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Ankylosing spondylitis


Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician
Next review due November 2019

Ankylosing spondylitis is a type of arthritis that mainly affects the joints in your spine (backbone). Your spine becomes stiff and painful and this can affect how well you’re able to move. Some of the bones in your spine may join together. Ankylosing spondylitis affects other joints too, especially your hips, shoulders and the wall of your chest. Ankylosing spondylitis develops when the bones in your spine become inflamed where the tendons are attached and between the joints. Your body tries to mend the damage by producing new bone and as this grows, it can eventually join the bones of your spine together.

You can develop ankylosing spondylitis at any time, but it usually starts when you’re a young adult in your late teens or early twenties. Men are almost three times more likely to have it than women. Ankylosing spondylitis belongs to a group of conditions called ‘spondyloarthritis’. You may sometimes hear ankylosing spondylitis referred to as ‘axial spondyloarthritis’.

Image showing how ankylosing spondylitis can affect the spine

Symptoms of ankylosing spondylitis

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.

Diagnosis of ankylosing spondylitis

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:


Treatment of ankylosing spondylitis

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.

Self-help

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.

Physiotherapy

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. 

Medicines

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.

Other medicines

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

Surgery

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.

Causes of ankylosing spondylitis

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

Complications of ankylosing spondylitis

Complications of ankylosing spondylitis include the following.

  • Osteoporosis – this is when your bones become weak and brittle, which can make them more likely to break.
  • Respiratory problems – for example, fibrosis of the lung.
  • Heart problems – it’s important to have regular check ups.

Living with 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.

Frequently asked questions

  • 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.

  • 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.

    Exercises for low back pain by Bupa UK
    Click on the image to view a PDF of the exercises for low back pain.

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Related information


    • Ankylosing spondylitis. BMJ Best Practice. bestpractice.bmj.com, last updated February 2016
    • Ankylosing spondylitis. PatientPlus. patient.info/patientplus, last checked February 2015
    • Ankylosing spondylitis and undifferentiated spondyloarthropathy. Medscape. emedicine.medscape.com, updated January 2016
    • Ankylosing spondylitis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised February 2013
    • Musculoskeletal medicine: Spondyloarthritis. GP Update Handbook (online). GP Update Ltd, gpcpd.com, accessed 9 September 2016
    • Rheumatology. Oxford handbook of clinical medicine (online). Oxford Medicine Online. oxfordmedicine.com, published January 2014
    • 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
    • Dagfinrud H, Hagen KB, Kvien TK. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD002822. DOI: 10.1002/14651858.CD002822.pub3
    • Exercises for ankylosing spondylitis. Arthritis Research UK. www.arthritisresearchuk.org, accessed 11 September 2016
    • Driving and ankylosing spondylitis (AS). Arthritis Research UK www.arthritisresearchuk.org, accessed 9 September 2016

  • Reviewed by Nick Ridgman and Michelle Harrison, Bupa Health Content Team, November 2016
    Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician
    Next review due November 2019



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