What Is Spondylitis? How To Recognize This Commonly Missed Back Condition

Millions of people live with back pain. For many, rest helps. But if your pain gets better with movement, the cause might not be arthritis or strain. It could be spondylitis, an inflammatory form of arthritis that affects the spine and often goes undiagnosed for years.

“The average patient with ankylosing spondylitis often waits six to eight years for a diagnosis.

That’s a long time to be in pain and not getting the help you need,” said Marcia Johnson, MD, a board-certified rheumatologist at Franciscan Health Lafayette East.

Explore what spondylitis is, how to recognize the signs and when it’s the right time to get care from a specialist.

What Is Spondylitis?

Spondylitis means inflammation of the spine. It behaves differently than regular degenerative joint disease or disc problems. It falls under a group of diseases called spondyloarthropathies, which also includes:

• Ankylosing spondylitis
• Juvenile idiopathic arthritis in younger patients
• Psoriatic arthritis affecting the spine
• Reactive arthritis after an infection, such as Salmonella or certain sexually transmitted infections (STIs)
• Spondylitis related to inflammatory bowel disease (Crohn’s or ulcerative colitis)

“Before we had better recognition and treatment, some patients developed what’s known as bamboo spine. They would be so fused they couldn’t stand up straight or look forward,” Dr. Johnson explained. “I saw a young man recently who was already partly fused and nearly wheelchair-bound. He hadn’t been diagnosed early enough.”

How Does Spondylitis Differ From Age-Related Back Pain?

Unlike common back pain caused by aging or disc problems, spondylitis involves chronic inflammation in the joints of the spine. It’s part of an autoimmune process, not a result of wear and tear.

“People often assume they’re just getting older or it’s a pulled muscle,” said Dr. Johnson. “But spondylitis pain gets better with movement, not rest, and that’s a key clue that something inflammatory is going on.”

What Are The Symptoms Of Spondylitis?

Spondylitis symptoms often start gradually and can seem like everyday aches and pains. This makes it easy to miss. “I often hear people say they’re always stiff in the morning for an hour, but they think it’s normal. If you’re 30, that kind of stiffness is not normal,” Dr. Johnson said.

Symptoms include:

• Morning stiffness lasting more than 30 minutes, sometimes for hours
• Pain that goes away with activity but worsens with rest or sleep
• Pain in the sacroiliac joints, where the spine meets the pelvis
• Discomfort during long car rides or when standing still
• Swelling in a whole finger or toe (dactylitis or “sausage digits”)
• Achilles tendon pain or plantar fasciitis
• Fatigue, low-grade fever or eye inflammation

Because symptoms show up gradually and can seem unrelated at first, many people don’t realize it’s something more than everyday back pain.

Who Is At Risk For Spondylitis?

Spondylitis often begins in younger adults. It was once considered more common in men, but research shows that it affects men and women equally, and may even appear more in women.

Risk factors include:

• Back pain beginning before age 45
• Family history of autoimmune diseases
• Psoriasis, inflammatory bowel disease or uveitis
• A positive HLA-B27 blood marker, though not all who test positive have spondylitis

“There is often a genetic component,” Dr. Johnson said. “It’s common to hear someone say, ‘Oh yes, my uncle had that.’”

How Do Doctors Diagnose Spondylitis?

Diagnosing spondylitis requires a combination of patient history, labs and imaging.

“It can be challenging because sometimes people have only some of the signs, not all,” said Dr. Johnson.

Doctors may use:

• HLA-B27 testing
• Inflammatory markers (CRP and ESR)
• X-rays of the sacroiliac joints (often normal in early stages)
• MRI scans of the lower spine to identify hidden inflammation

“In some cases, if a patient has symptoms and has tried anti-inflammatory medicines, it might make sense to try a drug like HUMIRA^®, Remicade^® or Enbrel^®," Dr. Johnson said. "These medications are generally safe and can make a big difference when people are struggling.”

When Should You See A Specialist?

If you’ve had persistent back pain for months, especially if you’re under 45 and the pain improves with activity, it’s time to talk with your provider. Your primary care doctor can order labs and imaging and refer you to a rheumatologist.

“I’ve seen patients who didn’t have the HLA-B27 marker or elevated inflammatory markers, and only had some minor imaging changes, and we still moved forward with treatment because their symptoms told the full story,” Dr. Johnson said.

You don’t need to meet every textbook definition to get help.

Explore Your Options

There is real hope for patients with spondylitis.

“You can improve someone’s quality of life,” said Dr. Johnson. “These medicines may even stop joint or spine damage. We can do so much more for people than we could in the past.”

Treatment can dramatically change the outlook for someone who’s lived with pain and uncertainty for years.

If you or someone you love experiences the signs of spondylitis, learn more about current treatment options and request an appointment or call (877) 285-6180 to connect with a rheumatologist at Franciscan Health.