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Ophthalmic (Eye) Involvement

The eye is the most common organ affected by ankylosing spondylitis. Approximately 40% of patients with AS develop a condition called anterior uveitis (inflammation of the eye affecting a structure of the eye called the uvea). Symptoms include:

• Blurred vision usually in one eye
• Sharp pain in the eye
• Bloodshot eye
• Increased lacrimation (tear production)
• Photophobia (fear and avoidance of light)

It is important for patients who develop symptoms of anterior uveitis to seek medical attention promptly in order to avoid permanent damage to the eye.

Inflammatory Bowel Disease

Up to 60% of patients with ankylosing spondylitis are reported to have asymptomatic inflammatory bowel disease. Approximately 20% of patients with inflammatory bowel disease, (Crohn's disease and ulcerative colitis) also experience spinal inflammation which highlights the close association between the IBD and AS. Symptoms of inflammatory bowel disease include abdominal pain, cramping, fatigue, and diarrhea.

Cardiac (Heart) Involvement

Cardiac complications of ankylosing spondylitis are rare and occur in less than 2% of patients. With disease progression and in advanced cases, however, some patients with ankylosing spondylitis may develop:

• Aortitis (inflammation of the aorta) that can lead to a condition called aortic insufficiency characterized by abnormal function of the aortic heart valves
• Angina pectoris - chest pain due to coronary heart disease
• Pericarditis - inflammation of the pericardial membranes surrounding the heart
• Arrhythmias - electrical conduction heart abnormalities

Pulmonary (Lung) Involvement

Development of pulmonary complications in patients with ankylosing spondylitis is also rare. Some patients with ankylosing spondylitis may develop pulmonary fibrosis (chronic inflammation of the lungs associated with progressive fibrosis or scarring of lung tissue) which is detected on X-ray. Some health care providers recommend that patients with ankylosing spondylitis should have an x-ray every five years to check for presence of lung fibrosis.

Ankylosing spondylitis can also affect the joints and muscles of the ribs and may result in painful deep breathing, sneezing, coughing, or yawning. Costochondritis - chronic inflammation of the cartilage around the sternum (breast bone) can lead to reduced chest expansion and difficulty breathing. Poor chest wall movement results in reduced lung capacity and, as a result, the lungs are not fully ventilated (filled and emptied to capacity) during inhalation and exhalation due to the pain involved in breathing.

Some patients with ankylosing spondylitis who develop limited chest expansion find that it takes them longer to recover from colds or other upper respiratory infections. Cessation of smoking is vitally important for patients with AS who smoke.

Renal (Kidney) Involvement

In rare cases, chronic inflammation associated with AS may produce renal amyloidosis (deposits of amyloid proteins in the kidney glomeruli) which may cause albuminuria (presence of albumin protein in the urine) with subsequent deterioration of kidney function. Amyloidosis may also occur with long-term use of non-steroidal anti-inflammatory drugs (NSAIDs).

Osteoporosis

Osteoporosis (reduced bone mineral density) is considered a common complication in patients with ankylosing spondylitis and occurs in up to 62% of patients. The occurrence of osteoporosis increases with increasing patient age and disease duration. In AS patients, osteoporosis is usually limited to the spine while peripheral bones remain unaffected. Affected patients are at greater risk for developing spinal fractures.

Neurologic Involvement