Ankylosing spondylitis: night-time back pain
An inflammatory spinal rheumatism
Dr. Marc Lefèvre
Rheumatologist
A chronic inflammatory disease
Ankylosing spondylitis affects 0.3% of the population, typically young men. Inflammation of sacroiliac joints, spine, sometimes peripheral joints. Strong association with HLA-B27 (80-90%).
Symptoms
Inflammatory low back pain (night-time, morning stiffness >30 min, improves with activity), buttock pain alternating from side to side, enthesitis (Achilles), uveitis, psoriasis or IBD possible.
Diagnosis
Pelvic MRI (sacroiliitis), HLA-B27, CRP. ASAS classification criteria.
Treatments
- NSAIDs: first-line, often continuous
- Physical therapy daily: essential to prevent ankylosis
- Anti-TNF (adalimumab, etanercept): very effective
- IL-17 inhibitors (secukinumab, ixekizumab) and JAK inhibitors (upadacitinib)
Lifestyle
Quit smoking (worsens progression), regular physical activity (swimming, yoga), preserve good posture.
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