The symptoms of ankylosing spondylitis can develop slowly and it may be years before the condition is actually diagnosed. Symptoms can be mild but they can also be severe enough to be disabling. The condition can flare up and then go into remission, which means symptoms can come and go.
The main symptoms include the following.
- Lower back pain and stiffness which lasts for more than three months. This is usually worse in the second half of the night or when you get out of bed, but gets better when you start moving. You may also find that the pain and stiffness is bad enough to wake you.
- An inflamed iris, which is the coloured part of your eye. The white of your eye may also become red as a result. If this develops, see a doctor straightaway because if it’s not treated, it can lead to blindness.
- Pain and swelling of your hip, knee or other joints.
- Feeling tired and having disturbed sleep.
- Difficulty breathing (shortness of breath).
- A curving spine.
- Buttock pain.
If you have any of these symptoms, see your GP.
Your GP will ask about your symptoms and examine you, including looking at your back, joints and chest. They may also ask you about your medical history.
If your GP thinks you may have ankylosing spondylitis, they’re likely to refer you to a rheumatologist. A rheumatologist is a doctor who specialises in diagnosing and treating conditions that affect your joints and surrounding tissues. At your GP practice or hospital, you may be asked to have the following tests:
Ankylosing spondylitis is a long-term and progressive condition. This means it usually gets worse over time. However, the large majority of people with the condition live normally until later life.
There is no cure for ankylosing spondylitis at present. However, there are treatments that can help to ease any symptoms you may have.
Exercise can help to ease your pain and stiffness and will help you to move more easily. This means doing daily exercises for low back pain and, if you’re able to, swimming regularly. You can find out more about exercise in our FAQ on self-help exercises.
Your doctor may refer you to a physiotherapist. They can give you exercises that will help you to stay as flexible and fit as possible. You may also be asked to do breathing exercises to keep your ribs and chest flexible. Your physiotherapist may suggest hydrotherapy, which means doing exercises in the water in a hydrotherapy pool.
Painkillers and anti-inflammatory medicines
Non-steroidal anti-inflammatory drugs (NSAIDs) can help to reduce your pain and the stiffness in your joints. They may also help to slow down any worsening of your condition. Depending on how severe your pain is and the strength of painkillers you need, your doctor may need to prescribe these.
If you take NSAIDs regularly, your doctor may suggest you take a medicine called a proton pump inhibitor as well. This will protect your stomach and reduce the risk of side-effects from NSAIDs.
If you can’t take NSAIDs for any reason, your doctor may suggest a different painkiller, such as paracetamol or codeine.
Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
If your joints are painful and swollen, your doctor may suggest a steroid injection into the joint.
If your symptoms are severe, and if other treatments haven’t worked, your doctor may suggest other medicines. These may include the following.
- Disease-modifying anti-rheumatic drugs (DMARDs), such as sulfasalazine.
- Biological treatments such as tumour necrosis factor (TNF) blockers including etanercept and adalimumab
Most people with ankylosing spondylitis don’t need surgery. But if one of your joints such as your hip or shoulder is severely affected, your doctor may suggest having it replaced. A small number of people with a fused and bent spine may have an operation to correct it.
Doctors don’t yet know exactly what causes ankylosing spondylitis.
The condition often runs in families. If you have a gene called HLA-B27, you may be more likely to develop the condition. However, if you do have this gene, it doesn’t mean you will definitely be affected. Fewer than seven in 100 people with the gene go on to develop ankylosing spondylitis
Ankylosing spondylitis affects people in different ways. You might need to make changes to your work and home life to help reduce pain and stiffness and make it easier for you to move. For example, getting the right chair and bed can make it easier for you to get up.
Exercise is crucial if you have ankylosing spondylitis. Exercise helps to ease your symptoms and most people feel much better afterwards. A physiotherapist with specific experience of ankylosing spondylitis can help you to develop a daily routine of exercises. This may include exercises and stretches designed to keep you fit and increase the amount of movement in your joints. You may also be given exercises that will help your posture, which will help you to stand upright. These can include deep breathing exercises and spine extension exercises.
Some people with ankylosing spondylitis find tai-chi, yoga and Pilates useful because these regimes help you to stretch, which is good for posture and flexibility.
It's best not to take part in contact sports, such as rugby, or high impact activities like basketball and hockey. This is because you’re more likely to be injured doing this type of activity.
If you need advice about ankylosing spondylitis and exercise, talk to your doctor or physiotherapist.
Many people with ankylosing spondylitis have few or no problems driving. But if you’re finding driving difficult, these tips may help.
- During long journeys, stop regularly and get out of the car to stretch and move around.
- If you have problems turning your head when you reverse your car, wide rear-view mirrors and parking sensors may help. If you have any adaptations to your car, you will need to tell the Driver & Vehicle Licensing Agency (DVLA). You should also tell them if your condition starts to affect your driving in any way.
- Adjust your seat and neck rest so that they are comfortable and supportive.
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- Musculoskeletal medicine: Spondyloarthritis. GP Update Handbook (online). GP Update Ltd, gpcpd.com, accessed 9 September 2016
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- Ankylosing spondylitis. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 9 September 2016
- TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis. National Institute for Health and Care Excellence (NICE), February 2016. www.nice.org.uk
- Osteoporosis. BMJ Best Practice. bestpractice.bmj.com, last updated August 2015
- Living well with AS. National Ankylosing Spondylitis Society. nass.co.uk, published March 2015
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Reviewed by Nick Ridgman and Michelle Harrison, Bupa Health Content Team, November 2016
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