The Myth That Women Don’t Get Ankylosing Spondylitis
What are the signs and symptoms of ankylosing spondylitis?
Ankylosing spondylitis is a chronic inflammatory autoimmune disorder. The symptoms of the condition result from inflammation of the spine, joints, and other organs. Classically, these include the sacroiliac joint of the hip and the joints of the spine, but other joints may be affected as well, like the shoulders, knees, and ankles.
Dull pain and stiffness in the lower back or buttocks is the most common first symptom, from inflammation of the sacroiliac (hip) bone. This pain tends to come on gradually over a period of months or years. The pain and stiffness may wake individuals in the early morning, unlike mechanical back pain. It often begins on just one side of the back, waxing and waning in intensity over time. As the disease progresses, the pain may start to become more persistent, involving both sides of the back. Typically, it starts to move up the bones of the spinal column, but it can occur on any region of the column. Over time, severe inflammation can cause the affected spinal bones to join together (ankylosis). This eliminates the pain in the spine, but the individual loses spinal mobility in that region.
Chronic pain and stiffness may occur in other joints as well, and enthesitis — inflammation of tendons, ligaments, and muscle fascia where they attach to bone — may develop. This causes soreness, stiffness, and pain in the affected regions, for example in the Achilles tendon. As in many autoimmune diseases, fatigue is a common symptom. Less frequently, inflammation outside the joint occurs, for example in the uvea of the eye, causing blurred vision, eye pain, and potentially even vision loss. Even more rarely, the condition causes various cardiac and pulmonary problems.
What are some misconceptions of women about ankylosing spondylitis? How many women have ankylosing spondylitis?
It used to be thought that the ankylosing spondylitis was five or six times more common in men than in women, but recent studies have shown this ratio to be incorrect. The disease is two or three times more common in men when diagnosed with traditional methods. Some researchers, however, believe even this ratio is too high. Recent studies raise the possibility that overall, female patients may have more atypical and somewhat milder disease symptoms than men, leading to underdiagnosis. Women may have less frequent inflammatory back pain with more involvement of the tendons and ligaments and more generalized pain. Women also tend to have slower development of the signs of AS on X-rays which have traditionally been used to diagnose the disease. If one includes women with many of the symptoms of AS, but who don’t yet qualify for a traditional diagnosis of AS based on their X-ray findings, an equal number of men and women seem to be affected. These patients have what clinicians call “preradiographic AS,” but really it is just ankylosing spondylitis in an early stage. Often, the damage can be detected by magnetic resonance imaging (MRI), which detects earlier stages of inflammatory damage than an x-ray can. The prevalence of classical AS is about 0.5% in the general population. However, if one includes these other patients with “preradiographic AS” the incidence may rise to 1% or higher, or over 1,500,000 women in the US alone (based on United States population at the time of this writing).
I have psoriatic arthritis with inflammation of my sacroiliac joint, and my doctor told me I had a “spondyloarthropathy.” Does that mean I have ankylosing spondylitis?
Not exactly, though psoriatic arthritis shares some overlapping features with ankylosing spondylitis. A spondyloarthropathy is any joint disease involving the vertebral column. Psoriatic arthritis and ankylosing spondylitis are part of a group of related and somewhat overlapping disorders that also include Crohn’s disease and ulcerative colitis. In psoriatic arthritis, a person may have inflammation of the sacroiliac joints and the bones of the spinal column, leading to similar symptoms as seen in AS, in addition to the other symptoms of psoriasis. Crohn’s disease or ulcerative colitis can follow a similar pattern; they are both frequently associated with inflammation of the hip joint, spinal column, or other joints, as well as their other more characteristic symptoms.
Questions for your doctor:
- What sorts of exercises are best for my ankylosing spondylitis?
- Could I have pre-radiographic AS, even if my doctors don’t see changes on X-ray? Should I get a MRI?
- What sort of monitoring is required for problems outside my joints (e.g., my eyes and heart)?
About the Author
Ruth J. Hickman, MD, is a freelance health, science, and medical writer. She specializes in writing about medical topics for the lay public and for health science students. She can be reached at email@example.com or through her website: ruthjhickmanmd.com.
This blog post was originally published by AutoimmuneMom.com, written by Ruth J. Hickman, MD, and first published on Mar 21, 2013.
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