Diagnosis of Ankylosing Spondylitis

To diagnose ankylosing spondylitis, your doctor will ask you about your medical history and perform a physical exam. Your doctor may order imaging studies and lab tests to help confirm a diagnosis.

Medical and Family History

Your doctor may ask about your medical and family history, including questions such as:

• How long have you had pain?
• Where is your pain?
• What makes the pain better or worse?
• Does anyone in your family have a history of back pain, joint pain, or arthritis?

Physical Exam

A physical exam may include:

• Examining your joints, including your spine, pelvis, heels, and chest.
• Watching how you move and bend in different directions, checking for flexibility.
• Asking you to breathe deeply to check for rib stiffness and inflammation. 

Imaging Studies

Your doctor may order imaging studies to help diagnose ankylosing spondylitis:

• X-rays help doctors see joint changes. However, you may have the disease for years before the changes show on x-rays. Doctors may use x-rays to monitor the progression of the disease or to rule out other causes for the joint pain.
• Magnetic resonance imaging (MRI) uses energy from a powerful magnet to produce signals that create a series of cross-sectional images. These images or “slices” are analyzed by a computer to produce an image of the joint. MRI can help diagnose ankylosing spondylitis in the early stages of the disease.

Your doctor may use both x-rays and MRIs to follow the progression of your disease.

Lab tests

At this time, no single test diagnoses ankylosing spondylitis. Your doctor may order a blood test to check for the HLA-B27 gene, which is present in most people with the disease. You may have the HLA-B27 gene and never develop ankylosing spondylitis, but it can give doctors more information when making a diagnosis. Your doctor may also order labs to check blood counts and markers of inflammation, which may help to give your doctor a sense of the extent of disease.

Treatment of Ankylosing Spondylitis

There is no cure for ankylosing spondylitis; however, your doctor will work with you to help manage the disease. The goals of treatment include:

• Relieve symptoms.
• Help maintain proper posture, flexibility, and strength.
• Halt or slow the progression of the disease.

In most cases, treatment includes medication and physical therapy. Sometimes, people with severe disease need surgery to repair joint damage.

Medications

Most people with ankylosing spondylitis take medications, which may include one or more of the following:

• Over-the-counter anti-inflammatory medications to relieve pain and inflammation are commonly used.
• Biologic medications target specific immune messages and interrupt those signals to decrease or stop inflammation.
• Janus kinase (JAK) inhibitors may also be prescribed if your disease is unresponsive to other treatments. These medications send messages to specific cells to stop inflammation from inside the cell. 
• Corticosteroids can help decrease inflammation and provide some immediate pain relief. They are usually injected into the joint. 

Physical Therapy

Your doctor may recommend physical therapy to help:

• Relieve pain.
• Strengthen back and neck muscles.
• Improve core and abdominal muscle strength because these muscles provide support for your back.
• Improve posture.
• Maintain and improve flexibility in joints.

A physical therapist can recommend the best sleeping positions and an exercise program. Because your symptoms may worsen when inactive or at rest, it’s important to stay active and exercise regularly.    

Surgery

If you have severe joint damage and you are unable to participate in your daily activities, your doctor may recommend surgery. Surgery is not for everyone. You and your doctor can discuss the options and choose what is right for you.

Your doctor will consider the following before recommending surgery:

• Your overall health.
• The condition of the affected bone or joint.
• The risks and benefits of the surgery.

Types of surgery may include joint repairs and joint replacements.

Rarely, some people may have surgery to correct or straighten the spine or repair fractures (breaks) in the vertebrae.

Who Treats Ankylosing Spondylitis?

Diagnosing and treating ankylosing spondylitis may require a team of health care professionals.  These may include:

• Rheumatologists, who specialize in arthritis and other diseases of the bones, joints, and muscles.
• Dermatologists, who specialize in conditions of the skin, hair, and nails.
• Gastroenterologists, who specialize in conditions of the digestive system.
• Mental health professionals, who help people cope with difficulties in the home and workplace that may result from their medical conditions.
• Nurse educators, who specialize in helping people understand their overall condition and set up their treatment plans.
• Occupational therapists, who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy.
• Ophthalmologists, who specialize in conditions of the eye.
• Orthopaedic surgeons, who specialize in treatment and surgery for bone and joint diseases.
• Physiatrists (physical, medicine, and rehabilitation specialists), who supervise exercise programs.
• Physical therapists, who help improve joint function.
• Primary care doctors, such as a family physician or internal medicine specialist, who coordinates care between the different health providers and treats other problems as they arise.
• Psychologists or social workers, who help with psychosocial challenges caused by medical conditions.