Ankylosing Spondylitis: Symptoms, Causes, Treatment

Medically Reviewed by Poonam Sachdev on July 03, 2023
11 min read

Ankylosing spondylitis (AS) is a rare type of arthritis that causes pain and stiffness in your spine. This lifelong condition, also known as Bechterew disease, usually starts in your lower back. It can spread up to your neck or damage joints in other parts of your body.

"Ankylosis" means fused bones or other hard tissue. "Spondylitis" means inflammation in your spinal bones, or vertebrae. Severe cases can leave your spine hunched.

There’s no cure for AS. But medication and exercise can ease pain and help keep your back strong.

What is the first sign of ankylosing spondylitis?

AS often starts with inflammation in your sacroiliac joints, where your spine connects to your pelvis. You might first notice pain and stiffness in your lower back and hips.

If it gets worse, AS can affect places where your tendons and ligaments attach to bones. It can even cause your vertebrae to fuse together.

Other symptoms of ankylosing spondylitis

You might also have:

  • Neck pain or stiffness
  • Shoulder pain 
  • Pain and stiffness in your ribcage 
  • Pain in your hips or thighs
  • Foot, heel, or hand pain 
  • Pain that’s worse in the morning or after you sit for a long time
  • A rigid spine that curves forward
  • Tiredness
  • Swelling in your joints

Symptoms differ from person to person. Your condition also may change more quickly or more slowly than someone else’s.

Your symptoms will probably flare up and then get better from time to time.

Learn more about the symptoms of ankylosing spondylitis.

AS belongs to a group of conditions called spondyloarthritis, which cause inflammation in your spine and joints. There are two kinds of conditions in this group:

  • Axial spondyloarthritis, diseases that mostly affect your spine. Ankylosing spondylitis is the type of axial spondylitis that doctors can spot on an X-ray. Another type, called non-radiographic axial spondyloarthritis, doesn't show up on X-rays. 
  • Peripheral spondyloarthritis, conditions that mostly involve joints in your limbs, heels, fingers, and toes.  

Some people have elements of both types.

 

Researchers aren’t sure what triggers AS, but they think it’s tied to your genes. Most people with AS have a gene that makes a protein called HLA-B27. Doctors think it tells your immune system to attack some common bacteria in your body and sets off AS symptoms.

Ankylosing spondylitis epidemiology

AS is fairly rare, affecting only about .2% to .5% of the U.S. population. Males, and people assigned male at birth, are thought to be more likely than their female counterparts to have AS. But some experts think women are simply less likely to get a diagnosis. 

Unlike most types of arthritis, AS often starts during your teens or in young adulthood. About 80% of cases begin before age 30, and 95% by age 45.

AS most often affects White people. Some research shows they're 3 times more likely to get it than Black people are. There's not a lot of research into AS rates among other ethnic and racial groups.   

 

One of the main risk factors for AS is having the HLA-B27 gene. So you're more likely to get AS if others in your family have it. But most people who have the gene don't end up with AS, which means that things in your environment may also play a role. People who don't have the HLA-B27 gene can also get AS.

Along with your age, gender, and race, having another autoimmune disease could raise your chances of having AS. These conditions include:

  • Crohn's disease
  • Psoriasis
  • Ulcerative colitis

One risk factor you can take steps to avoid is smoking. People with AS who smoke tend to have more pain and disability. If you need help quitting, ask your doctor for advice.

 

AS can be tough to spot because so many people have back pain, its main symptom. 

Tests for ankylosing spondylitis

There’s no single test to confirm AS. Your doctor may rely on your symptoms as well as:

But imaging tests don't always help. Joint damage may not show up on them right away. 

Everyone's AS progresses in different ways. Some people never have more than mild back pain and stiffness. Others have more serious symptoms that get worse over time. Treatment can help at any stage. 

Early ankylosing spondylitis

In the first stages of AS, the inflammation in your sacroiliac joints can lead to:

  • Back pain and stiffness that usually starts in the morning and gets better as the day goes on, or when you exercise
  • Pain in your buttocks and the back of your thighs

Worsening ankylosing spondylitis

If AS progresses, it starts to affect your vertebrae and slowly moves up your spine, leading to more discomfort and stiffness in your back. It may affect your entheses, where your ligaments and tendons join to your bones, and cause pain in your feet, legs, hips, ribs, and shoulders. 

You might feel extra tired as your body works to try to fight the inflammation.

Advanced ankylosing spondylitis

As AS advances, more of the joints in your spine join together (fuse). This limits your movement. It may also flatten out the curve in your lower back and lead to a bent-over posture. You might find it harder to breathe because your chest can't expand as much as it should. 

 

Medications help some people. But staying active is one of the keys to managing AS.

Exercise. The less you sit or lie down, the better you’ll feel. Exercise helps you stand straighter and keeps your spine limber. Staying active may even banish your pain without medication.

Physical therapy. You'll need to practice good posture, learn how to stretch tight muscles and keep your spine stable, and use other techniques that can lower your pain. You can do them at home, but most people benefit more from working with a professional physical therapist or with a group.

Find out about the latest treatments for ankylosing spondylitis.

Medications for ankylosing spondylitis

Prescription nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin (Indocin) help most people who have AS. They do have some possible side effects, such as stomach bleeding, heart problems, and others.

If your condition is serious, your doctor may have you try stronger medications like biologics. These are made with things like proteins. They can help protect your joints from future damage. But these drugs can be very expensive, depending on your insurance coverage. They may also cause serious side effects, including infections.

Learn more about medications to treat ankylosing spondylitis.

Surgeries for ankylosing spondylitis

Most people with AS won't need surgery. But if you have advanced AS, you could be a candidate for:

  • Joint replacement, to help you regain movement after serious damage to your hip or another joint
  • Laminectomy, in which a surgeon removes part of a vertebra to take pressure off your spinal cord
  • Spinal osteotomy, in which a surgeon realigns your vertebrae to allow you to stand up straight 

Natural or alternative treatment for ankylosing spondylitis

There's little scientific evidence that alternative treatments like probiotic supplements can benefit those with AS. But some people find mind-body movements, like yoga, tai chi, or Pilates, to be helpful. 

Always check with your doctor before trying any alternative treatment. 

Ankylosing spondylitis lifestyle and home remedies

Some things you do every day can help you feel better:

  • Make time to exercise every day, even a few minutes at a time. Working out in water helps many people who have AS.
  • Keep a healthy weight so your joints aren’t under as much stress. A diet high in omega-3 fatty acids might help. Watch for patterns if you think certain foods might trigger changes in how you feel.
  • Don’t smoke. People who smoke tobacco often have symptoms that get worse as they get older.
  • Manage stress with things like massageyogameditation, and counseling.
  • Apply heat to stiff joints and tight muscles, and use cold on inflamed areas. 

While it can be tricky to diagnose AS in anyone, the process often takes longer for women. That may be because the disease is less likely to show up on X-rays in women, or because health care providers tend to think of AS as a men's disease. By the time many women are diagnosed, AS is in a later stage and harder to treat.

Black people are less likely to get AS than some other racial and ethnic groups. But when they do have it, it's likely to be more serious and more disabling. Doctors may also overlook some cases of AS in Black people because it's less common for them to get the condition.

Studies have shown that people with lower social and economic statuses also tend to have more serious AS. And the condition is likely to have more of an effect on their daily lives.   

 

AS can cause pain and inflammation throughout your body, including in your:

  • Spine. In rare cases, your vertebrae may become weak, making them more likely to fracture or break. Damaged vertebrae can press on or irritate a group of nerves in the bottom of your spinal cord called the cauda equina. You might have sexual problems, a loss of reflexes, or trouble controlling your bowels or bladder.
  • Eyes. About 40% of people with AS have an eye problem called uveitis. It’s a kind of eye inflammation that's painful and can blur your vision and make you sensitive to bright light. If you have uveitis, your doctor might check for AS even if you don’t have any other symptoms.
  • Lungs. Stiffness in your spine and ribs may keep you from breathing deeply. Sometimes, AS also leads to scarring in your lungs that can affect your breathing.
  • HeartRarely, AS can enlarge your aorta, the largest artery in your body. This can change the shape of your aortic valve, allowing blood to leak back into your heart. Your heart won’t pump as well, which can leave you tired and short of breath.

People with AS are also more likely to get certain types of cancers. They include bone and prostate cancers in men and colon cancer in women, as well as blood-related cancers in both sexes.

It's not always easy to live with a chronic condition like AS. Taking good care of your physical and mental health can improve your daily life. 

Ankylosing spondylitis diet

No particular diet has been shown to help with AS symptoms. But a balanced eating plan that helps you maintain a healthy weight is important. Extra weight adds stress on your joints, which can increase the pain of AS. 

Your diet should include:

  • Plenty of brightly colored fruits and vegetables, which are rich in anti-inflammatory nutrients called antioxidants
  • Lean sources of protein
  • Calcium and vitamin D for bone health
  • Omega-3 fatty acids, found in fatty fish and some vegetable oils, which may benefit people with inflammatory types of arthritis

Limit highly processed and sugary foods as well as alcohol, all of which can contribute to inflammation.

Watch for patterns if you think certain foods might trigger changes in how you feel.

Costs of ankylosing spondylitis

If you have AS, you can expect to have extra health care expenses for things like doctor visits, hospitalizations, and medication. One study found that people with AS spent 10 times more for health care each year than people without the condition. Their expenses were nearly $23,000 a year, compared with about $2,100 for healthy people. 

Depending on how serious your AS is, you may also have costs related to:

  • Lost work time and productivity
  • Mobility aids like canes and reachers
  • Accessibility upgrades to your home, like handrails and grab bars 
  • Hiring caregivers 

Managing ankylosing spondylitis

Here are some things you can do to deal with some of the everyday effects of AS:

  • Move daily. Make time to exercise every day, even a few minutes at a time. Working out in water helps a lot of people who have AS. Make sure your exercise routine includes moves that help you stay flexible. Stretching keeps your muscles from shortening and helps you avoid becoming bent over. 
  • Use good posture. Work to keep your spine in good alignment, whether you're sitting, standing, lying down, driving, or walking. If you work at a desk, make sure it and your chair are properly positioned. Your physical therapist can teach you exercises to help with posture. 
  • Pace yourself. Listen to your body. To help preserve your energy when you're having a flare, break difficult tasks into small segments and do one at a time. Take rest breaks every 30 or 40 minutes. Delegate tasks to others when possible.
  • Make sleep a priority. It can be hard to sleep when you're hurting. But getting enough shut-eye helps you heal and preserves your energy. To ease pressure on your neck and spine, use a pillow that's right for the sleep position you prefer. An extra pillow beneath or between your legs can help keep you comfortable. If you're a stomach sleeper, switch to another sleep position that puts less stress on your back.
  • Choose comfortable shoes. To avoid ankle pain, choose shoes that support your ankles and arches. Look for a wide toe box and a cushioned sole. 
  • Use heat to manage pain. Taking a hot shower or using a heating pad can help relax muscles, keep you flexible, and ease pain.

Ankylosing spondylitis and mental health

Having a long-term inflammatory condition like AS often brings feelings of frustration and sadness. It can lead to depression or anxiety. There are several reasons for this:

  • Physical symptoms like pain and fatigue 
  • Being unable to work or to do things you enjoy 
  • Feeling that you're losing your independence or letting people down

At the same time, feeling stressed or depressed can lead to a flare-up of your AS symptoms. 

If you notice changes in your mood, consider counseling or therapy. It may also help to join an AS support group, where you can share your experiences and feelings with people who understand. 

Don't let your emotions keep you from your exercise routine. Physical activity can help you manage sadness and stress as well as pain.

Most people who have AS – about 70% to 90% – never become seriously disabled. But some have spinal fusion and joint damage that limit their movement. They may need help with daily activities like bathing, dressing, and household chores. 

AS itself doesn't usually shorten your life. But some of its complications, like heart disease or spinal fractures, can affect life expectancy. 

Can ankylosing spondylitis be cured?

AS is a lifelong disease that doesn't have a cure. You also can't reverse its damage to your spine and joints once you have it.

But you can ease pain and prevent further damage with exercise, physical therapy, and medications. If you're diagnosed early on and get the right treatment, odds are good that you can live without serious pain.

What to expect with ankylosing spondylitis

It's hard to predict what course AS will take. Some people have an initial flare-up of symptoms that then improve. Some go through periods of mild back pain and stiffness from time to time. Others' symptoms gradually get worse over time over a period of months or years. 

The long-term goals of treating AS are to:

  • Keep the disease from progressing or slow it down
  • Prevent disability and keep you functioning as well as possible
  • Retain your quality of life

Early diagnosis and treatment can prevent disability in people with AS. Talk to your doctor if you think you might have AS. If you've already been diagnosed, exercise, physical therapy, and medications can ease symptoms and keep you active. 

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