About ankylosing spondylitis

What is ankylosing spondylitis?

Ankylosing spondylitis facts

  • Ankylosing spondylitis belongs to a group of arthritis conditions that tend to cause chronic inflammation of the spine (spondyloarthropathies).
  • Ankylosing spondylitis affects males two to three times more commonly than females.
  • Ankylosing spondylitis is a cause of back pain in adolescents and young adults.
  • The tendency to develop ankylosing spondylitis is genetically inherited.
  • The HLA-B27 gene can be detected in the blood of most patients with ankylosing spondylitis.
  • Ankylosing spondylitis can also affect the eyes, heart, lungs, and occasionally the kidneys.
  • The optimal treatment of ankylosing spondylitis involves medications that reduce inflammation or suppress immunity, physical therapy, and exercise.

What is ankylosing spondylitis?

Ankylosing spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints. The sacroiliac joints are located at the base of the low back where the sacrum (the bone directly above the tailbone) meets the iliac bones (bones on either side of the upper buttocks) of the pelvis. Chronic inflammation in these areas causes pain and stiffness in and around the spine, including the neck and back. Over time, chronic inflammation of the spine (spondylitis) can lead to a complete cementing together (fusion) of the vertebrae, a process referred to as ankylosis. Ankylosis causes loss of mobility of the spine.

Ankylosing spondylitis is also a systemic disease, meaning it can affect tissues throughout the body, not just the spine. Accordingly, it can cause inflammation in and injury to other joints away from the spine manifest as arthritis, as well as to other organs, such as the eyes, heart, lungs, and kidneys. Ankylosing spondylitis shares many features with several other arthritis conditions, such as psoriatic arthritis, reactive arthritis (formerly called Reiter's disease), and arthritis associated with Crohn's disease and ulcerative colitis. Each of these arthritic conditions can cause disease and inflammation in the spine, other joints, eyes, skin, mouth, and various organs. In view of their similarities and tendency to cause inflammation of the spine, these conditions are collectively referred to as "spondyloarthropathies." Ankylosing spondylitis is considered one of the many rheumatic diseases because it can cause symptoms involving muscles and joints.

Ankylosing spondylitis is two to three times more common in men than in women. In women, joints away from the spine are more frequently affected than in men. Ankylosing spondylitis affects all age groups, including children. When it affects children, it is referred to as juvenile ankylosing spondylitis. The most common age of onset of symptoms is in the second and third decades of life. Ankylosing spondylitis is often abbreviated AS and has been referred to as Bechterew's disease.

What are the symptoms for ankylosing spondylitis?

Early signs and symptoms of ankylosing spondylitis might include Pain and Stiffness in your lower back and hips, especially in the morning and after periods of inactivity. Neck Pain and Fatigue also are common. Over time, symptoms might worsen, improve or stop at irregular intervals.

The areas most commonly affected are:

  • The joint between the base of your spine and your pelvis (sacroiliac)
  • The vertebrae in your lower back
  • The places where your tendons and ligaments attach to bones (entheses), mainly in your spine, but sometimes along the back of your heel
  • The cartilage between your breastbone and ribs
  • Your hip and shoulder joints

When to see a doctor

Seek medical attention if you have low back or Buttock Pain that came on slowly, is worse in the morning or awakens you from your sleep in the second half of the night — particularly if this Pain improves with exercise and worsens with rest. See an eye specialist (ophthalmologist) immediately if you develop a painful red eye, severe light sensitivity or blurred vision.

What are the causes for ankylosing spondylitis?

Ankylosing spondylitis has no known specific cause, though genetic factors seem to be involved. In particular, people who have a gene called HLA-B27 are at greatly increased risk of developing ankylosing spondylitis. However, only some people with the gene develop the condition.

What are the treatments for ankylosing spondylitis?

The goal of treatment is to relieve pain and stiffness and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage.


Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as naproxen (Aleve, Naprosyn, others) and ibuprofen (Advil, Motrin IB, others) — are the medications doctors most commonly use to treat ankylosing spondylitis. These medications can relieve inflammation, pain and stiffness, but they also might cause gastrointestinal bleeding.

If NSAIDs aren't helpful, your doctor might suggest starting a tumor necrosis factor (TNF) blocker or an interleukin-17 (IL-17) inhibitor. These drugs are injected under the skin or through an intravenous line. These types of medications can reactivate untreated tuberculosis and make you more prone to infections.

Examples of TNF blockers include:

  • Adalimumab (Humira)
  • Certolizumab pegol (Cimzia)
  • Etanercept (Enbrel)
  • Golimumab (Simponi)
  • Infliximab (Remicade)

IL-17 inhibitors used to treat ankylosing spondylitis include secukinumab (Cosentyx) and ixekizumab (Taltz).


Physical therapy is an important part of treatment and can provide a number of benefits, from pain relief to improved strength and flexibility. A physical therapist can design specific exercises for your needs. To help preserve good posture, you may be taught:

  • Range-of-motion and stretching exercises
  • Strengthening exercises for abdominal and back muscles
  • Proper sleeping and walking positions


Most people with ankylosing spondylitis don't need surgery. Surgery may be recommended if you have severe pain or if a hip joint is so damaged that it needs to be replaced.

Lifestyle and home remedies

Lifestyle choices can also help manage ankylosing spondylitis.

  • Stay active. Exercise can help ease pain, maintain flexibility and improve your posture.
  • Don't smoke. If you smoke, quit. Smoking is generally bad for your health, but it creates additional problems for people with ankylosing spondylitis, including further hampering breathing.
  • Practice good posture. Practicing standing straight in front of a mirror can help you avoid some of the problems associated with ankylosing spondylitis.

Coping and support

The course of your condition can change over time, and you might have painful episodes and periods of less pain throughout your life. But most people are able to live productive lives despite a diagnosis of ankylosing spondylitis.

You might want to join an online or in-person support group of people with this condition, to share experiences and support.

Preparing for your appointment

You might first bring your symptoms to the attention of your family doctor. He or she may refer you to a doctor who specializes in inflammatory disorders (rheumatologist).

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

  • Your symptoms, including any that may seem unrelated to the reason you made the appointment, and when they began
  • Key personal information, including major stresses, recent life changes and family medical history
  • All medications, vitamins and other supplements you take and their doses
  • Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you're given.

For ankylosing spondylitis, basic questions to ask your doctor include:

  • What's likely causing my symptoms?
  • Other than the most likely cause, what are other possible causes for my symptoms?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What's the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Should I see a specialist?
  • Are there brochures or other printed material I can have? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

  • Where is your pain?
  • How severe is your pain?
  • Have your symptoms been continuous or occasional?
  • What, if anything, seems to worsen or improve your symptoms?
  • Have you taken medications to relieve the pain? What helped most?

What are the risk factors for ankylosing spondylitis?

  • Your sex. Men are more likely to develop ankylosing spondylitis than are women.
  • Your age. Onset generally occurs in late adolescence or early adulthood.
  • Your heredity. Most people who have ankylosing spondylitis have the HLA-B27 gene. But many people who have this gene never develop ankylosing spondylitis.

Is there a cure/medications for ankylosing spondylitis?

While there is no cure for ankylosing spondylitis, there are treatments to help control symptoms and slow down the progression of the disease.

1. One of the most common medications doctors prescribe for ankylosing spondylitis is methotrexate. This drug has been used for rheumatoid arthritis and other inflammatory diseases for many years. It works by inhibiting the body's immune system from attacking itself and reducing inflammation in joints.

2. Methotrexate also reduces pain and stiffness in joints, but it can cause problems like nausea and vomiting, low white blood cell count (which can lead to infections), liver damage (if taken for long periods of time), hair loss, mouth sores, ulcers in the stomach or intestines (which may require surgery), skin rash or itchiness (which can lead to infection).

Other medications that may be prescribed include:

1. Anti-inflammatory drugs can help reduce inflammation and pain in your joints. These include methotrexate (Rheumatrex) and sulfasalazine (Azulfid).

2. Steroids can be given by injection or taken orally to reduce swelling, stiffness, and pain. Corticosteroids can also help with weight gain caused by a loss of appetite associated with AS.

3. Immunosuppressants are used to slow down or stop the body's immune system from attacking itself (autoimmunity). These medications might be used if anti-inflammatory drugs don't work well enough on their own or if they cause side effects like nausea or stomach upset that make it difficult for you to eat normally. They include cyclophosphamide (Cytoxan), azathioprine (Imuran), methotrexate (Rheumatrex), and mycophenolate mofetil (CellCept).

4. NSAIDS (nonsteroidal anti-inflammatory drugs) like ibuprofen or naproxen

5. Hydroxychloroquine (an antimalarial drug)

6. Corticosteroids like prednisone

7. Biologics—biologic agents that help suppress the immune system (these are expensive and often require infusions)

8. Pain relievers, such as acetaminophen (Tylenol) or NSAIDs (such as ibuprofen)

9. Bisphosphonates, which help prevent bone loss

10. Immunosuppressants, which decrease inflammation and pain

11. Corticosteroids, which reduce inflammation in the body

Pain in your lower back or other areas of your body,Stiffness in your lower back or other areas of your body,Pain in the morning when you wake up or when you sit down for long periods of time,Pain that gets worse as the day goes on,Pain when you move from lying down to sitting up or standing up,Numbness and tingling in the hands and feet (peripheral neuropathy)
Rheumatic fever,Celiac disease,Psoriatic arthritis,Hodgkin's lymphoma or leukemia, Lupus erythematosus (lupus)
Methotrexate,TNF inhibitors (anti-tumor necrosis factor),Corticosteroids (such as prednisone),Immune modulators

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