The following symptoms and complaints may indicate ankylosing spondylitis:
- Anorexia (loss of appetite).
- Sensitivity to movement of the spine
- Restricted breathing width (2 cm) at the level of the 4th intercostal space.
- Sensitivity to vibration of the spine
- Fever
- Weight loss
- Ischialgiform pain (or positive Mennell’s sign – when the patient’s extended leg is jerkily hyperextended, lying in the prone or lateral position, in the sacroiliac joint (ISG; sacroiliac joint). If pain is reported, this is referred to as a positive Mennell’s sign (= sacroiliitis). A negative sign does not exclude damage to the sacroiliac joint)Note: The sacroiliac joints are typically always affected first in ankylosing spondylitis.
- Bone pressure pain, especially at the iliac crests and spinous processes.
- Morning stiffness of the spine, which improves with movement.
- Fatigue
- Night sweats (night sweats)
- Neck pain
- Neck stiffness
- Girdling thoracic pain (chest pain)
- Back pain, especially in the lumbar spine and buttocks (sacroiliitis – inflammatory change in the lower spine (sacroiliac joints/joints between the sacrum and ilium)); persistent pain, which also occurs mainly at night/especially in the early morning; pain subsides with movement and not with rest
- Hunchback formation
- Buttock pain, alternating (left or right).
Extra-articular manifestations (occurrence outside joints).
- Chronic inflammatory bowel disease (IBD) – e.g., Crohn’s disease (usually occurs in episodes and can affect the entire digestive tract; characterized by segmental involvement of the intestinal mucosa, i.e., several intestinal segments may be affected that are separated by healthy segments)
- Psoriasis (psoriasis)
- Recurrent anterior uveitis (iridocyclitis/inflammation of the iris (iris) and ciliary body) with reddened eyes and burning pain
Side symptoms
- Arthritis (inflammation of the joints) of the shoulder/hip joints – occurs in up to 35% of sufferers.
- Peripheral arthritis (as oligoarthritis/joint inflammation (arthritis) in fewer than 5 joints), with asymmetric synovitis (synovitis) predominantly in the lower extremity (especially knee, ankle) or/and heel pain – occurs in up to 30% of cases
The following anatomical structures may be affected in ankylosing spondylitis:
- Axial skeleton:
- Spine incl. small vertebral joints.
- Sacroiliac joints
- Pubic symphysis
- Extremities joints and tendon insertions.
In advanced stages, there is a change in statics and habitus (increased cervical lordosis and thoracic kyphosis).
