Ankylosing Spondylitis is a chronic inflammatory disease that affects the spine and other joints, and is often perceived as a condition that predominantly affects men. However, the reality is that women are also significantly impacted, and their symptoms frequently go unrecognised or misdiagnosed. This delay in diagnosis can have far-reaching consequences, affecting not only the progression of the disease but also the overall quality of life for those affected. In this article, we'll explore why Ankylosing Spondylitis often gets missed in women and the impact of delayed diagnosis withDrArunangshu Mukherjee, Consultant, Orthopedics, Joint replacement, Arthroscopic & Shoulder Surgeon, Kokilaben Dhirubhai Ambani Hospital, Indore.
Why Ankylosing Spondylitis Often Gets Missed in Women and the Cost of Delayed Diagnosis
For many women, chronic back pain is part of daily life—brushed off as poor posture, stress, or “just aging.” But for some, it’s a warning sign of something more serious: Ankylosing Spondylitis (AS), a form of inflammatory arthritis that primarily affects the spine. And yet, women are often misdiagnosed or diagnosed late, leading to years of unnecessary suffering.
The truth is, AS doesn’t look the same in women as it does in men. In men, it often presents as classic lower back stiffness, particularly in the morning. In women, the symptoms can be more diffuse—neck pain, hip discomfort, fatigue, or even pain that seems unrelated to the spine. As a result, doctors may initially misdiagnose it as fibromyalgia, depression, or even anxiety.
One of my patients, Ritu, a 34-year-old teacher, spent nearly six years going from doctor to doctor. She was told her pain was due to a sedentary lifestyle or stress. Some said it was all in her head. When we finally diagnosed her with AS through imaging and blood tests, it was a bittersweet moment—relief from the not knowing, but anger at the years lost.
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A delayed diagnosis is not only frustrating, it can be dangerous. The unfortunate reality is the longer AS goes undiagnosed, the worse it can become, leading to spinal fusion, loss of mobility, and/or damage to the heart and eyes. If caught early enough and having physiotherapy, medications, or lifestyle modifications, the patient can significantly slow the disease progression.
So why is there a gap?
- Gender bias still exists in the medical profession. Textbooks often refer to autoimmune diseases as "default male."
- Symptoms can manifest differently by sex, and medical education does not always provide an explanation for these nuances.
- Women can underestimate their own pain, particularly when they have been told repeatedly it is "not too serious."
There needs to be awareness, from not only the medical community, but also family, workplaces, and communities. If you are a woman suffering from chronic back pain, fatigue, or stiffness that does not improve with rest, then you need to listen to your gut. You can advocate for yourself. You can ask someone if it could be inflammatory arthritis.
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