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Spondylitis is a form of chronic inflammatory arthritis. It is an autoimmune disease that attacks mainly the axial skeleton (the skull, spine, and ribs), joints, and entheses (the connective tissues between ligaments and bones). The most common symptoms of the disease are back pain, joint pain, reduced range of motion, and fatigue, but spondylitis can also cause difficulty speaking.
Speech problems in spondylitis can have many causes. Some are problems with the jaw, nerve compression, changes to the bones, and cognitive impairment (also referred to as “brain fog”). Here, we will explore what causes difficulty speaking in spondylitis, as well as how it can be managed.
MySpondylitisTeam members often share the many ways they experience speech problems. “I’ll go to say a word,” wrote one member, “and loads of random words come out instead.”
Some members experience confusion and brain fog instead. “I can look at someone and call them the wrong name, even though I have known them for years,” said one member.
Others experience speech problems along with other neurological symptoms. One member shared, “I can’t get the right words out or even think of words. Also, I have dizziness and vertigo.”
Difficulty speaking can be embarrassing and affect a person’s quality of life. Members share that they are afraid that their speech problems may affect their professional relationships. One member shared that they were worried about their ability to keep their job: “I’m not sure how much longer my boss is going to look the other way.”
Some members wonder if speech problems could be a symptom of other issues, which can be a scary idea. “I went to a psychologist,” wrote one member, “and was tested for dementia and Alzheimer’s.” Another member shared that their family was worried about similar cognitive issues: “My family says I am going senile, but I know I am not.”
Speech problems may arise from physical, cognitive, or neurological (nerve-related) issues. Common causes of difficulty speaking in people living with spondylitis include jaw problems, brain fog, or compressed nerves in the neck. Regardless of the cause of your difficulty speaking, it is important to mention this symptom to your doctor to find the right treatment plan for you.
About 15 percent of people with ankylosing spondylitis (a severe subtype of spondylitis) will experience jaw problems. Inflammation of — and resulting damage to — the temporomandibular joints (TMJs) of the jaw can lead to difficulties with speaking and eating.
Other symptoms of TMJ disorders include:
When TMJ problems are suspected as a cause of speech difficulties, X-rays or other imaging can usually confirm this diagnosis.
Some people with spondylitis feel that they simply can’t make the right words come out. As one member described, “I find it hard to get my words out at times, and sometimes when easily speaking, my words don’t make sense but do in my mind.”
This member described a condition known as dysarthria. Dysarthria is caused by muscle weakness of the tongue and throat. In spondylitis, dysarthria may result from nerve compression.
When the posterior (back) cervical spinal cord is compressed, it impairs sensory function (things like touch, smell, and taste). Compression of the anterior (front) cervical spinal cord causes motor (movement) dysfunction. It is possible for both the front and back of the cervical spine to be compressed at the same time.
Nerve compression in people living with spondylitis usually results from changes to the bones in the spine. Ankylosing spondylitis, in particular, can result in changes to the bones in the neck.
When the bones of the spine begin to fuse, the spine becomes less flexible. The new bone that grows to fuse the spine is thinner and weaker than regular bone. It’s also more prone to fractures or breaks. A person living with ankylosing spondylitis is therefore at a much greater risk of spinal fractures.
Other spondylitis-related spine changes that can compress the nerves include:
Cervical fractures can cause neurological problems and spinal stenosis, a narrowing of the vertebrae in the spine. Cervical stenosis causes discomfort when the spinal cord has been compressed by 30 percent or more.
Severe nerve compression in the cervical spine (neck) can cause a condition known as cervical myelopathy. This condition can cause neurological symptoms such as difficulty speaking. Other symptoms of cervical myelopathy can include:
The changes that spondylitis causes in the cervical spine can sometimes lead to instability in the neck. This instability can result in compression of nerves in the brainstem that control movements between the head and the neck.
The hypoglossal nerve, in particular, controls the muscles in the pharynx (throat). It helps to move food between the mouth and the esophagus. When this nerve is compressed, speech and swallowing can be affected.
The glossopharyngeal nerve is responsible for the movement of the tongue and throat muscles. The compression of this nerve also could cause difficulty swallowing or speaking.
If you often forget words, have trouble remembering the right words, or experience a feeling of mental “fuzziness” or forgetfulness, you may be experiencing brain fog — a mental sluggishness. Brain fog has been connected to some inflammatory conditions, including spondylitis.
Brain fog is not a medical condition in itself, but rather a symptom. Inflammation is thought to affect the brain and prevent it from reaching a full state of alertness. The inflammation can also lead to pain spikes that prevent signals from reaching the brain.
Spondylitis-related brain fog also can be caused by:
These feelings of cognitive impairment can be difficult. Brain fog made one member think negatively about their intellect: “I sound like a bumbling fool. Can’t think of words or articulate things most days.”
Learn more about spondylitis and brain fog, including ways to manage it.
As with any spondylitis complication, it is important to figure out the cause of your difficulty speaking so you can best manage it. Speak to your doctor if you have symptoms of jaw problems, nerve compression, or other complications that may lead to speech problems.
Your doctor can refer you to health care professionals for physical therapy and occupational therapy. They may also suggest other management approaches.
Stenosis is important to catch early, so you can manage it before it becomes too severe. In some cases, physical and occupational therapy will not be enough. Surgery will be needed to relieve stenosis.
Surgery can prevent symptoms from worsening and remove pressure from the spinal cord. The typical surgery recommended for stenosis is called spinal decompression. If osteophytes (bone spurs) are causing your symptoms, your surgeon will remove the spurs to relieve the pressure on your spinal cord.
Other procedures include:
If memory loss and brain fog seem to be the cause of your difficulty speaking, lifestyle remedies may help you manage it.
Talk to your doctor about medications that might be impacting your memory. Your doctor may be able to adjust your dosage or recommend a new medication. It is also important that you work with your team of doctors to manage your pain effectively.
If you have difficulty falling or staying asleep, practice good sleep hygiene — including going to bed at the same time every night — and talk to your doctor about ways to improve your sleep.
Anecdotal evidence suggests that depression may have an impact on memory, which could potentially contribute to or worsen speech problems in spondylitis. Ask your doctor for a referral to a mental health care professional. Your doctor can also help you find ways to manage stress and improve your mental health.
As with any chronic health condition, it is important that you stay hydrated and eat a brain-boosting diet.
MySpondylitisTeam members share how they manage difficulty speaking, including medical treatment, nutritional supplements, and lifestyle changes.
Removing sources of stress helped one member. “Stress creates inflammation, which in turn signals your already compromised immune system to attack,” they said.
Another member found relief from sleep difficulties by using a continuous positive airway pressure (CPAP) machine: “Sleeping with a CPAP gives the air needed to sleep better and wake feeling refreshed.”
Several MySpondylitisTeam members found fish oil supplements helpful. “High-dose fish oil and other supplements may help,” one said. Another member said, “Try using an omega-3 daily supplement.” Another recommended B vitamins: “The brain needs these essential vitamins.”
Spondylitis symptoms like difficulty speaking are easier to manage with help. MySpondylitisTeam is an online network of over 85,000 members living with spondylitis who share common experiences and support each other. Here, members come together to ask questions, offer advice, and connect with others who understand life with spondylitis.
How has your speech been affected by spondylitis? Comment below or start your own conversation on MySpondylitisTeam.
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Ariel D. Teitel, M.D., M.B.A.
is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network.
Learn more about him here.
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