Can Ankylosing Spondylitis Cause Stomach Pain? the Connection - Internal Medicine

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Ankylosing Spondylitis (AS) is a type of inflammatory arthritis that primarily affects the spine and the sacroiliac joints in the pelvis. It can lead to chronic pain and stiffness in the back and can also have systemic effects, including gastrointestinal symptoms. Your experience of stomach pain accompanying your back pain is not uncommon among individuals with AS, although the connection may not be immediately apparent to all healthcare providers.

The relationship between AS and gastrointestinal symptoms, including stomach pain, can be attributed to several factors:
1. Inflammation: AS is characterized by systemic inflammation, which can affect various organs, including the gastrointestinal tract. Inflammatory cytokines released during AS flare-ups can lead to symptoms such as abdominal pain, nausea, and even vomiting.

2. Medications: The medications used to manage AS, particularly nonsteroidal anti-inflammatory drugs (NSAIDs), can irritate the gastrointestinal lining, leading to symptoms such as gastritis or ulcers. If you are taking medications like Celebrex (celecoxib) or other NSAIDs, this could explain some of your stomach discomfort.

3. Stress and Anxiety: Chronic pain conditions can lead to increased stress and anxiety, which can exacerbate gastrointestinal symptoms. Stress can affect gut motility and lead to symptoms like nausea and abdominal pain.

4. Dietary Factors: If you have experienced episodes of gastrointestinal distress after eating, it may be worth considering whether certain foods trigger your symptoms. Some individuals with AS report that certain dietary choices can exacerbate both their joint and gastrointestinal symptoms.

5. Comorbid Conditions: Conditions such as inflammatory bowel disease (IBD) are more prevalent in individuals with AS. If you have not undergone thorough gastrointestinal evaluations, it may be beneficial to discuss this with your healthcare provider.

Regarding your current treatment with Humira (adalimumab), it is important to follow your physician's recommendations. Biologic medications like Humira can help manage inflammation and may provide relief from both joint and gastrointestinal symptoms. However, it is crucial to communicate any persistent or worsening symptoms to your healthcare provider, as they may need to adjust your treatment plan.

In terms of your symptoms, the absence of morning stiffness does not necessarily rule out AS. Symptoms can vary widely among individuals, and some may experience stiffness primarily during periods of inactivity or after prolonged sitting, as you mentioned. The variability in symptoms can sometimes lead to confusion regarding the diagnosis, especially if your symptoms do not align perfectly with typical presentations of AS.

If you find that your stomach pain is significantly impacting your quality of life, it is advisable to seek a gastroenterology consultation. They can perform further evaluations, such as imaging studies or endoscopic procedures, to rule out any underlying gastrointestinal conditions that may be contributing to your symptoms.

In summary, while AS is primarily a musculoskeletal disorder, it can indeed have gastrointestinal manifestations. Your symptoms warrant a comprehensive approach that includes both rheumatological and gastrointestinal evaluations. Open communication with your healthcare team is essential to ensure that all aspects of your health are being addressed effectively.