From the Guidelines
Yes, ankylosing spondylitis (AS) can cause pain in the groin area of females. AS is a type of inflammatory arthritis that primarily affects the spine and sacroiliac joints (where the spine connects to the pelvis), but it can also involve other joints and structures, including the hip joints, which can lead to groin pain 1. When inflammation affects the hip joints or the sacroiliac joints, pain can radiate to the groin area. In females with AS, groin pain may be mistaken for gynecological issues, leading to delayed diagnosis. This pain typically worsens with inactivity, especially after waking up in the morning or after prolonged sitting, and improves with movement.
Key Points to Consider
- AS-related groin pain is often associated with inflammation in the hip joints or sacroiliac joints
- Treatment for AS-related groin pain includes non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen or celecoxib, as recommended by the 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 1
- Physical therapy focusing on stretching and strengthening exercises can also help alleviate groin pain
- In more severe cases, biologics such as TNF inhibitors (adalimumab, etanercept) or IL-17 inhibitors (secukinumab) may be necessary, as conditionally recommended by the 2019 update 1
Management of AS-Related Groin Pain
The pain occurs because inflammatory processes in AS release substances that sensitize nerve endings and cause muscle spasms in the affected areas, including those that can refer pain to the groin region. Treatment with NSAIDs, such as naproxen (500mg twice daily) or celecoxib (200mg daily), is conditionally recommended over on-demand treatment with NSAIDs 1. Additionally, treatment with TNFi, such as adalimumab or etanercept, is strongly recommended over no treatment with TNFi 1. It is essential to work with a healthcare provider to develop a personalized treatment plan to manage AS-related groin pain and improve quality of life.
From the Research
Ankylosing Spondylitis and Groin Pain in Females
- Ankylosing spondylitis (AS) is a chronic inflammatory disease that can cause pain and stiffness in the spine and other parts of the body 2.
- While the studies provided do not specifically mention groin pain in females with AS, they do discuss the various types of pain experienced by patients with AS, including neuropathic pain 3, 4.
- Neuropathic pain is a type of pain that is caused by damage to the nervous system, and it can occur in patients with AS 3, 4.
- One study found that patients with AS and neuropathic pain had higher disease activity and lower quality of life than those without neuropathic pain 3.
- Another study found that disease activity is higher in patients with neuropathic pain, and that there is a positive correlation between disease activity parameters and neuropathic pain scales 4.
- While these studies do not specifically mention groin pain, they do suggest that patients with AS can experience a wide range of pain types and locations, including neuropathic pain 3, 4.
- A review of the literature on pain in AS notes that pain and inflammation are not always correlated, and that the assumption that pain in AS is a reliable surrogate marker for inflammation might be an over-simplification 5.
- The same review discusses the complex interplay between the activation of the immune system and pain pathways in the nervous system, and notes that the immune system can modify pain in patients with AS 5.
Pain Locations and Types in AS
- Patients with AS can experience pain in various locations, including the spine, hips, and other joints 2, 6.
- The types of pain experienced by patients with AS can include inflammatory pain, mechanical pain, and neuropathic pain 3, 4, 5.
- Neuropathic pain can occur in patients with AS, and it is associated with higher disease activity and lower quality of life 3, 4.
- The relationship between pain and inflammation in AS is complex, and pain and inflammation are not always correlated 5.