Previously referred to as Marie-Strumpells spondylitis, poker back, and rheumatoid spondylitis, ankylosing spondylitis (AS) is a term that few people will have heard of unless they've been diagnosed with the condition. Generally, it's thought of as a type of arthritis that affects the joints of the spine.
There are many ways to define ankylosing spondylitis. AS is an autoimmune disorder, an inflammatory arthritic disorder, a rheumatic disease, and one of the various spondylarthropathies.
Ankylosing spondylitis is an inflammatory condition that can affect various areas of the body (such as the heart, the eyes, the lungs, and kidneys), but it mainly attacks the joints of the spine and the joints between the pelvis and the spine, called the sacroiliac (SI) joints. Over time, the inflammation brought on by AS can lead not only to chronic pain and stiffness in affected areas, but can also result in "ankylosis" (new bone formation), which can cause the fusion or fixation of joints.
Individuals with ankylosing spondylitis may suffer from stiffening of the spine and reduced mobility that impairs their ability to engage in normal daily activities. They may also suffer damage to non-vertebral joints such as the hips, knees, ankles, and even shoulders. If the damage is severe enough, arthroplasty, or total joint replacement, may be advised. AS is a condition for which there is no cure, that, left undiagnosed and untreated, can cause severe physical impairments.
As much as 1% of the U.S. population may be affected by this condition, but ankylosing spondylitis is more commonly diagnosed in men than in women. Ankylosing spondylitis also tends to be a younger person's illness, as onset for AS after the age of forty is somewhat uncommon (ankylosing spondylitis is generally diagnosed between the middle teen years and the early thirties).
Ankylosing spondylitis also seems to run in families, as the probability of diagnosis increases when relatives also have the disease. With regard to genetic predisposition, the majority of individuals with ankylosing spondylitis carry the HLA-B27 gene. However, the gene itself may only predispose an individual toward developing ankylosing spondylitis.
Ankylosing spondylitis can cause significant damage to joints and internal organs, and the pain and limitation in mobility can make work difficult. However, if diagnosed early and if properly treated with medications, most people can minimize the damage that results from inflammation brought on by this disorder.
If your AS makes it impossible or painful for you to work, you can apply for disability benefits through Social Security. First, we'll look at advanced cases where claimants have limited spinal motion or fixation of the spine at a flexed or stooped position. Next, we'll look at cases where claimants' symptoms may have been lessened with medications, but where claimants nonetheless have difficulty working.
The Social Security Administration (SSA) recognizes ankylosing spondylitis as a potentially disabling illness, under the ankylosing spondylitis section of its inflammatory arthritis listing (along with other spondyloarthropathies). But the agency grants benefits only to those whose spinal fusion or flexion means that their ability to see in front of them, above them, and/or to the side is limited, and thus their ability to walk is affected. Specifically, Social Security states that you must have one of the following symptoms of AS, as shown by medical imaging and physical examination:
If your AS is not severe enough to fulfill one of the above requirements, you might still be able to get disability benefits if it limits your functioning so much that there are many work activities you can't do.
To assess your capabilities and limitations, the SSA will prepare a "residual functional capacity" assessment (RFC) for you. An RFC is a detailed report that discusses the level of physical exertion you are capable of (heavy, medium, light, or sedentary) and how your AS affects your ability to do certain work-related activities, such as standing, walking, bending, stooping, reaching overhead, and sitting.
Your rheumatologist or other treating doctor should be able to write up a list of your limitations to submit to Social Security, including the physical evidence from a physical exam or medical imaging (such as an x-ray or MRI) that supports the limitations. Among other things, your doctor should measure the degree to which you are able to bend forward and the ability to which you can perform movements of flexion, extension, lateral bending, and spinal rotation. In addition, if your breathing is affected, your doctor should submit chest expansion measurements. You should also submit a positive blood test for the gene HLA-B27 if you have it.
Any limitations or restrictions you have can rule out certain types of jobs, making it more likely that you will be approved for disability benefits. For example, an inability to stand or walk for more than two hours in combination with an inability to bend, crouch, or reach overhead would mean that there are very few jobs you can do. For more information on how Social Security assesses your limitations, see our articles on how Social Security uses your RFC to decide if you should be able to work.
If you're applying for Social Security disability insurance (SSDI), you can file your entire claim online on Social Security's website. (For SSDI, you must have enough work credits to qualify.) If you're not comfortable filling out forms online, you can call Social Security at 800-772-1213 to start your claim.
If you don't have enough work credits, and you have low income, you can apply for SSI. Most individuals filing for SSI only cannot file the whole application online, but they can get started on Social Security's website. For more information, see our article on applying for Social Security disability benefits.
April 16, 2021