Ankylosing spondylitis
Your health expert: Dr Sundeept Bhalara, Consultant Rheumatologist and Physician
Content editor review by Victoria Goldman, Freelance Health Editor, October 2023
Next review due October 2026
Ankylosing spondylitis is a type of arthritis. This long-term condition affects the joints in your backbone (spine). It causes pain and stiffness in your lower back. The symptoms often get better with physiotherapy, exercise and medicines.
About ankylosing spondylitis
Ankylosing spondylitis belongs to a group of conditions called spondyloarthritis. Axial spondyloarthritis means the arthritis affects your spine and middle (central) part of your skeleton.
If you have ankylosing spondylitis, the joints in your spine become inflamed and worn down. Your body may eventually start to make new bone. If the disease progresses, this can eventually cause the bones of your spine to join together (fuse).
Usually, ankylosing spondylitis starts in your lower back and pelvis. But it can affect other joints too. These include:
- the rest of your spine
- the wall of your chest
- your hips
- your shoulders
- your knees
- your hands and fingers
- your feet
Ankylosing spondylitis is a long-term (chronic) disease – it can affect you over many years. The symptoms can come and go, and you may have periods of feeling well. For a lot of people, the symptoms stay mild and don’t cause any major problems.
You can get ankylosing spondylitis at any age, but it often starts in your twenties. Men are almost three times more likely than women to have ankylosing spondylitis.
Causes of ankylosing spondylitis
It’s not clear exactly why some people get ankylosing spondylitis and others don’t. But it’s thought to be a combination of genetics and environment.
Ankylosing spondylitis often runs in families. If you have a gene called HLA-B27, you’re more likely to develop the condition. But not everyone who has this gene develops it. You’re more likely to have ankylosing spondylitis if you also have a close relative with the condition. Other genes and environmental factors may also be involved.
Ankylosing spondylitis is an autoimmune condition. This means your body attacks its own healthy tissues. In someone with the HLA-B27 gene, the inflammation may be triggered by an infection or something in the environment.
Symptoms of ankylosing spondylitis
Ankylosing spondylitis symptoms tend to develop slowly over several years. Your symptoms may be very mild at first, but they may get more noticeable over time. You may also have times when your symptoms temporarily get worse (flare-ups), followed by times when you feel better again (remission).
The main symptoms of ankylosing spondylitis are pain and stiffness in your lower back. The pain:
- is usually worse in the second half of the night or first thing in the morning
- can sometimes be severe enough to wake you up
- usually gets better when you start to move around
- may affect your bottom and back of your thighs
- pain in joints, such as your neck, shoulders, chest and hips – this can be worse if you haven’t been keeping active
- pain in parts of your body where tendons attach to a bone, such as your elbows, knees, and heels – this is called enthesitis
- a red and sore eye, with sensitivity to bright lights – if you develop this, seek medical help straightaway to prevent permanent damage
- weakness and exhaustion (fatigue)
- other inflammatory conditions, such as inflammatory bowel disease or psoriasis
The symptoms can affect other parts of your body too. You may have:
If you have severe back pain that gets worse or doesn’t get any better over time (over three months), see your GP.
Diagnosis of ankylosing spondylitis
Your GP will ask about your symptoms and medical history and will examine you. They may ask you to do certain movements to check how well you can move different joints. They may also feel your back to see if your joints are tender. Your GP may refer you to a rheumatologist (a doctor who diagnoses and treats conditions that affect your joints and surrounding tissues).
You may have several tests to help diagnose ankylosing spondylitis. These tests include:
Treatment of ankylosing spondylitis
Ankylosing spondylitis is a long-term condition. There’s no cure, but there are lots of ways to manage your symptoms and stop them getting worse. A physiotherapist can give you some exercises to keep you mobile. You can also take medicines to ease any pain and stiffness. This should reduce how much the disease affects your everyday life.
Your GP or rheumatologist will discuss with you the best way to manage your symptoms. This may depend on:
- whether you’re having a flare-up at the time
- the symptoms you’re having and how severe they are
- your personal preferences
Physiotherapy and exercise
Physiotherapy is an important part of ankylosing spondylitis treatment. Your doctor will refer you to a physiotherapist or you may be able to refer yourself.
A physiotherapist will put together an exercise programme for you. This will be designed to help you to stay as flexible and mobile as possible. It may include:
- exercises to help stretch and strengthen your back
- exercises to help maintain a good posture
- deep breathing exercises to help expand your chest muscles
- exercises that extend your spine
- exercises that work the different sections of your spine and help to improve how well you can move in each area
- aerobic exercise (exercises that increase your heart rate and get you out of breath)
- water therapy (hydrotherapy) – exercises in a heated pool may help to manage your pain and improve how much you can move
Medicines
Painkillers and anti-inflammatory medicines
Your doctor will usually offer you treatment with non-steroidal anti-inflammatory drugs (NSAIDs) first. These will help to reduce pain and stiffness in your joints. If you take them regularly, these medicines may help to slow down how quickly your condition worsens. But doctors don’t know this for sure. If your medicine doesn’t help within a few weeks, your doctor may change the dose or try a different medicine.
If you take NSAIDs, 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 some reason or they’re not helping, your doctor may suggest a different painkiller. This may be paracetamol or codeine.
If you have a very painful and swollen joint, your doctor may suggest you have a steroid injection into it.
Disease-modifying anti-rheumatic drugs
Your rheumatologist may recommend you take a type of medicine called a disease-modifying anti-rheumatic drug (DMARD).
There are different types of DMARD, including a group of medicines called tumour necrosis factor (TNF) blockers, or biological DMARDs. These medicines include:
- etanercept
- adalimumab
- golimumab
- certolizumab pegol
- secukinumab
- ixekizumab
- upadacitinib
DMARDs target your immune system to reduce inflammation. Your rheumatologist may recommend you take them if your symptoms are severe and other treatments haven’t helped. You can have these medicines as an injection – you can learn to do this yourself. Your rheumatologist will track your response to these medicines closely and only continue your treatment if it’s clearly working.
Older types of DMARD include methotrexate and sulfasalazine. Your rheumatologist may suggest you try these if your symptoms have spread to your arms or your legs (peripheral disease). They don’t seem to help with pain and stiffness in your spine.
Surgery
Most people with ankylosing spondylitis don’t need surgery. But if one of your joints, such as your hip or shoulder is badly affected, your doctor may suggest you have it replaced. If you have a fused and bent spine that really affects your quality of life, you may be offered an operation to correct it.
Physiotherapy services
Our evidence-based physiotherapy services are designed to address a wide range of musculoskeletal conditions, promote recovery, and enhance overall quality of life. Our physiotherapists are specialised in treating orthopaedic, rheumatological, musculoskeletal conditions and sports-related injury by using tools including education and advice, pain management strategies, exercise therapy and manual therapy techniques.
To book or to make an enquiry, call us on 0345 850 8399
Complications of ankylosing spondylitis
If you’ve had severe disease for a long time, you’ll have a higher risk of developing complications. Ankylosing spondylitis complications may include the following.
- Spinal fractures. You’re at greater risk if the bones in your spine have fused.
- Osteoporosis. This is when your bones become weak and brittle, which can make them more likely to break. Up to a third of people with ankylosing spondylitis are thought to develop osteoporosis.
- Heart problems. People with ankylosing spondylitis seem to be at greater risk of developing problems with their heart and circulation.
- Breathing problems. People with ankylosing spondylitis seem to be at greater risk of developing problems with their breathing.
Living with ankylosing spondylitis
Ankylosing spondylitis affects people in different ways. Most people will have very mild symptoms that cause few problems. But some people find their symptoms slowly keep getting worse. This can affect their daily life and lead to ongoing problems with pain and movement. Understanding your condition may help you keep your symptoms under control.
When you’re first diagnosed, your doctor should talk you through how to deal with any flare-ups. This may include:
- telling you who to contact if you need help (such as a rheumatology nurse)
- showing you some stretches and exercises to do
- giving you information on how to manage your pain and fatigue
You may live more easily with ankylosing spondylitis if you’re a non-smoker. Smoking can make your ankylosing spondylitis worse. It can also make you more likely to have problems with your lungs. If you smoke, you can ask your pharmacist or GP for advice on how to stop smoking.
Some people with ankylosing spondylitis have problems with their feet. Your GP or physiotherapist may recommend that you see a podiatrist (who diagnoses and treats conditions that affect your feet) if you’re getting any foot or ankle pain.
Keeping active
Keeping active is one of the most important things you can do if you have ankylosing spondylitis. Exercise can help to ease stiffness and pain. It also improves your strength, flexibility and how well you can move different joints. A physiotherapist can help you to develop a daily routine of exercises. For more information, see our Treatment of ankylosing spondylitis section.
You may find exercises such as T’ai-chi, yoga and Pilates useful. These help with posture, flexibility, and core strength. Swimming and hydrotherapy are great exercises for ankylosing spondylitis too. They work all your joints and muscles, without putting pressure on them. If you need advice about which types of exercise to do, talk to your doctor or physiotherapist.
Work
Most people with ankylosing spondylitis can carry on working. But you may need to make changes at work, especially if you have a physically demanding job. If you’re having difficulties with everyday activities, your doctor may refer you to an occupational therapist for advice. They can tell you about any changes you can make or devices you can use to make life easier.
Driving
Most people with ankylosing spondylitis don’t have any problems driving. But if you’re finding it difficult, make sure you take regular breaks to stretch and move around. You may have problems turning your head when you reverse your car. If you do, wide rear-view mirrors and parking sensors may help. If you make any adaptations to your car, or your symptoms affect your driving, you’ll need to tell the Driver & Vehicle Licensing Agency (DVLA).
Posture
Making sure you have good posture during the day may help to ease your symptoms.
- Stand up and move around regularly.
- Try not to stay in the same position for too long.
- Lying on your back on the floor may help to stretch out the front of your hips and improve your posture.
Sleep
Ankylosing spondylitis may affect your sleep. Having a warm bath before you go to bed, or using a hot water bottle or electric blanket, may help to ease any pain. You can try sleeping on a firm mattress with a thin pillow to reduce the chances of getting any neck problems.
The causes of ankylosing spondylitis aren’t fully known. But the condition often runs in families. Things in your environment or an infection may trigger the disease too. For more information, see our Causes of ankylosing spondylitis section.
Ankylosing spondylitis causes pain and stiffness in your lower back, your bottom and at the top of your thighs. The symptoms are usually worse if you haven’t been active for a while. You may feel very tired too. For more information, see our Symptoms of ankylosing spondylitis section.
Ankylosing spondylitis pain is worse in the second half of the night or first thing in the morning. It usually gets better when you move around. It can be worse if you haven’t been very active. For more information, see our Symptoms of ankylosing spondylitis section.
The main warning sign of ankylosing spondylitis is pain in your lower back that’s getting worse or isn’t getting better. The condition can also cause stiffness and fatigue early in the morning. For more information, see our Symptoms of ankylosing spondylitis section.
If you have ankylosing spondylitis, the joints in your spine (backbone) get inflamed and worn down. Your body may eventually start to make new bone and the bones of your spine may join together. For more information, see our About ankylosing spondylitis section.
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