Ankylosing Spondylitis
Sources consulted
This article is original patient-education content.
- WHO—Health topics A–Z(2024)
- NHS—Health A to Z(2024)
- CDC—Health topics(2024)
Based on international clinical guidelines
Overview
Ankylosing spondylitis is a type of arthritis that mainly affects the spine. It causes inflammation (swelling and pain) in the joints of the spine, and over time this can lead to the bones in the spine fusing together, making it stiff. It can also affect other joints, like the hips and shoulders.
Key facts
- It is a chronic (long-term) condition that usually starts in young adults.
- Early treatment can help manage symptoms and slow the progression of the disease.
- Regular exercise and good posture are very important for keeping the spine flexible.
No, it is not very common. In the UK, it affects about 1 in 200 people.
It typically starts between the ages of 17 and 45. It is more common in men than women, though women can also develop it.
Symptoms
- Chest pain that could be a sign of inflammation of the aorta or other heart problems.
- Sudden loss of vision or severe eye pain.
- Loss of bladder or bowel control, which can indicate a serious spinal problem (cauda equina syndrome).
- ⚠Severe joint pain that prevents you from moving your spine or legs.
- ⚠Signs of iritis (eye redness, pain, blurred vision, sensitivity to light) – this needs same-day care to prevent eye damage.
Common symptoms
- Lower back pain and stiffness that is worse in the morning or after sitting still, and gets better with movement.
- Pain in the buttocks, hips, or neck.
- Fatigue (feeling very tired).
- Pain and swelling in other joints, such as the shoulders, knees, or ankles.
- In some people, eye inflammation (redness, pain, and sensitivity to light).
Symptoms in children
- In children, symptoms often start in the hips, knees, or heels rather than the spine.
- Children may also have eye inflammation (redness and pain).
- They may complain of pain and stiffness after rest.
Symptoms in older adults
- Symptoms may be mistaken for other types of arthritis, such as osteoarthritis.
- Older adults might have more stiffness and less pain compared to younger people.
- The spine may become noticeably stiff over time.
Causes
Main causes
- The exact cause is not fully understood, but it is strongly linked to a gene called HLA-B27. Most people with ankylosing spondylitis have this gene.
- Having the gene does not mean you will get the condition, so other factors, like an infection, might trigger it in some people.
Risk factors
- Having a close family member with ankylosing spondylitis.
- Being male (though it affects women too).
- Being between the ages of 17 and 45 when symptoms usually start.
- Having certain other autoimmune or inflammatory conditions.
When to see a doctor
See a doctor urgently if:
- If you have sudden severe back pain after a fall or injury.
- If you lose control of your bladder or bowels, or have numbness in your legs (this could be a medical emergency).
Book a routine appointment if:
- If you have persistent lower back pain or stiffness that does not improve with rest and lasts for more than a few weeks.
- If you have morning stiffness that lasts longer than 30 minutes and improves with activity.
Diagnosis
Your doctor will ask about your symptoms, family history, and perform a physical exam to check your spine and joints. They may also order imaging tests and blood work. Because symptoms can be like other conditions, diagnosis may take some time.
Tests that may be done
- X-rays of the spine and pelvis can show changes in the joints and bone.
- Magnetic resonance imaging (MRI) can detect early inflammation before it shows on X-rays.
- Blood tests to check for the HLA-B27 gene and for signs of inflammation (such as C-reactive protein or ESR).
- Your doctor may refer you to a rheumatologist (a specialist in arthritis) for a full evaluation.
What to expect at your appointment
The diagnosis can sometimes take months or even years because symptoms develop slowly and can be similar to other forms of back pain. It is important to see a specialist for a thorough assessment if ankylosing spondylitis is suspected.
Treatment
Treatment aims to relieve pain and stiffness, reduce inflammation, and prevent the spine from becoming too bent. It usually involves a combination of medication, physical therapy, and lifestyle changes. Early treatment is best.
Self-care at home
- Exercise regularly, especially stretching and strengthening exercises for the back and core.
- Maintain good posture when sitting, standing, and sleeping. Use a firm mattress.
- Apply heat or cold packs to painful areas to help ease stiffness.
- Quit smoking, as smoking can worsen symptoms and speed up spinal damage.
- Get plenty of rest when needed, but also stay as active as possible.
Medical treatments
Medications may include anti-inflammatory drugs (NSAIDs) to reduce pain and swelling, and disease-modifying antirheumatic drugs (DMARDs) or biologic therapies that target the immune system to control inflammation. Physical therapy is a key part of treatment to maintain flexibility.
When is surgery considered?
Surgery is rarely needed, but if the hip joints are severely damaged and causing disability, hip replacement surgery can help. In rare cases where the spine becomes very bent, corrective surgery may be considered.
Living with this condition
Many people with ankylosing spondylitis manage well and lead full lives. It is important to find a balance between activity and rest, and to listen to your body. With proper care, most people can continue to work and enjoy hobbies.
Lifestyle tips
- Stay physically active with gentle exercises like swimming, walking, or yoga.
- Use supportive chairs and avoid soft sofas or low seats that encourage slouching.
- Take short breaks from sitting every 30 minutes to avoid stiffness.
- Sleep on your back on a firm mattress with a flat pillow to keep your spine aligned.
Diet and exercise
A balanced diet rich in calcium and vitamin D (like dairy products, leafy greens, and fortified foods) helps keep bones strong. Regular exercise is essential – aim for at least 30 minutes of activity most days, including stretching and strengthening exercises. Swimming is excellent because it supports the body and allows gentle movement.
Mental health and emotional wellbeing
Living with a chronic condition can be stressful and may lead to anxiety or depression. It is normal to feel frustrated or worried. Talk to your healthcare provider about your feelings and consider speaking with a mental health professional. If you are in crisis, please contact your local emergency services or a mental health crisis line.
Prevention
There is no known way to prevent ankylosing spondylitis, but early diagnosis and treatment can help prevent or delay long-term damage to the spine and joints.
Vaccines
People with ankylosing spondylitis, especially those taking immunosuppressive medications, should stay up to date with recommended vaccines (such as flu, pneumococcal, and COVID-19 vaccines) to reduce the risk of infections. Always discuss vaccinations with your healthcare provider.
Screening programmes
There is no routine screening for the general population. If you have a close family member with ankylosing spondylitis, you may want to discuss your risk with a doctor, but screening tests are not routinely performed.
Complications
If left untreated
- Permanent fusion of the spine (bamboo spine), causing severe stiffness and loss of movement.
- Difficulty breathing if the ribs are affected and become stiff.
- Eye inflammation (uveitis) that can cause pain and vision problems if not treated promptly.
- Rarely, heart problems such as inflammation of the aorta or heart valve issues.
- Compression of nerves in the spine (cauda equina syndrome), which is a medical emergency.
Long-term outlook
With early treatment, regular exercise, and a healthy lifestyle, most people with ankylosing spondylitis can manage their symptoms well. The condition is not life-threatening, and many people continue to work, have families, and enjoy an active life. Staying hopeful and proactive about your care makes a big difference.
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Always verify with your doctor
Health guidelines vary by country and region. The information in this article is based on international clinical guidelines but may not reflect the specific guidelines, medications, or practices in your country. Always discuss your health concerns with your own doctor or healthcare provider, and refer to your local national health guidelines where available.
Important notice This information is for educational purposes only. It does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your specific situation. If you are experiencing a medical emergency, call your local emergency services immediately.