What is ankylosing spondylitis?

ankylosing spondylitis (AS) is a type of arthritis in which chronic inflammation primarily affects the back and neck (spine).

In severe cases, the bones in the spine may fuse or stick together (also called ankylosis). These adhesions cause stiffness and stiffness in the spine. Therefore, abnormal posture may result.

This condition can sometimes involve other joints, including the hips, knees, ankles, or shoulders. The disease may also affect various organs systemically—systemic means affecting the entire body, not individual body parts.

This article explains the symptoms, causes, diagnosis, and treatment of ankylosing spondylitis.

type of arthritis

AS belongs to a group called Spondyloarthropathy.

What is spondyloarthropathy?

Spondyloarthropathy is a type of arthritis that affects the bones of the spine and surrounding joints. At least 2.7 million adults in the United States have spondyloarthritis.

Other spondyloarthropathies include:

  • reactive arthritis
  • psoriatic arthritis
  • enteropathic arthritis

Spondyloarthropathies are axial or peripheral, depending on the joints involved. Axial refers to diseases that involve the spine, while peripheral refers to diseases that affect other joints than the spine.

AS is an axial spondyloarthropathy.


AS is a spondyloarthropathy, a group of arthritis disorders that affect the spine and surrounding joints.

Ankylosing spondylitis symptoms

Symptoms of AS usually begin before age 45. They usually happen in stages.

Early symptoms

The earliest symptoms of AS include:

  • lower back pain and stiffness
  • Pain that worsens with rest or inactivity and improves with activity
  • Morning stiffness​​lasting more than 30 minutes

Eventually, pain and stiffness can develop into chronic symptoms.

chronic symptoms

Over time, pain and stiffness can develop up the spine and into the neck. When this happens, you may experience the following symptoms:

  • Bones in the spine and neck may fuse
  • limited range of motion
  • decreased spinal flexibility of the spine
  • Shoulder, hip, and other joints may be involved

Pain in the hip, groin, or buttocks may make walking difficult. If your chest cavity is involved, abnormal chest expansion can make breathing difficult.Additionally, tendons and ligaments may be affected, resulting in Achilles tendinitis and plantar fasciitis.

Systemic symptoms

AS is also a systemic disease, which means people may experience symptoms throughout the body, including:

  • fever
  • fatigue
  • eye inflammation
  • Intestinal inflammation
  • Cardiovascular or lung problems (rare)

While anyone can develop AS, more men than women develop the disease. The age of onset is usually between 17 and 35 years old.


Symptoms of ankylosing spondylitis appear in stages. It starts with pain and stiffness in the lower back. Eventually, as the condition becomes chronic, pain and stiffness can spread to the neck, buttocks, and chest. Some people notice systemic organ-related symptoms.

What are the symptoms of ankylosing spondylitis?


The reason for this is unclear, but the genetic marker HLA-B27 is present in 90 percent of people with the disease, suggesting a genetic link. However, it is important to note that not everyone with the HLA-B27 marker will develop AS.

According to the American Spondylitis Association, more than 60 other genes or genetic markers predispose people to AS. The researchers believe that a combination of triggering environmental events and genetic susceptibility can lead to disease development.

Causes of Ankylosing Spondylitis


A healthcare provider makes a diagnosis based on symptoms, a physical exam, blood tests, and imaging studies. Because early symptoms of ankylosing spondylitis can mimic other conditions, healthcare providers use diagnostic tests to rule out other rheumatic diseases.

If other tests show no evidence of rheumatoid factor and rheumatoid nodules, this helps distinguish it from rheumatoid arthritis.

Rheumatoid factor and rheumatoid nodules

Rheumatoid factor is an autoantibody against rheumatoid arthritis. Rheumatoid nodules are masses of inflammatory tissue that form under the skin.

blood test

While no single blood test can definitively diagnose AS, some tests provide important diagnostic clues. These tests include:

  • HLA-B27 test
  • Nonspecific inflammatory tests (sedimentation rate and CRP)

These tests help shape the clinical presentation, but they are not diagnostic. For example, while 95% of whites with AS have the HLA-B27 gene, only 50% of blacks with AS have HLA-B27. Therefore, a blood test is an unreliable independent diagnostic criterion.


Imaging studies often show characteristic changes in bone sacroiliac joint Joint (space between sacrum and hip bone). These changes may be visible in:

  • X-ray
  • Magnetic Resonance Imaging (MRI)

Health care providers use X-rays to evaluate evidence of damage to the joints and spine. However, symptoms can take years to be observed after they appear. MRIs can often detect them earlier than X-ray images.


The diagnosis of ankylosing spondylitis includes a physical examination, medical history, blood tests, and imaging studies. Genetic factors in blood tests may provide some clues, but alone cannot definitively diagnose the condition.


Treatment goals include reducing pain, stiffness, and inflammation, preventing deformities, and maintaining function and posture.


Many medications treat AS. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for the disease, and many people use NSAIDs alone. However, when NSAIDs do not control pain well, analgesics or pain relievers may help.

Protein and Molecular Blockers

Tumor necrosis factor inhibitors (TNF blockers) block a protein called TNFα to reduce inflammation. These drugs have shown significant improvement in disease activity. They include:

  • Humira (adalimumab)
  • treat (Infliximab)
  • Embrel (etanercept)
  • Sinzia (Certolizumab polyethylene glycol)
  • Simpony (Golimumab)

also, Cosentyx (secukinumab)is an IL-17 inhibitor (signaling molecule blocker) approved in 2016 for the treatment of AS.


DMARDs (disease-modifying antirheumatic drugs) slow disease progression. usually, Sulfasalazine Helps patients with AS and peripheral arthritis who cannot use TNF blockers.

Methotrexate alone may help some people, but in general, it’s not enough to treat AS. Likewise, another DMARD, Arava (leflunomide), has little benefit in treating AS.


Few healthcare providers prescribe short-term courses of oral corticosteroids. These should not be used long term.

physical therapy

Physical therapy and exercise are an important part of any AS treatment plan. Exercise is essential for managing disease and maintaining mobility and function.


The goals of treatment for ankylosing spondylitis are pain control and mobility. Medications reduce inflammation, control pain, and slow disease progression. Additionally, physical therapy and exercise are integral to maintaining spinal function.

Treatment options for ankylosing spondylitis


Some people have a milder disease and can work and function normally. Others develop severe illness and suffer from many restrictions.

While some people with ankylosing spondylitis experience life-threatening extra-articular (extra-articular) complications, this is rare and not the case for most people.

Often, the disease activity a person deals with is largely manageable. A small number of people with this disorder will reach a stage where symptoms are relieved and relieved.

If you have any questions or concerns, please consult a healthcare provider. The treatments and coping strategies they offer can improve how you feel and your overall outcome.


A fused or less flexible spine is more likely to fracture. Therefore, you must be aware of additional risks and take precautions. Protect your spine by limiting or avoiding behaviors that may increase your risk of falling, including:

  • Limit drinking
  • Install the handrail
  • Pick up your carpet
  • Avoid high-impact activities

Also, consider using a pillow to keep your neck and back well aligned while you rest or sleep. Always wear a seat belt when driving or riding in a vehicle.

People with AS who smoke should quit smoking to reduce the risk of breathing problems. And don’t forget the importance of participating in an exercise program to strengthen your spine and improve your overall joint health.

How To Live With Ankylosing Spondylitis


Ankylosing spondylitis is a type of arthritis that affects the spine. Symptoms include pain, stiffness, and limited range of motion. The condition is systemic and affects organ systems. AS is treated with medications that reduce pain, reduce inflammation, and slow disease progression.

VigorTip words

If symptoms of ankylosing spondylitis are affecting your daily life, know that there are treatment options available. Discuss with your healthcare team what medicines or treatment plans are right for you.

In addition to medication, many people find that simple stretching and physical therapy go a long way in helping their bodies feel better. Start slowly and explore moves that work for you. This might take some time, but you might find something useful.

Spondyloarthropathy: Types, Symptoms, and Treatment