These are called flares, and your doctor can help you recognize and properly treat them 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 of AS, although it’s not always the first one to appear, says Robert Goldfien, MD, a retired rheumatologist who worked 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 occur 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 says.
Signs and Symptoms of AS Flares
During an AS flare you may experience any or all of the following effects. 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 tendinitis or joint swelling during a flare, especially in the knees and ankles, says Eric Matteson, MD, the chair of rheumatology and a professor of medicine at the Mayo Clinic in Rochester, Minnesota. Other areas of the body that may become swollen and painful include the hands, feet, heels, ribs, hips, and shoulders. An AS flare can also cause inflammation where the tendons and ligaments meet the bone, which can cause pain in the heel, the top of the shin, and the elbow, adds Bharat Kumar, MD, the associate rheumatology fellowship program director at the University of Iowa in Iowa City. 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. Take notice if your eyes are red or sensitive to light. As many as 40 percent of people with spondylitis — an umbrella term for several inflammatory diseases including ankylosing spondylitis — experience inflammation of the eye, called iritis or 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 may lose sleep because of 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. But the risk of spinal fusion can be lowered with treatment to control flares and inflammation, Goldfien says.
Diagnosing and Managing AS Flares
Be sure to talk to your doctor in advance about what you should do if your AS symptoms worsen or new symptoms develop. Goldfien recommends making an appointment with your rheumatologist anytime your symptoms get significantly worse, especially if they begin to affect your quality of life or day-to-day activities. Your rheumatologist can determine whether your symptoms are likely related to a flare or some other cause and help you manage them properly with treatment. As of now, there are no specific tests to diagnose an AS flare, Dr. Kumar says. Other conditions that may look like an AS flare include joint infections, which can be tested for with a fluid draw from the affected joint. If your symptoms appear to be those of a flare, the treatment your doctor prescribes depends on the severity of your symptoms, Dr. Matteson says. “Flares can be managed sometimes with nonsteroidal anti-inflammatory drugs (NSAIDs), but may also require a brief course of prednisone [a steroid drug] or sometimes joint injections.” In the case of a prolonged flare that isn’t going away, your rheumatologist may consider disease-modifying therapies, he says. Depending on the severity of your flare, you may need to ease up on everyday activities. Temporary rest (for a couple of days) can help prevent injury to an inflamed joint, Kumar says. He adds, “Applying ice to the area can also reduce the swelling and signs of inflammation.” Advances in treatment can help you not only manage your flares but also manage your AS over the long term. As Goldfien notes, “It’s important for people to know that there are medicines available that can be remarkably effective for this disease.” Additional reporting by Susan Jara.
