Ankylosing spondylitis overview

Overview

Ankylosing spondylitis (say: AN-kih-loh-sing spon-dih-LY-tiss) is a long-term condition that causes inflammation in the joints of the spine and the places where the spine meets the pelvis. Over time, this inflammation can lead to stiffness and sometimes the bones of the spine fuse together, making the back less flexible. It is a type of arthritis that mainly affects the back, but it can also affect other joints and parts of the body.

Ankylosing spondylitis is not very common. It affects about 1 in 1,000 people in the UK. It is more common in certain populations, but overall it is considered a rare condition.

Ankylosing spondylitis affects more men than women. It usually begins in late teens or early adulthood, but it can start at any age. Women may have milder symptoms and be diagnosed later. A family history of the condition increases the chance of developing it.

Symptoms

Common symptoms

• Persistent lower back pain and stiffness that lasts for more than 3 months, often worse in the morning or after sitting still, and improves with exercise or a warm shower.
• Pain and stiffness in the buttocks and hips that may shift from side to side.
• Stiffness and pain in other joints like the shoulders, knees, or ankles.
• Fatigue (feeling very tired) because inflammation uses up the body's energy.
• Pain or redness in the eye (uveitis or iritis) – this needs urgent medical attention.
• In severe cases, the spine can become less flexible, leading to a stooped posture.

Symptoms in children

• Children may get pain in the hips, knees, or heels instead of the back at first.
• They may complain of pain in the bottom of the foot or the heel (enthesitis).
• Stiffness in the morning that gets better with activity.
• Sometimes a child may have a fever or feel generally unwell.

Symptoms in older adults

• Older adults may have more widespread stiffness and joint pain, not just in the back.
• They may already have other forms of arthritis, so the diagnosis can be missed.
• Fatigue and reduced mobility can be more noticeable.
• Older adults are at higher risk of spinal fractures from minor falls, so any new severe back pain after a fall needs immediate medical attention.

Causes

Main causes

• The exact cause is not known, but it is thought to be an autoimmune condition where the body's immune system attacks healthy joints, causing inflammation.
• Genetics play a strong role – most people with ankylosing spondylitis have a gene called HLA-B27, but many people with this gene never get the condition.

Risk factors

• Having a family member with ankylosing spondylitis or another inflammatory arthritis.
• Being male – men are 2 to 3 times more likely to develop it than women.
• Being in your 20s or 30s – this is when symptoms most often start.
• Having a different autoimmune condition, such as psoriasis or inflammatory bowel disease.

When to see a doctor

See a doctor urgently if:

• If you have new pain, redness, or sensitivity to light in one eye – this needs same-day care.
• If you have a sudden severe back or neck pain after a fall.
• If you have numbness, weakness, or loss of bladder or bowel control.

Book a routine appointment if:

• If you have long-term back pain that started before age 45, lasts more than 3 months, and feels better with movement or worse with rest.
• If you have morning stiffness in your back that lasts more than 30 minutes.
• If you have a family history of ankylosing spondylitis and are worried about symptoms.

Diagnosis

A doctor will ask about your symptoms, medical history, and family history. They will do a physical exam to check your spine flexibility and feel for tender spots. If they suspect ankylosing spondylitis, they will refer you to a rheumatologist (a joint specialist) for a full diagnosis.

Tests that may be done

• Blood tests – to check for inflammation (like CRP and ESR) and to test for the HLA-B27 gene.
• X-rays of your spine and pelvis – these can show changes in the joints and possible fusion.
• MRI scans – these can show inflammation in the spine and sacroiliac joints earlier than X-rays.

What to expect at your appointment

Being diagnosed can take some time because symptoms can be similar to other types of back pain. A rheumatologist will look at all your test results and symptoms together. They may also check other joints and ask about eye problems, psoriasis, or bowel issues. The diagnosis is based on a combination of factors, not just one test.

Treatment

There is no cure for ankylosing spondylitis, but treatments can help reduce pain and stiffness and keep your spine flexible. Treatment usually includes a combination of physical therapy, medication, and lifestyle changes. The goal is to control inflammation, maintain mobility, and prevent the spine from fusing in a poor position.

Self-care at home

• Do daily gentle stretching exercises – especially for your back and neck. A physiotherapist can show you the best moves.
• Practice good posture – try to sit and stand straight. Sleeping on your back on a firm mattress may help.
• Apply heat (like a warm bath or a heating pad) to ease morning stiffness.
• Cold packs can help reduce swelling in painful joints.
• Stay as active as possible – low-impact activities like swimming, walking, and yoga are great choices.

Medical treatments

Doctors often start with anti-inflammatory medications (called NSAIDs) to reduce pain and swelling. If those are not enough, they may prescribe other medicines that target the immune system to calm down the inflammation. These are called disease-modifying drugs. In more severe cases, a class of medications called biologics may be offered. These are given by injection or infusion and block specific proteins that cause inflammation. All medications have benefits and risks, so your doctor will discuss the best option for you. You may also receive regular eye checks if you have had uveitis.

When is surgery considered?

Surgery is very rarely needed for ankylosing spondylitis. It may be considered if the spine has fused in a very bent position that affects daily life, or if there is severe hip joint damage. Surgery can include hip replacement or, in rare cases, spinal osteotomy to straighten the spine. Most people manage without surgery.

Living with this condition

Living with ankylosing spondylitis means finding a balance between rest and activity. Mornings can be stiff, so allow extra time to warm up. Work with a physiotherapist to develop a daily exercise routine. At work, ask about an ergonomic chair or standing desk. Plan breaks to stretch. Listen to your body – rest when you need to, but try not to stay still for too long.

Lifestyle tips

• Exercise regularly – swimming and walking are excellent because they are gentle on joints.
• Avoid smoking – smoking worsens inflammation and can speed up spine damage.
• Maintain a healthy weight – extra weight puts more stress on your joints.
• Get enough sleep – use a firm mattress and a thin pillow to support your neck.
• Consider joining a support group – talking to others who understand can help.

Diet and exercise

There is no special diet proven to cure ankylosing spondylitis, but eating a balanced diet helps overall health. Some people find that avoiding processed foods and eating more fruits, vegetables, and fish helps with inflammation. Exercise is crucial – aim for at least 30 minutes of moderate activity most days. A physiotherapist can tailor exercises to your needs. Stretching, swimming, and yoga are especially helpful for keeping the spine flexible.

Mental health and emotional wellbeing

Living with a chronic condition can be challenging and may cause feelings of frustration, sadness, or anxiety. It is important to look after your mental health as well as your physical health. Talk to your doctor if you are feeling low or anxious. Consider counselling or joining a support group. Remember: you are not alone, and help is available. If you are having thoughts of harming yourself, reach out to a crisis helpline or emergency services right away.

Prevention

Ankylosing spondylitis cannot be prevented because it is largely genetic. However, you can help reduce the risk of complications by staying active, not smoking, and seeking treatment early. Early diagnosis and management can slow the progression and maintain flexibility.

Complications

If left untreated

• Fusion of the spine bones (ankylosis) leading to a rigid, stooped posture.
• Reduced ability to move the neck or twist the back.
• Spinal fractures – the fused spine can break more easily even with minor injury.
• Chest stiffness – fusion of the ribs can make deep breathing harder and increase the risk of lung infections.
• Uveitis (inflammation of the eye) – if not treated quickly, it can cause vision loss.
• Heart problems – such as inflammation of the aorta or heart valves.
• Osteoporosis (brittle bones) – more common in people with long-standing AS.

Long-term outlook

With early treatment and good self-care, most people with ankylosing spondylitis can live full, active lives. The condition does not usually reduce life expectancy significantly. While there is no cure, modern treatments are very effective at controlling inflammation and preventing severe stiffness. Staying active and working with your healthcare team are the best ways to maintain a good quality of life.

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