How Does AS Affect Men?

Last updated: May 2019

While ankylosing spondylitis (AS) can develop in both men and women, there are some differences in the condition between the genders.

Incidence of AS

AS occurs more often in men than women. Earlier estimates suggested AS occurred in 3 men for every 1 woman, but more recent estimates suggest it occurs in 2-3 men for every woman with AS. In both men and women, AS typically begins in adolescents or younger adults, under the age of 45.1,2

Symptoms of AS in men

In men with AS, the spine and pelvis are the most common sites the disease shows up and where the symptoms are the most serious.1 AS most often begins in the sacroiliac joints - the joints located between the bottom of the spine (the sacrum) and the ilium of the pelvis. This can cause low back pain, which is the most common symptom experienced by people with AS. The pain may come on gradually but can become constant and severe, although some people have pain that comes and goes. Symptoms are usually worse at night or in the morning and improve with activity.3,4

Progression of AS in men

There is wide variability in progression and severity between different individuals with AS. Some people may experience rapid progression while others experience a mild or slower progression. While the disease may cause joint damage and disability, some with AS may never experience significant joint damage, and early and effective treatment may help prevent or slow joint damage. There is no single pattern of progression that applies to everyone with AS.

AS can progress from the sacroiliac joints to the joints between the vertebrae. The chronic inflammation of the ligaments that attach to the spine can lead to the development of bone in the vertebral joints. This calcification of the spinal ligaments is called syndesmophytes. As the condition develops and the spine becomes more immobilized by the formation of bone in the joints, the spine can take on the appearance of bamboo on x-rays and is referred to as "bamboo spine." The presence of bamboo spine increases the risk of fractures in the vertebrae.5

Bony fusion of the vertebrae causes pain and stiffness and can lead to a lack of flexibility in the spine. Some men with AS have difficulty rotating or twisting their spine.6 Fusion of the joints between the ribs and spine or between the ribs and the breastbone can make it difficult to fully expand the chest cavity, causing chest pain or difficulty taking deep breaths.7

Research has found that x-rays show men with AS have more erosive damage to the joints than women with AS. Men also have more advanced joint fusion, although women report higher levels of pain and functional limitations.8-10

Differences in inflammatory markers in men

Recently, researchers discovered that the inflammatory markers in the blood may differ between men and women with AS. One study found that men with AS have higher levels of inflammatory markers in their blood. These elevations were not seen in women with AS in the study.9,10

While additional research is needed to confirm these results in larger groups of people with AS and to fully understand how the difference in these inflammatory markers impact the disease activity, the identification of differences like these may lead to more tailored treatment approaches.9

Treatment of AS in men

Treatment for AS usually involves a combination of approaches, including medications, physical therapy, and exercise. Medications used to treat AS include11,12:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Pain relievers (analgesics), including acetaminophen and opioid pain medications
  • Corticosteroids (glucocorticoids), which are generally used for short-term therapy
  • Slow-acting anti-rheumatic drugs (SAARDs)
  • TNF inhibitors

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