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Back pain that wakes at night and improves with movement — that reversal is what matters.
Also known as: ankylosing spondylitis · axial spondyloarthritis · AS
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Ankylosing spondylitis is an inflammatory disease of the spine and the sacroiliac joints. Its back pain looks different from the ordinary kind: it usually begins before the age of forty, creeps in over months, sits low in the back, wakes the person in the second half of the night and comes with a morning stiffness that lasts half an hour or longer. And then comes the reversal: movement makes it better, rest makes it worse. Exactly this reversal is the most important sign — and the reason years often pass before the diagnosis, because someone who does not recover while lying down does not fit the familiar picture of a strained muscle. Complaints outside the back belong to it too: a painful heel at the tendon insertion, a whole swollen toe or finger, an inflammation of the bowel, psoriasis — and above all the suddenly red, light-sensitive, painful eye, for which one belongs at the eye doctor the same day. The inherited marker HLA-B27 is often found but proves nothing, since many healthy people carry it. The most important long-term treatment is daily movement.
Here this is not an extra but the main treatment: daily stretching, breathing exercises for the chest and strengthening of the back. Learn it with guidance and then carry on alone.
An inflammation inside the eye can permanently affect sight if treated too late. Anyone who knows the diagnosis should say on the phone that they have spondyloarthritis — that changes the urgency.
A warm shower or a heat cushion before the exercises makes the first half hour bearable. It is no treatment of the inflammation, but it gets the day going.
Smoking is linked in this illness with a worse course and more stiffening — and the mobility of the chest is already limited anyway.
Inflammation and reduced mobility weaken the bone while the spine becomes stiffer. Together these raise the risk of spinal fractures even after small falls.
Anyone under forty with back pain for more than three months, woken at night and better with movement, should ask about it. These four points together are the reason to look further.
Anyone who has ever lived in the tropics or subtropics can carry a threadworm unnoticed for decades. Under cortisone or a treatment with antibodies it can multiply massively. So this question belongs before the treatment starts — checked with antibodies in the blood and the eosinophils.
A threadworm can stay silent in the gut for decades and, under cortisone, biologicals or other immune suppression, flood lung and bloodstream. Anyone who ever went barefoot in the tropics or subtropics is looked for beforehand with a blood test — one effort, and it prevents the worst course this worm has.
Anti-inflammatory painkillers are not purely symptomatic here: taken regularly they slow the bony stiffening in some people. TNF and IL-17 blockers act far more strongly on the inflammation. What none of them replaces is the daily mobility exercise — mobility once lost does not come back.
About five in a thousand people are affected; men and women similarly often, though it is recognised later in women. Five to seven years pass on average before the diagnosis, because back pain in a young person rarely brings it to mind. The decisive clue is the rhythm: worse at rest, better with movement.
With ordinary back pain it is the other way round. Someone who becomes clearly more mobile after getting up and taking a few steps, and stiffens up when sitting long, is describing exactly this picture.
Waking at three or four in the morning because of the pain, having to get up and walk about, and then feeling better. In the consultation this detail is worth more than any laboratory value.
Inflammation at tendon insertions, at the heel, at the sitting bone or on the chest wall belongs to the picture. Stubborn heel pain in someone under forty is a clue in its own right.
Not just one joint but the whole finger like a sausage. That is a very specific sign for this group of illnesses and belongs shown, even once it has settled — then with a photo.
One eye, deep red around the iris, painful and shy of light, with blurred vision — that is not conjunctivitis. It belongs at the eye doctor the same day.
Often positive, but no proof: many carriers stay healthy all their lives. The value weights the suspicion, it does not make the diagnosis — the symptoms and the imaging do that.
Can be raised, but in a good share of those affected it is not. A normal value therefore does not rule the illness out.
Like the CRP a measure of inflammation in the body, slower and longer-lasting. The two together show the course better than either alone.
Important, because the inflammation and the reduced mobility weaken the bone. A good status is part of the protection against spinal fractures.
Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.
The night-time back pain that wakes in the second half of the night and eases on getting up follows the same rhythm as the body’s own cortisol. Exactly that pattern separates inflammatory back pain from mechanical.
The condition mostly begins between twenty and forty and affects men more often and often more severely. Why is open — the link is described, not explained.
May ease symptoms; not a substitute for treatment.
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