Ankylosing spondylitis symptoms can unexpectedly get worse, but these episodes can be managed. Learn how to recognize a flare so you can take prompt action.
Back pain and stiffness are part of life when you have ankylosing spondylitis (AS), but there are times when symptoms get worse or new problems appear, only to go away after a period of time.
These are called “flares,” and working with your doctor to recognize and properly treat them will allow you to better manage your AS.
Ankylosing Spondylitis Flares: An Overview
People with AS have chronic inflammation of the sacroiliac joints that connect the spine to the pelvis, according to the Spondylitis Association of America. Back pain is the most common symptom and characteristic of AS, although it’s not always the first one to appear, says Robert Goldfien, MD, a rheumatologist at Kaiser Permanente East Bay in Richmond, California.
Flares are characterized by a worsening of symptoms like pain and stiffness. They’re typically followed by periods of remission, in which pain lessens. “Any form of inflammatory disease like AS has periods where it’s better or worse,” Dr. Goldfien says.
How often flares come on varies from person to person. Some may experience a flare once or twice a year for a week or two, while others may experience flares once a month or so, he adds.
Signs and Symptoms of AS Flares
During a flare you may experience:
More back pain and stiffness. Many people with AS have back pain every day, but flares can cause back pain and stiffness to get worse, Goldfien says.
Other painful joints. You may also experience tendonitis or joint swelling during a flare, especially in the knees and ankles, says Eric Matteson, MD, chair of rheumatology and a professor of medicine at the Mayo Clinic in Rochester, Minnesota. Other areas of the body that may also become swollen and painful include the hands and feet, heels, ribs, hips, and shoulders.
Eye problems. Any time AS gets worse, such as during a flare, there’s the potential to experience a complication of the disease that affects the eyes. As many as 40 percent of people with spondylitis experience inflammation of the eye, such as iritis or anterior uveitis, according to the Spondylitis Association of America. Eye inflammation can be painful, and you need to see your rheumatologist or ophthalmologist if you develop this complication of AS, Goldfien says.
Fatigue. “Fatigue is a very common symptom with inflammatory disease,” Goldfien notes, and it can get worse during a flare. It takes energy for your body to fight inflammation, and you could lose sleep from arthritis pain. “But if you treat the inflammation, the fatigue should be better, too,” he adds.
Spinal fusion. When you’ve experienced severe, frequent flares over the course of the disease, inflammation of the spine can lead to scarring of the tissue and the formation of extra bone, which can cause the spine to fuse into a curved position. However, the risk for spinal fusion can be lowered with treatment to control flares and inflammation, Goldfien says.
Managing AS Flares
Be sure to talk to your doctor in advance about what you should do when you’re hit with a flare. Goldfien recommends making an appointment with your rheumatologist any time your symptoms get significantly worse, especially if they begin to affect your quality of life and/or day-to-day activities. Your rheumatologist can diagnose whether your symptoms are related to a flare — or another cause — and help you manage them properly with treatment.
How your doctor treats a flare depends on the severity of your symptoms, Matteson says. “Flares can be managed sometimes with nonsteroidal anti-inflammatory drugs (NSAIDs), but may also require a brief course of prednisone or sometimes joint injections,” he says. In the case of a prolonged flare that isn’t going away, your rheumatologist may consider disease-modifying therapies, Matteson adds.
Advances in treatment can help you not only manage your flares but allow to better manage your AS over the long term as well. As Goldfien notes, “It’s important for people to know that there are medicines available that can be remarkably effective for this disease.”