Can Ankylosing Spondylitis Cause Stomach Pain? the Connection

Does ankylosing spondylitis accompany stomach pain?

During my military service, I tested positive for a blood test and was diagnosed, but I haven't seen a specialist in this area for the past ten years.
The pain I experience is located in the center of my lower back, around the spinal area.
Whenever I have this pain, I also experience stomach pain, which can lead to vomiting, sometimes to the point of bile being expelled.
Additionally, if I have an upset stomach, the spinal pain becomes unbearable.
These two symptoms seem to occur simultaneously.
I have undergone gastroscopy and colonoscopy, both of which showed no issues.
In the past two years, I have been visiting doctors more frequently, but about 70% of them say there is no correlation between the two issues.
Currently, I am taking Celecoxib 200 mg; I take it when I have pain, and it usually alleviates the discomfort, although there are times when it is ineffective.
My peers with similar conditions mention experiencing stiffness in the morning, but I do not have that symptom.
My flare-ups seem to be triggered by significant weather changes or prolonged sitting.
I would like to ask the doctor if I truly have ankylosing spondylitis (even though I have been diagnosed), as my symptoms seem quite different.
Also, should I continue taking the medication regularly or only when I have pain? Thank you.

A Kai, 40~49 year old female. Ask Date: 2020/10/08

Dr. Zeng Guosen reply Internal Medicine

Hello, a positive HLA-B27 blood test does not necessarily indicate that you have ankylosing spondylitis.
The most important factors for diagnosis are: 1.
Do the symptoms match? 2.
Is there evidence of sacroiliitis on X-ray? Ankylosing spondylitis is not directly related to stomach pain, unless it is due to medication side effects or associated inflammatory bowel disease (IBD).
It is recommended to consult a rheumatologist.
Thank you for your question.

Reply Date: 2020/10/08

More Info

Ankylosing Spondylitis (AS) is a type of inflammatory arthritis that primarily affects the spine and can lead to severe, chronic pain and discomfort. It is part of a group of diseases known as spondyloarthritis, which can also involve other parts of the body, including the gastrointestinal tract. Your question about whether AS can cause stomach pain is quite relevant, especially considering your symptoms.

While AS primarily affects the spine and sacroiliac joints, it can also have extra-articular manifestations, including gastrointestinal symptoms. Inflammation associated with AS can lead to conditions such as inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis. These conditions can cause abdominal pain, diarrhea, and other gastrointestinal symptoms. However, it is important to note that not all individuals with AS will experience gastrointestinal issues, and the connection between AS and stomach pain is not universally accepted among all healthcare providers.

In your case, you mentioned experiencing stomach pain and vomiting, sometimes with bile, alongside your spinal pain. This could indicate a gastrointestinal issue that may or may not be directly related to your AS. The fact that you have undergone endoscopy and colonoscopy without any significant findings is reassuring, but it does not completely rule out functional gastrointestinal disorders, such as irritable bowel syndrome (IBS) or dyspepsia, which can coexist with AS.

The relationship between your spinal pain and stomach pain could also be influenced by factors such as stress, diet, and physical activity. Stress is known to exacerbate both AS and gastrointestinal symptoms. Additionally, certain foods may trigger gastrointestinal discomfort, which could lead to a cycle of pain and discomfort that affects your overall well-being.

Regarding your current treatment with Secukinumab (Cosentyx), it is an interleukin-17A inhibitor used to treat AS and can help reduce inflammation and pain. It is essential to follow your healthcare provider's recommendations regarding medication usage. If you find that your pain is not adequately controlled with your current regimen, it may be worthwhile to discuss this with your rheumatologist. They may consider adjusting your treatment plan or exploring additional therapies that could provide better symptom relief.

In terms of your symptoms of stiffness and pain, it is common for AS patients to experience morning stiffness, which may improve with movement throughout the day. However, the absence of morning stiffness does not negate your diagnosis. AS can present differently in different individuals, and symptoms can vary widely.

In conclusion, while there may be a connection between Ankylosing Spondylitis and gastrointestinal symptoms, it is crucial to approach this issue holistically. Consider discussing your symptoms with a gastroenterologist to rule out any underlying gastrointestinal conditions that may be contributing to your discomfort. Additionally, maintaining open communication with your rheumatologist about your AS symptoms and treatment efficacy is vital for managing your condition effectively.

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