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Early symptoms of ankylosing spondylitis usually begin in early adulthood (between age 15 and 45) and may include pain and stiffness in the lower back and hips, often after periods of inactivity or sleeping. Pain is often worse during periods of rest and improves once activity begins. Areas most commonly affected are the joints between the base of the spine and the pelvis, vertebrae in the lower back, cartilage between the breastbone and ribs, and shoulder joints.
Patients often describe a chronic dull pain that feels like it’s coming from deep within the lower back or buttocks, along with morning stiffness. The pain increases gradually over several weeks or months and is typically spread throughout the body, rather than localized in one area. The back pain in ankylosing spondylitis is inflammatory in nature, not mechanical, and unlike typical back pain, it tends to improve with exercise. Over time the pain of ankylosing spondylitis usually becomes chronic and is felt on both sides of the body. Along with stiffness, the pain may spread from the back to other areas including the ribs, shoulders, hips and thighs.
It’s possible for inflammation to occur in other parts of the body, such as the eyes, and it is not unusual for symptoms to worsen, get better or stop completely at regular intervals. People with ankylosing spondylitis may also experience fatigue and lose mobility and flexibility in their spine because the joints fuse together. Sometimes lung involvement is seen, marked by a slow progression of fibrosis in the upper lung that limits chest expansion. The most serious complication is spinal fracture.