Do you often feel pain in your back or hips? When you wake up in the morning, do you feel stiff and unable to move? Often, when a young woman talks about something like this, some people think it's just normal fatigue or stress. But this could be the beginning of a deeper story. Today we're talking about a condition that many people think only affects men, but it can affect women just as much. That's Ankylosing Spondylitis (AS).
What are the differences when this disease affects women?
Simply put, ankylosing spondylitis (AS) is a type of arthritis that causes inflammation, or swelling, of the spine and its associated joints. It belongs to a larger group of diseases called spondyloarthritis. It was once thought to be a "men's disease." But research has now found that it affects women just as much as men. However, there are big differences in the way the symptoms appear, the time it takes to diagnose the disease, and the treatments. Let's take a look at what those are.
1. Delay in diagnosing the disease
This is one of the biggest challenges women face. Just imagine, if it takes a man about 6 ½ years from the onset of these symptoms to find out exactly what the disease is, studies have found that it can take a woman about 9 years .
This is not due to a difference in symptoms or age. Often, it is due to a bias in the way some doctors view women's pain. They may ignore your pain, or they may attribute it to stress.
2. Risk of misdiagnosis
It can be difficult to diagnose the condition, and sometimes the wrong condition can be treated. Axial spondyloarthritis (axSpA) is a type of AS. Research has found that up to a quarter (25%) of women with the condition are initially misdiagnosed.
Because women with AS often experience widespread pain throughout their body, doctors may mistake it for a condition called fibromyalgia . Let's take a look at the similarities and differences between the two conditions.
| Characteristic | In ankylosing spondylitis (AS) | In Fibromyalgia |
|---|---|---|
| Major pain | Pain caused by inflammation in the back, hips, and joints. | Pain that spreads throughout the body. No specific inflammation is visible on X-rays. |
| Morning stiffness | Most of the time it lasts more than half an hour. It decreases with exercise. | Although it exists, exercise may not make a big difference. |
| Medical tests | X-rays, MRIs, and blood tests (ESR, CRP) show joint damage and inflammation. | X-rays and MRIs do not show specific damage. Diagnosis is based on symptoms. |
3. The level of damage seen on X-ray examinations
Typically, when looking at an X-ray, men's spinal joints (joint erosion) are more visible than women's. Because of this, there is a belief that the disease progresses more quickly in men.
But that's not the truth. Even though the damage from X-rays is less, the pain, difficulty performing daily activities, and disease activity experienced by women are the same as men, and sometimes even greater.
Symptoms, treatment, and quality of life changes
In addition to joint pain, AS can also cause other symptoms. These differ between women and men, as follows.
- Enthesitis: This is a bit of a medical term. Simply put, it refers to inflammation where our tendons and ligaments connect to bones. This condition is more common in women and is more painful . It can cause severe pain in places like the heels and elbows.
- Eye infections: Acute Anterior Uveitis is a condition that causes red eyes, severe pain, and blurred vision. Some studies suggest that it is more common in women, while others suggest that it is more common in men. So there is still no consensus on this.
- Comorbidities: Women may also be more likely to suffer from other comorbidities that accompany AS. For example, inflammatory bowel disease (IBD) and the skin condition psoriasis are more common in women with AS.
- Response to treatment: This is a very important point. Research shows that treatments for AS do not work as well in women as they do in men. The exact reason for this is not known, but it is thought that women are more likely to have conditions like enthesitis and are more likely to be diagnosed late. This makes women more likely to stop treatment if they do not get the results they want.
- Quality of life: Taken together, many studies have shown that women with AS have a lower overall quality of life than men. This is mainly due to persistent pain, fatigue, and difficulty fulfilling work and family responsibilities.
The most important thing is to recognize that your pain is real. Don't dismiss it as "just a backache that girls always have." Listen to what your body is telling you.
Take-Home Message
- Ankylosing spondylitis (AS) is not a disease that only affects men. It affects women equally.
- If you have back pain, hip pain, or morning stiffness that has been going on for months, especially at a young age, don't ignore it. See a qualified doctor immediately.
- Because women can be late to receive a diagnosis, you need to be your own voice. Keep a journal of your symptoms (when the pain starts, how intense it is, how it comes and goes). It will be a great help to your doctor.
- Treatments don't work the same for everyone. If you're not feeling better with the treatments you've been prescribed or are having side effects, talk to your doctor about it. Discuss other treatments.
- You don't have to go through this journey alone. Talk to your family and friends about this. Don't hesitate to get psychological support if you need it.
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