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In most patients, the first symptom is dull pain, which starts slowly and gradually and is felt deep in the lower back or buttocks. This is usually accompanied by low-back morning stiffness, which lasts for a few hours and improves with activity. This stiffness may return with prolonged periods of inactivity.
Within a few months of onset, back pain becomes persistent and is generally worse at night. Some people even get up and walk around at night to alleviate it.
In some people, bony tenderness may accompany the back pain, while in others pain is the main complaint. Common sites of tenderness are the attachment of the ribs to the breastbone, along the spine, over the front of the pelvis, the top of the shins and the heels.
Arthritis of the hips and shoulders occurs at some stage in 25-35 percent of all patients. Arthritis of the peripheral joints other than the hips and shoulders is seen in 30 percent of patients and can occur at any stage of the disease.
Neck pain and stiffness are usually relatively late signs.
Some people with ankylosing spondylitis, usually those who develop the disease in their teens, may also complain of fever, fatigue, loss of appetite, weight loss or night sweats.
Ankylosing spondylitis may affect other organs too. A disorder of the eye, called acute anterior uveitis, is the most common. Attacks usually affect only one eye and can recur. The signs are pain and redness of the eye, difficulty coping with light (photophobia) and increased tearing of the eye (lacrimation).
A small number of patients develop problems with the aortic valve of the heart; this can occur early in the course of the disease.
The most specific things found on physical examination involve loss of mobility of the spine and limitation of chest expansion. Pain in the sacro-iliac joints of the pelvis may be reproduced when the doctor examines the patient either with direct pressure or with manoeuvres which stress the joints. There is often muscle spasm around the joints of the spine.
