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Overview
What Is Ankylosing Spondylitis?
Ankylosing spondylitis is a chronic inflammatory form of spondylitis that mainly affects the spine and the sacroiliac joints, where the lower spine meets the pelvis. Inflammation can cause back or buttock pain and stiffness, especially after rest. Symptoms and progression vary widely from person to person. It often begins in adolescence or early adulthood and is more common in people with a family history, although anyone can develop it.
Symptoms
Symptoms of Ankylosing Spondylitis
Ankylosing spondylitis symptoms often develop gradually. Pain and stiffness may be worse after sleeping or sitting and may ease with movement, unlike some types of mechanical back pain. Not everyone has the same pattern, and symptoms can come and go.
- Inflammatory pain in the lower back or buttocks.
- Morning stiffness.
- Reduced flexibility of the spine.
- Pain in the hips or shoulders.
- Heel pain from inflammation where tendons attach to bone (enthesitis).
- Fatigue.
- Eye inflammation (uveitis).
SEEK PROMPT CARE
Watch for eye inflammation
A painful red eye, sensitivity to light, or new vision changes can indicate uveitis. Arrange prompt medical assessment because untreated eye inflammation can affect vision.
Causes
Causes of Ankylosing Spondylitis
Ankylosing spondylitis develops when the immune system becomes overactive and causes inflammation where ligaments and tendons attach to bone. The spine and pelvis are common areas affected, particularly around the sacroiliac joints. Over time, ongoing inflammation may lead to new bone formation and stiffness.
Inherited genes, including HLA-B27, can increase susceptibility, but having this gene does not prove that someone will develop the condition. Environmental influences and gut-related factors may also contribute. The complete cause is not known for every person.
Risk Factors
Risk Factors for Ankylosing Spondylitis
- A family history of ankylosing spondylitis or related spondyloarthritis.
- HLA-B27 or another inherited genetic susceptibility.
- Younger age at symptom onset, often during adolescence or early adulthood.
- Male sex, which is a population-level association rather than a requirement.
- Psoriasis or psoriatic arthritis.
- Inflammatory bowel disease, including Crohn’s disease or ulcerative colitis.
- A history of uveitis or other related inflammatory conditions.
Complications
Complications of Ankylosing Spondylitis
- Spinal fusion and reduced mobility.
- Osteoporosis or vertebral fracture.
- Uveitis, or inflammation inside the eye.
- Inflammatory bowel disease.
- Cardiovascular disease.
- Reduced chest expansion or breathing difficulty.
- Persistent pain, stiffness, or reduced physical function.
KNOW THE WARNING SIGNS
Know when to seek urgent care
Seek urgent evaluation for sudden severe back pain after a fall, new weakness or numbness, loss of bladder or bowel control, chest symptoms, or vision changes. These symptoms may signal a serious complication or a problem requiring immediate treatment.
Diagnosis
How Ankylosing Spondylitis Is Diagnosed
There is no single test that confirms ankylosing spondylitis. Clinicians assess the pattern, duration, and inflammatory features of symptoms, examine the joints and spine, and use tests to support the diagnosis or rule out similar conditions.
- Medical and family history, including the timing and pattern of pain and stiffness.
- Physical examination of spinal movement, posture, joints, and areas of tenderness.
- Blood tests that look for inflammation.
- HLA-B27 testing to assess genetic susceptibility.
- Pelvic or spinal X-rays to look for joint or bone changes.
- MRI when early inflammation is suspected or X-rays do not show enough detail.
Treatment & Management
Ankylosing Spondylitis Treatment and Management
Ankylosing spondylitis treatment aims to reduce inflammation and pain, maintain posture and flexibility, protect physical function, manage related conditions, and prevent or limit complications. A rheumatology team may adjust the plan over time according to symptoms, examination findings, imaging, and treatment response.
| Approach | How it helps | Key considerations |
|---|---|---|
| Daily exercise and posture work | Supports spinal movement, strength, posture, and chest expansion. | The activities should be adapted to symptoms and done regularly. |
| Physical therapy | Provides an individualized plan for flexibility, strength, posture, and safe movement. | A therapist can modify exercises during flares or when joints are affected. |
| NSAIDs | Can reduce pain and inflammation. | Use should follow medical advice because these medicines may not be suitable for everyone. |
| Biologic or targeted medicines | Can reduce inflammatory activity when symptoms remain active or severe. | They require medical monitoring and treatment decisions tailored to the individual. |
| Conventional disease-modifying medicines | May help selected peripheral joint involvement. | They are not equally effective for all spinal symptoms and require specialist guidance. |
| Surgery | May address severe structural damage or major joint problems. | It is reserved for selected cases when other management is not enough. |
- Follow the exercise plan recommended by your healthcare team.
- Avoid smoking because it can worsen overall health and may affect disease outcomes.
- Protect bone health through appropriate activity, nutrition, and medical advice.
- Attend monitoring visits even when symptoms are controlled.
- Report new eye or bowel symptoms promptly.
- Take medicines as prescribed and discuss side effects before stopping them.
Outlook and Prognosis
Outlook and Prognosis
Ankylosing spondylitis has no known cure, but it can often be managed over the long term. Its course ranges from intermittent symptoms to progressive stiffness and structural change. Early assessment, appropriate ankylosing spondylitis treatment, regular movement, and follow-up can help protect mobility and quality of life.
WHAT CAN HELP
Early assessment, regular movement, medication adherence, posture and flexibility work, and monitoring of related conditions may support better function over time.
CLOSER MONITORING
Persistent inflammation, increasing pain, worsening mobility, new joint symptoms, eye inflammation, or bowel symptoms may require a review of the treatment plan.
When Should You See a Doctor
When Should You See a Doctor?
- Back or buttock pain lasting several weeks.
- Stiffness that is worse after rest or improves with movement.
- Symptoms that begin during adolescence or early adulthood.
- Recurring joint or heel pain.
- A family history of ankylosing spondylitis or related inflammatory disease.
GET URGENT HELP
Do not wait with emergency symptoms
Seek urgent care for a painful red eye or vision changes, sudden severe back pain after an injury, new limb weakness or numbness, loss of bladder or bowel control, chest pain, or breathing difficulty.
Branches
2 topics
Ankylosing Spondylitis
Orthopedics and Traumatology
Ankylosing Spondylitis
Rheumatology
Symptoms
2 topics
