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Complications and Comorbidities

Reviewed by: HU Medical Review Board | Last reviewed: January 2023

Having axial spondyloarthritis (axSpA) increases your risk of certain other health conditions. When you have more than one condition at the same time, doctors call them comorbidities.1

In some cases, people with axSpA develop problems that stem from a condition or its treatment called complications. These are different from axSpA symptoms and should be discussed with your doctor right away.2

While not everyone with axSpA has comorbidities or complications, many do. People with axSpA should visit their doctor on a regular basis. Finding these issues early and treating them effectively can reduce the risk of permanent damage.3

Comorbidities with axial spondyloarthritis

People living with axSpA can have a wide range of comorbidities. But some are more common than others.

Eye inflammation (uveitis)

Up to 1 in 3 people with axSpA will experience uveitis. Uveitis is inflammation that occurs in the middle layer of the eye. Symptoms of uveitis include:3,4

  • Redness
  • Pain
  • Sensitivity to light
  • Blurry vision
  • Excessive tears

Without treatment, uveitis can cause loss of vision.3

Heart problems

The inflammation caused by axSpA usually affects the joints, especially the joints in the spine. But long-term inflammation from the condition can occur throughout the body.5

Chronic inflammation can be harmful to your organs, including the heart. It can cause blockages or damage to your heart. Long-term inflammation can also disrupt the heart's electrical system, causing changes in its rhythm.5


Osteoporosis is a condition in which the bones become weak and brittle. This puts them at increased risk of fracture. People with axSpA are more likely to have osteoporosis than people who do not have axSpA. Doctors believe inflammation and physical inactivity are what make osteoporosis more common in those with axSpA.6

Inflammatory bowel disease

People with axSpA are more likely to get inflammatory bowel disease (IBD) than those without it. IBD includes ulcerative colitis and Crohn's disease. These conditions can cause digestive tract damage, which could require surgery. Symptoms of IBD include:3,7

  • Abdominal pain
  • Persistent diarrhea or constipation
  • Blood in the stool
  • Unexpected weight loss
  • Reduced appetite
  • Fatigue


Fibromyalgia is a problem with the nervous system that causes pain all over the body. People with axSpA are more likely to get fibromyalgia than the general population. This comorbidity can make their symptoms worse and cause their axSpA to get worse over time.3,8,9


Experts estimate that almost 1 in 10 people with AS also have psoriasis. Plaque psoriasis is a chronic condition that causes raised, red, scaly patches on the skin. The plaques may be itchy and painful. They may crack and bleed. Psoriasis is not infectious and may go through periods of flares and remission.10


Some past studies have shown a possible link between ankylosing spondylitis (AS), a type of axSpA, and certain cancers. New studies have not proven this link. Talk to your doctor about your personal risk.11

Complications of axial spondyloarthritis

Along with comorbidities, certain complications also occur in people with axSpA. Some are rare but can become more common as the disease progresses.

Limited mobility

Long-term inflammation in your joints, tendons, and ligaments damages the joints and can decrease your ability to move freely. In people with axSpA, decreased mobility most often occurs in the spine or hips.3

The inflammation from axSpA wears away at the bones of the joints. Your body reacts by making new bone to replace what was worn away. But your body could make too much bone, causing bones to grow together or fuse with other bones. This decreases your spine and hips' abilities to bend and flex.3

Also, inflammation over time hardens the tendons and ligaments. This adds to problems with mobility.3

Spinal fracture, kyphosis, or stenosis

Because axSpA most often affects the spine, it can lead to complications like:9

  • Spinal fractures – Cracks or breaks in the vertebrae (spinal bones)
  • Kyphosis – An outward curvature of the spine which causes a hunched or rounded back
  • Stenosis – A narrowing of the spinal column that can cause pain or nerve damage

Lung problems

AxSpA can make it hard to breathe in a few ways. It can affect the joints in the chest directly. Or the lungs can be impacted by inflammation throughout the body.5

Lung complications from axSpA may include:5,12

  • Fibrosis or interstitial lung disease – A scarring of the connective tissue between the air sacs in the lung that causes shortness of breath
  • Sleep apnea – A potentially serious condition in which breathing stops and starts during sleep
  • Restriction of the chest wall due to fused joints in the ribcage
  • Spontaneous pneumothorax – A collapse of the lung that causes pain and shortness of breath, and that can be life-threatening
  • Lung infections such as pneumonia

Hearing loss

Hearing loss is common among people with AS. There are 2 types of hearing loss, conductive and sensorineural. Some people have a combination of the 2 called mixed hearing loss.13,14

Conductive hearing loss happens when sound waves cannot move freely through the ear canal to the eardrum. This hearing loss usually results from a blockage in the ear canal, a hole in the eardrum, or problems with the three tiny bones (ossicles) in your middle ear.13,14

Nerve problems in the inner ear cause sensorineural hearing loss. While people with AS can have either or both types, conductive hearing loss is more common.13,14

Mouth and jaw problems

The temporomandibular joint (TMJ) is the hinge joint that connects your jaw to your skull. You have one TMJ on each side of your head, in front of your ears. The TMJs are among the most frequently used joints in your body. You use them every time you talk, chew, or yawn. These joints can be affected by axSpA, causing the jaw to be stiff and painful.15

Also, people with axSpA have a higher chance of gum disease. If you have axSpA, take good care of your teeth and see your dentist often.15

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