Degenerative disc disease and ankylosing spondylitis can both cause serious pain in the spine. Because the pain shows up in the same place, people often assume they’re the same thing.
They are very different conditions, with different causes, different symptoms and different treatments. Here’s what you should know, from the rheumatology and regenerative medicine team at Chicago Arthritis and Regenerative Medicine.
What Is Degenerative Disc Disease?
Degenerative disc disease (DDD) is wear-and-tear arthritis of the spine. At its core, it is a problem of instability.
How Degenerative Disc Disease Develops
DDD usually starts in one of two ways:
- An over-stressed joint in the spine
- An injury or significant trauma
Over time, the ligaments that support the spine become chronically strained and weakened. Weak ligaments let the spine become unstable. That instability then puts extra stress on:
- The facet joints
- The vertebral bodies (the bones of the spine)
- The nerves
That stress leads to the pain and changes typical of degenerative disc disease.
Symptoms of Degenerative Disc Disease
The classic pattern is:
- Pain that is worse with activity
- Pain that is better with rest
What Is Ankylosing Spondylitis?
Ankylosing spondylitis (AS) is an autoimmune condition. Your immune system normally protects you from bacteria and viruses. In AS, it attacks your own joints, especially the spine.
Symptoms of Ankylosing Spondylitis
AS causes what doctors call inflammatory back pain. The classic pattern is:
- Pain that is worst first thing in the morning
- Profound morning stiffness
- Pain that improves as the day goes on
- Pain that gets better with activity
DDD vs. AS at a Glance
| Degenerative Disc Disease | Ankylosing Spondylitis | |
|---|---|---|
| Type of condition | Wear-and-tear arthritis | Autoimmune inflammatory arthritis |
| Root problem | Spinal instability | Immune system attacking the spine |
| Activity | Makes pain worse | Makes pain better |
| Rest | Makes pain better | Morning pain and stiffness are worst |
How a Rheumatology Specialist Tells Them Apart
A Chicago rheumatologist separates these two conditions using two main tools.
1. Your Symptoms
Whether your pain is worse with activity or worse in the morning and better with movement is one of the most important clues.
2. Imaging
Imaging gives more clues:
- Ankylosing spondylitis shows classic inflammatory findings in the sacroiliac (SI) joints, where the spine meets the pelvis.
- Degenerative disc disease shows classic wear-and-tear arthritis findings in the spine.
Treatment Is Very Different
Treating Ankylosing Spondylitis
AS is treated with disease-modifying medications that control the immune system. The goals are to:
- Prevent inflammation in the spine
- Prevent the disease from progressing
- Reduce pain
- Keep the condition under control
This is why the right autoimmune disease treatment from a rheumatologist matters.
Treating Degenerative Disc Disease
DDD is a condition of instability, so treatment focuses on making the spine more stable. That starts with:
- The right strengthening exercises
- Losing weight
- Maintaining overall metabolic health
If those steps aren’t enough, regenerative medicine can help. Orthobiologic treatments include:
- Prolotherapy
- PRP therapy (platelet-rich plasma)
These treatments aim to:
- Strengthen weakened ligaments
- Reduce inflammation
- Improve instability in the spine
- Improve pain and function
What If You Have Both?
In real life, the two conditions can overlap. A person with ankylosing spondylitis can also have degenerative disc disease.
When that happens, both conditions need treatment at the same time, and each is treated in its own way. Treating only one can leave you with pain that doesn’t improve.
Questions to Ask Your Doctor
- Is my back pain inflammatory, mechanical, or both?
- What did my imaging show in my SI joints and spine?
- If I have both conditions, how is each one being treated?
Conclusion
Degenerative disc disease comes from spinal instability and wear and tear. Ankylosing spondylitis comes from the immune system attacking the spine. They need different treatments, and some patients need care for both.
An experienced rheumatologist should be able to tell these conditions apart and make sure each one is treated properly. With the right diagnosis and plan, you can feel better, function well and keep your quality of life.
If you’re looking for arthritis treatment in Chicago, joint pain relief or regenerative medicine in Chicago, our team can help.
Learn more or schedule a consultation at ChicagoArthritis.com.
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