Why Ankylosing Spondylitis Is Often Misdiagnosed in Women

Ankylosing spondylitis (AS) is a kind of arthritis that affects the spine and other joints and organs. It is a chronic inflammatory illness that causes the vertebrae (spinal bones) to fuse together, resulting in spine stiffness and limited mobility.

Genetic and environmental factors induce ankylosing spondylitis. The illness runs in families and is more frequent in males than in women. It may occur at any age but usually in late adolescence or early adulthood.

How do Females Often Show Symptoms?

Arthritis includes ankylosing spondylitis (AS). Pain and limited mobility are common symptoms of AS, a chronic inflammatory illness primarily affecting the spine and joints.

Diseases may exhibit cyclical patterns, with acute episodes of symptoms followed by periods of remission.

There is a wide range of AS symptoms and severity from woman to woman.

In women, the most typical AS symptoms are −

  • Suffering from back, hip, and neck discomfort

  • Muscle tightness after sleeping

  • Joint discomfort in the legs

  • Anemia

  • Fatigue

  • Diseases that affect the whole body, such as psoriasis and inflammatory bowel illness

However, not everyone with AS will have severe problems like spinal fusion if their condition is not detected and treated promptly.

What Percentage of People Experience This?

Rare cases of AS do occur. In the United States, inflammatory illness affects around 0.2% of the population. Research shows, however, that AS may be more prevalent than previously thought since it is still commonly under-diagnosed.

It has been estimated that 3 million persons, or around 1 percent of the population, fall into this category. This puts AS on par with rheumatoid arthritis, another inflammatory illness.

For decades, medical professionals assumed that males were at a far higher risk for developing AS, but this perception has shifted drastically as science has progressed. Men used to have a 10-to-1 advantage, but that gap has narrowed thanks to recent discoveries.

Additionally, women are more likely to get a delayed or inaccurate diagnosis. That's why scientists are skeptical that we know the frequency among women.

In What Time Frame Can a Diagnosis Be Made?

In contrast to males, women tend to wait longer for an AS diagnosis. Research conducted in 2017 found that the average time between diagnosis and treatment was 8.8 years for women and 6.5 years for males.

This lag for women is due to several interrelated causes. First, the method used to diagnose might cause delays for female patients.

The diagnosis of AS is often made by a rheumatologist. Since there is currently no definitive test for AS, a combination of methods may be required.

  • Health records, both personal and familial

  • Analysis of signs and symptoms

  • Check-up on the Body

  • Radiological Exams

  • Examination of the blood

X-rays and other imaging procedures help diagnose AS. That's because the condition might harm the sacroiliac joint (the one that links the hips to the sacrum). X-rays may reveal the damage.

However, some persons with the illness may not display any outward symptoms. Non-radiographic axial spondylarthritis (nr-AxSpA) is the medical term for this AS.

Women are more likely to be affected than males, and as MRI may need to be used for more sensitive imaging, diagnosis may be delayed.

Assumptions that AS is more common in men may also slow the diagnostic process for females.

In addition, males have been significantly overrepresented in research. This is being looked at in recent research. But there has to be a lot more study done to learn about distinctions between the sexes.

In What Ways Does AS Provide Difficulties?

Inflammation of the ligaments and tendons that connect to the spinal vertebral bodies causes AS. When left untreated, this swelling might lead to chronic back pain.

At first, you may have widespread back discomfort or stiffness that is most noticeable upon rising or after prolonged periods of sitting. After a hot shower or some little activity, you may feel a slight improvement.

The discomfort from AS may worsen to the point that it limits a person's ability to move. The neck, shoulders, elbows, knees, and ankles are some possible sites of discomfort.

While some individuals only have mild, occasional back pain, others deal with chronic, debilitating pain and stiffness affecting several joints and muscles.

As a result, women carry a more illness burden than males do.

Is AS More Prevalent Among Women?

No evidence indicates that females are at a higher risk of developing AS than males.

Underdiagnosis, however, may delay women from getting the answers and therapies they need for AS, which may be more common in women than previously assumed.

Women often have a more advanced illness when their symptoms are recognized and the inflammatory disease is diagnosed (more than 2 years after males are typically diagnosed).

This delays the initiation of therapy, further compromising their condition.

Does Age Have a Role?

The disease's severity is independent of age. However, old age itself is a risk factor.

Many people associate arthritis with becoming older. However, AS often affects young adults between 17 and 45. Some individuals get their diagnosis in their teenage years.

Men and women experience the onset at similar ages. As a result of this misperception and potential diagnostic delays, AS may be identified later in women.

Could There be a Genetic Component?

A person's risk of contracting the illness rises if they have a family history. The HLA-B27 gene is common among those who suffer from AS. However, even if you have this gene, you may never experience AS symptoms.

HLA-B27 and the risk of having AS have been shown to have different prevalence rates in persons of different ethnicities.

Roughly ninety-five percent of white patients with AS also carry the gene.

The syndrome and the gene are present in roughly 80% of persons from Mediterranean nations but only about 50% of those with AS of African American heritage.

The chance of having AS is also higher in persons diagnosed with Crohn's disease, ulcerative colitis, or psoriasis.

Is There Any Risk to Fertility Due to AS?

Although it does not seem to affect fertility, women's reproductive years are when AS often strikes.

If a woman with AS is pregnant or attempting to conceive, she and her doctor should work together to determine the best treatment options and keep inflammation under control.

Pregnancy-related symptoms, including back discomfort and a stiff spine, often persist after delivery.

Although NSAIDs like ibuprofen (Advil) may help alleviate the discomfort of AS, they pose a risk to the unborn child.

Breast milk might also pass on other drugs to your kid.


AS is unusual. Only 1% of Americans suffer from chronic inflammatory illness. Newer evidence shows it may be underdiagnosed, particularly in women.

We now know that it affects more women than previously anticipated.

Women's illness burden is higher since they're diagnosed later. Women may have more significant symptoms and start therapy later. Those elements might pose significant difficulties.

See your primary care doctor immediately if you have AS symptoms such as chronic back or neck discomfort. If it's inflammatory, a rheumatologist will examine you.

Even if your symptoms are minor, consult your rheumatologist annually after diagnosis.

AS is incurable. Early identification and therapy may reduce pain and slow disease development in men and women.

Updated on: 28-Apr-2023


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