Ankylosing Spondylitis Treatment in Katy, TX

Meet Dr. Syed Alam, MD, FACR

Double Board-Certified, Fellowship-Trained Rheumatologist · Musculoskeletal Ultrasound Trained · 10+ Years of Experience

Dr. Alam completed his rheumatology fellowship at Temple University Hospital after an internal medicine residency at John H. Stroger, Jr. Hospital. His clinical interests include rheumatoid arthritis, lupus, psoriatic arthritis, gout, Sjögren’s disease, osteoporosis and other rheumatic conditions.

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What is ankylosing spondylitis?

Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine and the sacroiliac joints, where the base of the spine meets the pelvis. Inflammation at these sites causes pain and stiffness, and over years the body may lay down new bone in response, which can gradually fuse segments of the spine.

It belongs to a family called axial spondyloarthritis. Some people have clear changes on X-ray, which is classical ankylosing spondylitis, while others have identical symptoms with inflammation visible only on MRI. Both are treated the same way, and both deserve the same attention.

Inflammatory versus mechanical back pain

This distinction is the single most useful thing to understand. Mechanical back pain, the common kind, is worse with activity and better with rest. Inflammatory back pain does the opposite: it is worse after sitting or lying still, wakes people in the second half of the night, comes with morning stiffness lasting over half an hour, and eases once you get moving. Inflammatory back pain beginning before the age of 45 and lasting more than three months should always prompt a rheumatology assessment.

Symptoms of ankylosing spondylitis

Back and pelvic symptoms

• Dull, aching pain in the lower back and buttocks, sometimes alternating from side to side
• Pain and stiffness that are worst in the morning or after sitting still
• Waking in the second half of the night with pain and needing to move about
• Improvement with exercise, a hot shower or activity, rather than with rest
• Gradual onset over months rather than a sudden injury
• Reduced spinal flexibility, or difficulty turning to look behind you

Symptoms beyond the spine

• Pain at the heel, where the Achilles tendon or plantar fascia attaches, called enthesitis
• Swelling in a knee, ankle or hip, usually on one side
• Swelling of a whole finger or toe
• Chest wall pain and reduced chest expansion when the rib joints are involved
• Fatigue, which is a genuine feature of the inflammation

Eye inflammation

Acute anterior uveitis occurs in a substantial minority of patients. It causes a painful, red eye with light sensitivity and blurred vision, usually on one side, and it comes on over hours to days. This needs same-day assessment by an eye specialist, because untreated uveitis can threaten sight.

Associated conditions

Psoriasis and inflammatory bowel disease occur more often in people with ankylosing spondylitis. Persistent diarrhoea, blood in the stool or unexplained weight loss should be mentioned, since they may indicate bowel involvement that changes the choice of treatment.

Photo for illustration. Images do not depict patients of this practice.

Causes and risk factors

• Genetics, principally HLA-B27, which is found in most patients. Importantly, around 8 percent of the general population carries HLA-B27 and the great majority never develop the disease, so the test alone proves nothing.
• Family history, which raises risk appreciably.
• Age, with onset typically in the late teens to thirties.
• Sex. It was long considered a male disease, but it is now recognised that women are affected nearly as often, frequently with more neck and peripheral joint involvement and less obvious X-ray change, which contributes to later diagnosis in women.

How ankylosing spondylitis is diagnosed

Diagnosis rests on recognising the inflammatory pattern and confirming it with imaging. There is no single blood test.

History and examination

Your rheumatologist will ask about the timing and character of the pain, night waking, morning stiffness and response to exercise, and about heel pain, eye inflammation, psoriasis and bowel symptoms. The examination measures spinal movement in several directions, chest expansion, sacroiliac tenderness and the tendon insertion points.

Imaging

X-rays of the sacroiliac joints are the starting point, but they only show change after damage has occurred, which can take years. MRI is far more useful early, because it shows active inflammation and bone marrow oedema before any structural change appears. A normal X-ray does not exclude the diagnosis, and this is one of the most common reasons that patients are told nothing is wrong.

Blood tests

HLA-B27 supports the diagnosis but neither confirms nor excludes it. ESR and CRP may be raised, though they are normal in many patients with active disease. Rheumatoid factor and anti-CCP are typically negative, which helps distinguish it from rheumatoid arthritis.

Ankylosing spondylitis treatment

The aims are to control inflammation, relieve pain, preserve spinal mobility and posture, and prevent long-term structural change. Treatment combines medication with a genuinely central role for exercise.

Exercise and physical therapy

Exercise is not an adjunct in ankylosing spondylitis; it is core treatment. A daily programme of spinal extension, rotation, stretching and deep breathing helps maintain posture and mobility. Swimming is particularly well suited. Working with a physical therapist who understands the condition makes a substantial difference, and consistency matters more than intensity.

Anti-inflammatory medication

Non-steroidal anti-inflammatories are first-line and are often more effective in ankylosing spondylitis than in other kinds of back pain. Taken regularly rather than only as needed, they control symptoms adequately for many patients.

Biologic and targeted therapies

When anti-inflammatories are not enough, biologic medicines that block TNF or interleukin-17 are highly effective, often producing rapid and marked improvement in pain, stiffness and fatigue. Oral JAK inhibitors are a further option. Conventional drugs such as methotrexate and sulfasalazine do not help spinal disease, though sulfasalazine can help peripheral joint involvement.

Posture and everyday care

• Sleep on a firm mattress with a thin pillow, and try lying flat on your front briefly each day
• Set up your desk to avoid prolonged forward flexion, and break up long periods of sitting
• Stop smoking, which worsens spinal progression and reduces lung capacity
• Look after bone health, since osteoporosis is more common in ankylosing spondylitis

Living with ankylosing spondylitis

Most people with ankylosing spondylitis work, exercise and live full lives. The severe spinal fusion that older textbooks describe has become far less common since effective biologic treatment became available.

• Keep the daily exercise routine going, including through good spells.
• Report a painful red eye the same day.
• Tell any physical therapist or chiropractor about the diagnosis before treatment, particularly if the spine has fused.
• Take care with the neck in car travel and contact sport, since a fused spine is more vulnerable to fracture.

Work, sleep and daily life with ankylosing spondylitis

Ankylosing spondylitis affects people during their working and family-building years, and the practical adjustments are as important to quality of life as the medication.

Managing the working day

• Break up prolonged sitting; stand and move at least every 30 to 45 minutes
• Set your screen at eye height so you are not looking downwards for hours
• Use a chair with good lumbar support, and consider a sit-stand desk
• Build a short mobility routine into the start of the day rather than the end
• Discuss flexible start times if morning stiffness is your worst period

Sleep

Night pain in the second half of the night is characteristic, and it is a marker of active inflammation rather than a poor mattress. If it persists despite regular anti-inflammatory treatment, tell your rheumatologist, because it often indicates that treatment needs escalating. A firm mattress, a thin pillow and a brief period lying flat on your front each day help maintain extension.

Exercise that suits the condition

Swimming is close to ideal because it works the whole spine without loading it. Yoga and Pilates help with extension and rotation when taught by someone who knows the diagnosis. High-impact contact sport is worth discussing individually, particularly where the spine has fused, since a fused spine is more vulnerable to fracture.

Things to mention to other clinicians

Always tell physical therapists, chiropractors, dentists and anaesthetists about the diagnosis. Neck mobility can be limited in ways that matter during dental work or intubation, and spinal manipulation may be unsafe in a fused spine.

When to see a rheumatologist about back pain

Ask for a rheumatology evaluation if back pain began before the age of 45, has lasted more than three months, is worse after rest and better with movement, wakes you in the second half of the night, or comes with morning stiffness lasting over half an hour. Heel pain, uveitis, psoriasis or a family history of spondyloarthritis strengthen the case further.

A normal X-ray is not a reason to stop looking. Early inflammation is visible only on MRI, and early treatment is what prevents long-term change.

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