Inflammatory Back Pain Features
- Gradual onset before age 40
- Pain improves with exercise, worsens with rest
- Night pain causing waking, improving on getting up and moving
- Morning stiffness lasting over 30 minutes
- Good response to NSAIDs
Diagnostic Tests
| Test | Purpose |
|---|---|
| HLA-B27 | Present in ~90% of AS patients — supports diagnosis but not diagnostic alone (8% of general population also carry it) |
| ESR/CRP | May be raised, but normal doesn't exclude AS |
| MRI sacroiliac joints | Can show inflammation years before X-ray changes |
| X-ray spine/pelvis | Shows characteristic changes in established disease |
Treatment
| Step | Treatment |
|---|---|
| First-line | NSAIDs regularly, plus physiotherapy and exercise |
| If inadequate response | Biologic therapy (TNF inhibitors like adalimumab, etanercept) |
| Newer option | IL-17 inhibitors (secukinumab) |
Exercise Is Essential TreatmentRegular exercise, particularly extension and stretching exercises, is as important as medication in AS — it maintains spinal mobility and reduces the risk of progressive stiffening and fusion.
Does everyone with HLA-B27 get ankylosing spondylitis?
No — only about 5% of HLA-B27 positive people develop AS. It's a risk marker, not a diagnosis on its own.
Can ankylosing spondylitis affect other body parts?
Yes — it can affect the eyes (uveitis), causing eye pain and redness, and rarely the heart and lungs in longstanding disease.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.