Some conditions, such as psoriasis and inflammatory bowel disease, may stem from some of the same causes as AS, while other health problems can be complications of AS itself. Either way, any of these coexisting conditions can affect how your doctor approaches your ankylosing spondylitis treatment plan. You may also need to see other medical providers for any health conditions that accompany your AS. If so, “Tell your doctor about all the medications you are taking for ankylosing spondylitis and other medical conditions to avoid overtreatment” and to alert your doctor to any possible drug interactions, says Petros Efthimiou, MD, a rheumatologist in private practice in New York City. Here are five common health conditions seen in people with ankylosing spondylitis, along with information on how they are often recognized and managed or treated.
1. Psoriasis
Ankylosing spondylitis is one type of spondyloarthritis, meaning a condition that inflames places in the body where ligaments meet bones. “Spondyloarthritis conditions all have a tendency to have the same genetic marker,” says Theodore Fields, MD, a professor of clinical medicine at Weill Cornell Medicine and an attending rheumatologist at the Hospital for Special Surgery in New York City. People with AS who also have psoriasis may develop psoriatic arthritis, another type of spondyloarthritis with symptoms similar to ankylosing spondylitis. Therefore, if you have ankylosing spondylitis, Dr. Fields recommends asking your doctor to examine you for psoriasis, which is characterized by red, itchy, scaly patches on the skin. If you are diagnosed with psoriasis and develop back, neck, or joint pain, you should also be checked for psoriatic arthritis. Psoriasis may be treated with topical medications, phototherapy (light therapy), or oral or injected medications, including biologic therapies — or a combination approach.
2. Inflammatory Bowel Disease (IBD)
Approximately 10 percent of people with ankylosing spondylitis also develop a form of inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis, according to the Spondylitis Association of America. What’s more, as many as 60 percent of people with AS who have no gastrointestinal symptoms are believed to have some measurable gut inflammation. People with inflammatory bowel disease who develop neck and spine pain typically have the same genetic marker as do people who develop psoriatic arthritis. Drug treatment for IBD includes aminosalicylates, corticosteroids, immunomodulators, antibiotics, and biologic therapies. Tell your doctor if you experience gastrointestinal signs or symptoms such as chronic diarrhea or blood in your stool, which may be signs of an IBD. You may be referred to a gastroenterologist for evaluation and diagnosis. If you do have IBD, it’s possible that a biologic therapy will be prescribed to treat your AS and your IBD at the same time.
3. Uveitis (Iritis)
Ankylosing spondylitis can cause health issues beyond your joints, including uveitis, or inflammation of the eye, says Erin Bauer, MD, a rheumatologist at Virginia Mason Franciscan Health in Seattle. According to the Spondylitis Association of America, up to 50 percent of people with ankylosing spondylitis will have at least one episode of uveitis. “It typically manifests as a painful and red eye, although sometimes it’s less obvious,” Dr. Bauer says, noting that some people may notice vision changes and sensitivity to light. Treatment for uveitis typically involves short-term use of steroid eye drops, and steroid injections may be used for severe or unresponsive cases. If necessary, immunosuppressant drugs may be used to prevent recurring uveitis. “Many of the same drugs we use to treat ankylosing spondylitis will also treat uveitis, although not all, so it is important to know if ankylosing spondylitis patients have uveitis,” Bauer explains.
4. Chronic Fatigue
Fatigue related to ankylosing spondylitis is common, and it isn’t just “feeling tired.” It may not go away after a good night’s sleep, and it’s sometimes accompanied by “brain fog” or cognitive difficulties. Fatigue in AS can make it difficult to complete work and everyday tasks, and may take a toll on your social life and relationships. According to the Spondylitis Association of America, most fatigue in AS is related to uncontrolled inflammation. Depression can also cause fatigue, both directly and by causing sleep disturbances. Other potential causes of fatigue may include anemia (inadequate red blood cells), thyroid problems, or other health conditions, so be sure to talk with your doctor about your fatigue and get it thoroughly checked out — don’t just assume it’s caused by your AS. Even if your fatigue is AS-related, it may indicate that your current treatment needs to be reevaluated. RELATED: Ankylosing Spondylitis: Dealing With Fatigue
5. Heart Problems
Approximately 2 to 10 percent of people with ankylosing spondylitis develop heart problems, according to the Spondylitis Association of America. Aortitis (inflammation of the aorta) can occur with ankylosing spondylitis and cause aortic valve regurgitation, which means that the aortic valve in the heart weakens, allowing some oxygenated blood to leak back into the left ventricle of the heart instead of moving forward through the aorta to the rest of the body. Symptoms of aortitis may include shortness of breath, dizziness, and chest pain. Conditions affecting the aorta may require surgical intervention, such as valve replacement. Other heart issues related to ankylosing spondylitis may include heart rhythm problems (arrhythmias), as well as heart failure, high blood pressure, and ischemic heart disease (heart problems related to reduced blood flow). Just as in people without AS, heart problems may sometimes be prevented or treated with lifestyle changes, or they may require treatment with medication. Additional reporting by Kristen Stewart.
