How Ankylosing Spondylitis Is Different in Black People

Medically Reviewed by Melinda Ratini, MS, DO on July 28, 2022
Written by Rebecca Shannonhouse
4 min read

If you’re Black, you may be less likely than someone who’s white to develop Ankylosing Spondylitis (AS). But if you do, it could be more severe than it would be in a white person.

This type of inflammatory arthritis usually affects people in young adulthood. It can lead to spinal stiffness, and your vertebrae may fuse together. This is called “ankylosis.” It can cause your spine to become inflexible.

And while it’s mainly been studied in white people, researchers are now learning how it affects Black people.

It’s relatively rare and happens more to white people.

Estimates show it affects less than 0.5% of people living in the U.S. One study found AS was three times more common in white people than Black people.

Research suggests that AS may be more severe in Black people who have it than in white people.

For example, Black people have higher levels of two markers of inflammation in the body that might be linked to arthritis like AS, one study found.

The same study showed that Black people with AS are more likely than white people with AS to also have:

  • High blood pressure
  • Diabetes
  • Depression
  • Heart disease
  • Inflammation in the front of the eye

On the other hand, it found that white people with AS are more likely than Black people with AS to have psoriasis and fibromyalgia.

Compared with white people, Black people with AS also had more functional impairment and disease activity. These findings, however, could be affected by various factors.

For example, because studies have found AS happens more in whites, doctors may be less likely to diagnose it or identify milder cases of it in Black people.

This could account for why Black people diagnosed with AS have more severe symptoms.

Misdiagnosis, socioeconomic status, and limited access to health care may be among the reasons that fewer Black people have been included in studies on AS.

No one knows why AS develops. But because it tends to run in families regardless of your race, your genes may be a cause. It’s 10 to 20 times more common in people whose parent or sibling has AS.

AS has been linked to a gene known as HLA-B27. This is a variant of the HLA-B gene, which helps your immune system function properly.

In one study, researchers found HLA-B27 in about 85% of white people who have AS, compared with about 63% of Black people.

But if you have the HLA-B27 gene, it doesn’t mean you’ll get AS.  And some people who don’t have that gene develop AS. Other research suggests unknown environmental factors may play a role in whether you get AS.

Some people experience only mild, periodic pain. In others, AS may cause chronic, severe pain.

If you have AS, your spine may not be the only part of your body that’s affected. For example, you may have other symptoms, including:

  • Pain, stiffness, and inflammation in your shoulders, ribs, knees, or feet
  • Trouble breathing if inflammation has spread to your ribs
  • Eye pain, resulting from inflammation of your eye (uveitis)
  • Fatigue
  • Weight loss
  • Fever
  • Anemia
  • Skin rashes
  • Gastrointestinal conditions (such as Crohn’s disease or ulcerative colitis)

If you have signs of AS, see your doctor. You’ll need to describe your symptoms to them and get a physical exam.

Don’t hold back when telling them about your pain. A study found that Black people are often undertreated for pain compared with white people who have the same symptoms.

And because AS is diagnosed more often in white people, your doctor may be less likely to think about the possibility of Black people having it. So you may need to ask your doctor if your symptoms could be due to AS. 

To make a diagnosis, your doctor will likely suggest you have some tests. Those may include an X-ray, a blood test to check your ESR levels (one of the inflammation markers that’s common in AS), and genetic testing to see if you carry the HLA-B27 gene.

In some cases, an MRI may be used to diagnose early-stage AS by looking for spinal inflammation that can’t be seen on an X-ray.

Staying active will help you control your symptoms. Regular exercise that strengthens your back muscles can help you manage your pain and minimize any stiffness or changes in your posture (such as stooping due to back pain).

Meds commonly prescribed for AS include:

  • Nonsteroidal anti-inflammatory drugs to help ease your inflammation and pain
  • Tumor necrosis factor blockers (a type of biologic drug) to curb your swelling and inflammation
  • Disease-modifying antirheumatic drugs (DMARDs), such as sulfasalazine, for your inflammation and other symptoms
  • Corticosteroids for short-term use to reduce your inflammation

In some cases, your doctor may suggest surgery to replace a damaged joint or repair affected areas of your spine.

Living with AS is easier when you have support. Some options focus on Black people living with this disease. Sources include:

  • Facebook hosts online groups for people with AS. This includes the Ankylosing Spondylitis Support Group for Black Women (known as BLASST!).
  • On Twitter, check out #ankylosing spondylitis. 
  • The Spondylitis Association of America at www.spondylitis.org provides resources including “Faces of AS,” which includes first-hand accounts of people of various races and ages living with AS.
  • The Arthritis Foundation sponsors Live YES! Arthritis Network, www.arthritis.org, which provides an online forum to connect people of all races and ages living with different types of arthritis.