Ankylosing Spondylitis: Symptoms, Diagnosis and Treatment

Overview

Ankylosing spondylitis (AS) is a chronic inflammatory arthritis that primarily affects the spine and sacroiliac joints (where the spine meets the pelvis). It causes inflammation, pain, and stiffness in the back and, in advanced cases, can cause the vertebrae to fuse together, leading to reduced mobility and a forward-stooped posture.

AS affects about 0.5% of the population and is more common in men, typically developing in early adulthood (teens to 30s). It is strongly associated with the HLA-B27 gene — about 90% of people with AS test positive for it. AS is part of a group of conditions called spondyloarthritis, which also includes psoriatic arthritis, reactive arthritis, and enteropathic arthritis (associated with IBD).

The disease is progressive but varies widely in severity. Early diagnosis and treatment are important to prevent spinal fusion and maintain mobility. Modern treatments, particularly biologic medications, have dramatically improved outcomes. Regular exercise and physical therapy are essential components of management. AS can also affect other organs, including the eyes (uveitis), heart, and lungs.

Symptoms

Chronic back pain and stiffness, especially in the lower back
Pain and stiffness worse in the morning or after rest (morning stiffness lasting 30+ minutes)
Pain that improves with exercise and movement
Reduced mobility of the spine
Pain in the sacroiliac joints, hips, or shoulders
Fatigue
Eye inflammation (uveitis) — redness, pain, blurred vision
Heel pain (enthesitis)
Reduced chest expansion
In advanced cases: forward-stooped posture (kyphosis)
Symptoms that alternate between sides of the body

Diagnosis

Clinical exam — assessment of back mobility, chest expansion, and tender points
Blood tests — HLA-B27 (positive in 90% of Caucasians with AS), ESR, CRP (inflammatory markers)
X-rays of the sacroiliac joints — may show sacroiliitis; changes may take years to appear
MRI of the sacroiliac joints — can detect early inflammation before X-ray changes
Imaging of the spine — to assess syndesmophytes and bamboo spine in advanced disease

A rheumatologist makes the diagnosis.

Treatments

NSAIDs — first-line treatment; reduces pain and inflammation
Biologic agents — TNF inhibitors (adalimumab, etanercept, infliximab), IL-17 inhibitors (secukinumab); for moderate to severe disease
DMARDs — sulfasalazine for peripheral joint involvement
Physical therapy — essential for maintaining spinal mobility, posture, and flexibility
Exercise — regular exercise, particularly swimming and stretching, is one of the most effective treatments
Corticosteroid injections — for specific inflamed joints
Surgery — joint replacement for severely affected hips; spinal surgery for severe deformity
Lifestyle — smoking cessation (critical — smoking worsens AS and spinal fusion), maintaining activity
Regular monitoring — inflammatory markers, imaging, eye exams for uveitis
Treating associated conditions — uveitis, IBD, psoriasis

Medical Resources

Your Care Plan

A step-by-step guide to navigating your condition, from finding the right doctors to advocating for the care you deserve.

Step 1: Doctors to See

Start with: Your primary care physician for initial evaluation and blood tests.

Then seek: A rheumatologist for diagnosis and treatment.

Build your team:

Rheumatologist — for disease management
Physical therapist — for exercise and posture
Ophthalmologist — for uveitis screening
Gastroenterologist — if IBD is associated
Dermatologist — if psoriasis is associated
Orthopedic surgeon — if severe joint damage requires surgery

Step 2: Advocate for Yourself

If you have chronic back pain and stiffness that's worse in the morning and improves with exercise, ask about ankylosing spondylitis — not all back pain is mechanical. If your X-rays are normal but you have symptoms, ask for an MRI of the sacroiliac joints — early AS doesn't show on X-rays. If you're HLA-B27 positive, mention it — it supports the diagnosis. If NSAIDs aren't enough, ask about biologics — they can prevent spinal fusion. If you smoke, quitting is critical — smoking accelerates spinal fusion. Get regular eye exams — uveitis is common and can cause vision loss.

Step 3: Your Action Plan

If you have chronic back pain and stiffness, especially in the morning, see a rheumatologist.
Get blood tests (HLA-B27, inflammatory markers).
Get imaging of the sacroiliac joints.
Start medication as prescribed — NSAIDs or biologics.
Begin a regular exercise and stretching program.
Discuss physical therapy for posture and mobility.
Get eye exams to screen for uveitis.
Track symptoms and medication response.

Important: This report is educational information, not medical advice. Always consult a qualified healthcare professional for diagnosis and treatment decisions.