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Conditions You Might Have Along With AS

Reviewed by Michael W. Smith, MD on November 17, 2020

If you have ankylosing spondylitis (AS), you may be more likely to develop another disease or illness. Some conditions are more common than others in people with AS. It’s not always clear why, but when you know what the possible risks are, you can take action to help prevent those problems.

Osteoporosis

This condition affects your bones. Your body either doesn’t make enough bone, loses too much, or both. Due to this, your bones become fragile and could break more easily.

This disease is common in people with AS and is linked to inflammation and loss of mobility. Pain and stiffness in AS can lead to lower physical activity, which can cause osteoporosis. But sometimes, doctors can see the symptoms of osteoporosis in people who haven’t yet had any physical changes from AS.

Nonsteroidal anti-inflammatory drugs (NSAIDs) might lower the chances of bone fractures in people with AS and osteoporosis. But there is limited data on NSAIDs and fractures, so doctors are still unsure if these medications can help everyone with the two conditions.

TNF blockers, which block a substance in your body that can cause inflammation, might help people these conditions. TNF blockers may help build bone density, but whether they can help prevent fractures is unclear.

Sleep Disorders

Lots of people have problems with sleep. And a condition like AS can make that more likely. In a study about sleep and AS, half of the people within the report had sleep issues because of physical and psychological issues. Reasons for poor sleep included:

Pain. Sleep issues and pain can be so closely related that it’s sometimes hard to tell which came first. Your pain may be from lack of sleep, but your sleep problems could also be due to pain from AS. And in another study of people with AS, those with sleep problems had a lot more morning stiffness and other AS symptoms than those who slept well.

Depression and anxiety. Both of these conditions can affect sleep and the body. If you have been feeling sad or hopeless for at least 2 weeks and not enjoying things that you usually like to do, or have persistent worries for at least 6 months that cause problems in your life, you should seek help. Your doctor or a therapist can help get your mental health back on track. Having a chronic condition such as AS can be a lot to deal with. It can help to join a support group where you can talk about what you’re going through.

Foot Problems

You may have pain in your feet because of AS.

AS can cause issues in various joints and tendons around your body. These might include plantar fasciitis, a common cause of heel pain. This happens when the thick band of tissue that connects your heel bone to your toes becomes inflamed. AS can also affect your Achilles tendon, which attaches to your heel. This can cause tenderness and discomfort. It may be called “insertional” Achilles tendonitis, which refers to inflammation in the area where the Achilles tendon attaches to the heel.

Apart from the feet, people with AS often have pain in the hips, shoulders, knees, and ankles.

Costochondritis

This is chest pain that can feel as intense as a heart attack, but it’s not related to the heart. Instead, it’s caused by inflammation in the cartilage that attaches the ribs to the breast bone. Stretching, which is part of taking care of yourself when you have AS, may help. If costochondritis doesn’t go away on its own, medication may be an option.

High Blood Pressure (Hypertension)

This potential problem isn’t about AS itself, but about a type of medication. If you constantly take NSAIDs to treat your AS, you might be at a higher risk of hypertension, or high blood pressure.

One study tracked 1,282 people with AS for at least a year. When the study started, none of them had high blood pressure. The group included 129 people who used NSAIDs continuously. There is research that shows that continuous NSAID has been shown to possibly slow the progression of AS. But those people were 12% more likely to develop high blood pressure during the study, compared to those who didn’t take NSAIDs or used them only as needed.

Heart Disease

It’s not common, but doctors have found a link between AS and cardiovascular conditions, which have to do with your heart and blood vessels.

These issues happen in about 2% to 10% of people who have AS. Many of these conditions could start before you realize you have symptoms of AS. It’s not clear how AS and heart problems are related. But chronic inflammation raises the risk of heart disease so that’s likely at least part of the connection with AS.

Continued

Issues include:

Cardiomyopathy. This means your heart muscles are larger and weaker. This makes it harder for your heart to pump blood throughout your body. If you don’t treat this condition it can lead to cardiac arrest, heart failure, blood clots, or valve problems.

Conduction disturbances. These can cause your heart to beat too fast, too slow, or not pump blood well enough. It can happen because of an interruption in your heart’s electrical conduction system or because of heart disease.

Aortitis. This condition causes inflammation in your aorta, the large artery that carries blood from your heart to the rest of your body. This can cause a lack of blood to be circulated to other parts of your body as well as high blood pressure.

Aortic valve disease. This causes issues in the valve between the main pumping chamber of your heart and the main artery to your body. If this happens, your heart can’t send as much blood into the rest of your body.

Ischemic heart disease. With this condition, also called atherosclerosis, less blood will reach your heart muscle, usually because of coronary artery disease.

Inflammatory Bowel Disease

Also called IBD, inflammatory bowel disease includes Crohn’s disease and ulcerative colitis. It’s rare with AS. Only about 2% to 3% of people with inflammatory bowel disease (IBD) will get AS. AS is more common in people with Crohn’s disease than those with ulcerative colitis.

The possible link between IBD and AS isn’t clear. Both are autoimmune conditions, in which the immune system mistakenly attacks the body. If you think you may have IBD along with AS, work with a rheumatologist.

Multiple Sclerosis

Multiple sclerosis (MS) is a disease that involves your brain and spinal cord. This condition causes your immune system to attack the protective cover over your nerve fibers and cause possibly disabling issues in your brain and body.

A very small amount of people with MS also have AS. It’s hard to know if these two conditions are related, or if people who go to the doctor for one condition are simply able to find the other condition more frequently. Doctors need to do more research to figure out how MS and AS are related.

WebMD Medical Reference

Sources

SOURCES:

BGS: “Morbidity - Comorbidity and multimorbidity. What do they mean?”

Spondylitis Association of America: “The Heart in Spondylitis,” “Continuous NSAID Use in Ankylosing Spondylitis Linked to Increased Risk of Hypertension,” “Overview of Psoriatic Arthritis,” “Possible Complications: How Is a Person Affected.”

National Cancer Institute: “Cardiovascular disease.”

Mayo Clinic: “Aortic valve disease,” “Multiple sclerosis,” “Plantar fasciitis.”

National Osteoporosis Foundation: “What is Osteoporosis and What Causes It.”

Rheumatic & Musculoskeletal Diseases: “Inflammation, bone loss and fracture

risk in spondyloarthritis.”

FDA: “Information on Tumor Necrosis Factor (TNF) Blockers (marketed as Remicade, Enbrel, Humira, Cimzia, and Simponi).”

Crohn’s & Colitis Foundation: “Arthritis and Joint Pain.”

Arthritis & Research Therapy: “Sleep disturbances are associated with increased pain, disease activity, depression, and anxiety in ankylosing spondylitis: a case-control study.”

Arthritis Action: “Axial Spondyloarthritis and Ankylosing Spondylitis.”

American Orthopedic Foot & Ankle Society: “What is Insertional Achilles Tendinitis.”

UpToDate: “Patient education: Axial spondyloarthritis, including ankylosing spondylitis (Beyond the Basics).”

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