vision loss, if not treated quickly. Symptoms may include light sensitivity, burning pain, blurred vision and redness of the sclera. Treatments include eye drops, including steroids. Severe cases may require oral or injected steroids.


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Enthesitis

The enthesis is where joint capsules, ligaments, or tendons attach to bone. Enthesitis is inflammation of the enthesis, causing pain, swelling, and tenderness in and around joints. In ankylosing spondylitis, enthesitis is a hallmark feature of the disease. It can occur in multiple areas of the body but is most common in the spine, sacroiliac joints, pelvic area, chest, and especially the heel. Treatment often includes anti-inflammatory medications and sometimes oral or injected steroids.


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Peripheral arthritis and arthritis of small joints

Ankylosing spondylitis is axial in nature, which means it primarily affects the axis or center of the body. People with ankylosing spondylitis can also have peripheral disease activity, or arthritis affecting outer parts of the body such as elbows, hands, wrists, fingers, knees, ankles, feet and toes. Few studies exist examining effective ways to treat peripheral activity in ankylosing spondylitis, but it is often treated with anti-inflammatory medications and slow acting anti-rheumatic drugs.


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Kyphosis

Another hallmark feature of ankylosing spondylitis is inflammation in the spine. In severe cases, this inflammation can cause bone spurs to form and fuse the spine into a column of fragile bone, often forcing the upper back into a hunched position. This is called kyphosis. Early treatment to control inflammation is key to preventing kyphosis. Surgery to correct the curvature is risky and considered only in severe cases.


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Heart disease

Several heart-related complications are recognized in ankylosing spondylitis, including inflammation of the aortic valve in the heart; narrowing of the arteries, or atherosclerosis; and arrhythmias. A variety of tests and procedures exist to detect and measure the presence of cardiac disease, which is best treated through preventative measures.


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Osteoporosis and spinal fracture

Osteoporosis can occur in ankylosing spondylitis from the degeneration of the spine and sometimes hips and sacroiliac joints. Inflammation can cause bone spurs to form and these changes can make the bone fragile, increasing the risk of spinal fracture. A bone density scan can check  the bones for osteoporosis. A number of drugs exist to slow the progression of osteoporosis.


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Depression

Clinical depression is common among people living with chronic diseases and is frequently present in people living with ankylosing spondylitis. Research suggests that living with depression and physical illness can exacerbate both conditions. A variety of treatments are available to manage depression, including therapy and medications.


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Neurological disorders

Neurological complications in ankylosing spondylitis are not common, but conditions like spinal stenosis and cauda equina syndrome can occur. These are conditions characterized by the narrowing of the spinal canal, which can lead to pain, tingling, and loss of bladder control.


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Cognitive dysfunction

Cognitive dysfunction, or mild cognitive impairment, is a common complication of ankylosing spondylitis that can cause symptoms like temporary memory loss and difficulty recalling specific words or phrases. Cognitive impairment can affect quality of life and is important to be monitored, especially among people living with immune mediated conditions.


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Comorbidities

Ankylosing spondylitis is an immune-mediated inflammatory disease which makes it part of a group of diseases that share a similar pathway or cause of inflammation. These shared pathways make the body more susceptible to comorbidities, or additional immune-mediated inflammatory diseases such as ulcerative colitis, Crohn’s disease, lupus, and rheumatoid arthritis.


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Ankylosing spondylitis is complicated

Ankylosing Spondylitis is a complex disease with multiple potential complications. Being aware of the common risks associated with this disease can be helpful as treatments are considered.