Does Ankylosing Spondylitis Get Worse AS You Get Older?

According to the Spondylitis Association of America, most people with AS are diagnosed before age 45, yet the disease's course can last a lifetime. This raises a critical question for many: Does ankylosing spondylitis get worse AS you get older? Understanding the long-term outlook is key to maintaining a high quality of life.

Quick Summary

Ankylosing spondylitis is a progressive disease for most individuals, meaning symptoms and joint damage typically worsen over many years. However, this progression is highly variable, and many can effectively manage their condition with early intervention, consistent treatment, and key lifestyle modifications.

Key Points

• Progression is Variable: Not everyone with AS experiences severe progression with age; the disease's course differs significantly from person to person.

• Early Intervention is Crucial: Starting and adhering to a treatment plan early can be the most effective way to slow down the long-term progression of AS and preserve function.

• Physical Activity is Key: Regular exercise, particularly physical therapy, is essential for maintaining spinal flexibility and preventing stiffness as the disease and natural aging progress.

• Comorbidities are a Concern: Older AS patients have a higher risk of cardiovascular disease, osteoporosis, and other conditions, which require careful management.

• Pain Patterns Change: In very advanced stages, pain from spinal inflammation may decrease as the spine fuses, but this comes with increased stiffness and a higher risk of fractures.

• Lifestyle Matters: Modifiable factors like smoking and weight management can significantly impact disease progression and overall health outcomes.

Understanding Ankylosing Spondylitis and the Aging Process

Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and sacroiliac joints, leading to pain and stiffness. As with any chronic condition, the prospect of managing it throughout a lifetime, especially as the body undergoes natural aging, is a significant concern. While the disease itself is progressive, the rate and severity of progression are not uniform and depend on various factors beyond age alone.

The Nature of AS Progression Over Time

AS progression typically follows a pattern of flares and remissions. During flares, inflammation, pain, and stiffness increase, while remission periods see a subsidence of symptoms. However, over decades, this chronic inflammation can lead to permanent structural changes. The body's inflammatory response can cause new bone formation, eventually fusing vertebrae in the spine, a process known as ankylosis. This can result in a loss of spinal mobility and, in severe cases, a hunched posture or 'bamboo spine'. It is this long-term, cumulative damage that can be mistaken for the sole effect of aging, when in fact it's a combination of both.

Factors Influencing AS Progression in Older Adults

While age is a factor, it's not the only predictor of disease severity in older adults. Several other elements play a crucial role in how AS presents later in life:

• Genetics: Specific genetic markers, such as HLA-B27, increase susceptibility, and family history can indicate a more aggressive disease course.
• Sex: Historically, AS has been observed to progress more rapidly and severely in men than in women, though this can vary.
• Disease Activity: Higher levels of inflammation in the early stages, indicated by markers like C-reactive protein (CRP), are associated with faster radiographic progression.
• Hip Involvement: If the hips are affected early in the disease, it can signal a less favorable long-term prognosis.
• Treatment Adherence: Consistent use of medications, especially biologics, can significantly slow disease progression and prevent fusion.
• Lifestyle Choices: Factors like smoking and obesity are known to accelerate disease progression.

Managing AS Throughout the Aging Process

Effective management requires a multi-pronged approach tailored to the individual's needs, particularly as they age. A treatment plan should evolve with the patient and involve more than just medication.

Key Management Strategies

• Physical Therapy and Exercise: Regular, gentle movement is paramount to maintaining flexibility and mobility, which can counteract the stiffness associated with aging and AS. Exercises should focus on posture, range of motion, and strengthening back muscles.
• Medication: A rheumatologist can determine the best pharmacological approach, which may include NSAIDs, biologics, or JAK inhibitors to control inflammation and pain effectively.
• Posture Awareness: Practicing good posture while sitting, standing, and walking is critical for preventing spinal deformity and reducing strain.
• Addressing Comorbidities: Older adults with AS face a higher risk of comorbidities like cardiovascular disease and osteoporosis. Proactive management of these conditions is essential for overall health.
• Bone Health Monitoring: Regular bone density scans (DEXA scans) can help assess and manage the risk of osteoporosis and fractures, which is increased in advanced AS.

Comparison: AS Pain vs. Normal Age-Related Joint Pain

Feature	Ankylosing Spondylitis Pain	Normal Age-Related Osteoarthritis Pain
Onset	Gradual, often starting in early adulthood.	Gradual, but typically starts later in life.
Nature	Inflammatory, often dull but widespread.	Mechanical, localized, often sharp with movement.
Location	Sacroiliac joints, lower back, neck, chest, heels.	Weight-bearing joints like knees, hips, and hands.
Morning Stiffness	Protracted, often lasting for more than one hour.	Shorter, typically lasting less than 30 minutes.
Effect of Activity	Improves with exercise and movement ('motion is lotion').	Worsens with physical activity and improves with rest.
Systemic Symptoms	Often accompanied by fatigue, eye inflammation, and gut issues.	Primarily confined to joint symptoms.

Advanced AS and Maintaining Function

Even in advanced stages where spinal fusion has occurred, maintaining function is possible. The focus shifts from preventing fusion to managing pain and maximizing mobility in the remaining areas of the body. Physical therapy remains a cornerstone of care, helping to strengthen muscles and improve balance, which is vital for preventing falls. The psychological impact should also be addressed, as adapting to progressive physical limitations can be challenging.

Conclusion: A Proactive Approach to Aging with AS

While ankylosing spondylitis does get worse as you get older for many, it is not an inevitable fate of complete disability. The disease’s progression is influenced by a complex interplay of genetic, lifestyle, and treatment-related factors. By taking a proactive role—maintaining consistent treatment, staying active, managing comorbidities, and being vigilant about symptoms—individuals can significantly influence their long-term outcome. The goal is not just to survive but to thrive, adapting strategies to meet the changing needs of the body and living a productive, active life for as long as possible.

For more detailed information on AS treatments and living with the condition, visit the Spondylitis Association of America.

Frequently Asked Questions

At what age does ankylosing spondylitis typically get worse?

Ankylosing spondylitis is a progressive disease that generally causes worsening symptoms and joint damage over decades, but there is no specific age when it suddenly accelerates. The rate of progression varies widely based on individual factors.

Can ankylosing spondylitis ever stop progressing?

Yes, in some individuals, the disease can enter a state where progression slows significantly or even appears to stop. The reasons for this are not fully understood, but it highlights the variability of the condition.

How can I tell if my worsening pain is from AS or normal aging?

AS pain is typically inflammatory, improving with exercise and worsening with rest, and often involves prolonged morning stiffness. In contrast, normal age-related osteoarthritis pain is mechanical, worsens with activity, and has shorter morning stiffness. A rheumatologist can help distinguish the cause.

Are older adults with AS at a higher risk of other health problems?

Yes, older patients with AS are more vulnerable to health issues, particularly cardiovascular disease, due to chronic inflammation. They also have an increased risk of osteoporosis and spinal fractures, making bone health a top priority.

Is late-onset ankylosing spondylitis different from early-onset?

Late-onset AS, which is less common, can present differently than early-onset. It may involve more peripheral joint and cervical spine issues at the outset, and disease activity and progression can be distinct from those diagnosed at a younger age.

What are the most important management strategies for seniors with AS?

Key strategies for older adults with AS include consistent physical therapy, medication adherence (often including biologics), regular monitoring for comorbidities like osteoporosis, maintaining good posture, and leading a healthy lifestyle that includes a non-inflammatory diet and exercise.

Does medication effectiveness change for older patients with AS?

While medication can be highly effective at any age, treating older AS patients can be more complex due to potential side effects, interactions with other medications (polypharmacy), and co-existing health conditions. Close collaboration with a rheumatologist is vital.