What are the signs and symptoms of ankylosing spondylitis (AS)?

Updated: Feb 02, 2021
  • Author: Lawrence H Brent, MD; Chief Editor: Herbert S Diamond, MD  more...
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Key components of the patient history that suggest AS include back pain with the following features [2] :

  • Improvement of symptoms with exercise [3]
  • Pain at night
  • Insidious onset of low back pain (symptoms for at least 3 months) - The most common symptom
  • Onset of symptoms before age 40 years
  • No improvement with rest

General symptoms of AS include the following:

  • Those related to inflammatory back pain - Stiffness of the spine and kyphosis resulting in a stooped posture are characteristic of advanced-stage AS.
  • Peripheral enthesitis and arthritis
  • Constitutional and organ-specific extra-articular manifestations

Fatigue is another common complaint, occurring in approximately 65% of patients with AS. Increased levels of fatigue are associated with increased pain and stiffness and decreased functional capacity. [4, 5]

Extra-articular manifestations of AS can include the following:

  • Uveitis
  • Cardiovascular disease
  • Pulmonary disease
  • Renal disease
  • Neurologic disease
  • Gastrointestinal (GI) disease
  • Metabolic bone disease

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