Many people first notice ankylosing spondylitis as a deep, dull ache in the lower back or buttocks that creeps in gradually over weeks to months, often worse in the early morning or after resting and easing with movement or a warm shower. You might also see early clues like morning stiffness lasting longer than 30 minutes, pain that wakes you in the second half of the night, or alternating buttock pain, sometimes along with heel soreness or unexplained fatigue. These first signs of ankylosing spondylitis often appear in late teens to early adulthood, and a pattern of symptoms improving with activity rather than rest is a key hint to seek medical evaluation.
Condition
Ankylosing spondylitis
This condition is associated to the following genes:
This condition has the following symptoms:
Back painMorning stiffnessReduced flexibilityButtock/hip painFatigueNeck painChest painAnkylosing spondylitis is a long-term inflammatory arthritis that mainly affects the spine and sacroiliac joints. People with ankylosing spondylitis often have back pain, morning stiffness, and fatigue that improve with movement. It usually starts in late teens to early adulthood, and it is more common in people with the HLA‑B27 gene. Most people with ankylosing spondylitis live a normal lifespan, but severe cases can limit flexibility and breathing. Treatment focuses on exercise, physical therapy, anti‑inflammatory medicines, and biologic therapies to reduce pain and protect mobility.
Short Overview
Symptoms
Ankylosing spondylitis causes deep low back and buttock pain with morning stiffness that eases as you move. Early symptoms may include pain waking you at night, reduced flexibility, heel or hip soreness, fatigue, and chest discomfort when taking deep breaths.
Outlook and Prognosis
Many people with ankylosing spondylitis lead full, active lives, especially with early diagnosis and a tailored care plan. Symptoms often come in waves; modern treatments can ease pain, protect mobility, and reduce flares. Regular movement, good posture, and follow‑up visits help long-term joint health.
Causes and Risk Factors
Ankylosing spondylitis likely stems from immune dysregulation in genetically predisposed people, most often linked to HLA‑B27 and family history. Risk rises with younger age (teens–30s), male sex, ancestries, and gut inflammation. Smoking and infections may trigger or worsen disease.
Genetic influences
Genetics play a major role in ankylosing spondylitis. Many people carry the HLA‑B27 gene, which raises risk but doesn’t guarantee disease. Other gene variations and family history also contribute, while environment and immune triggers influence who develops symptoms.
Diagnosis
Ankylosing spondylitis is diagnosed through history and exam focused on long‑lasting back pain and morning stiffness. X‑ray or MRI of the sacroiliac joints plus blood tests (inflammation markers, sometimes HLA‑B27) typically support the diagnosis of ankylosing spondylitis.
Treatment and Drugs
Ankylosing spondylitis care focuses on easing pain, protecting posture, and keeping the spine flexible. Many start with daily stretching, physical therapy, NSAIDs, and heat; if symptoms persist, biologics like TNF or IL‑17 inhibitors can calm inflammation. When joints are badly damaged, targeted steroid injections or surgery may help.
Symptoms
Morning stiffness, aching in the lower back, and pain that eases as you move can shape how you start the day. For many, early symptoms of ankylosing spondylitis show up in the lower back, hips, or buttocks and can wake you in the second half of the night. Symptoms vary from person to person and can change over time. Over months to years, you may also notice fatigue, limited flexibility, or chest discomfort with deep breaths.
Lower back pain: Aching deep in the lower back and buttocks, often on one side or switching sides. Pain tends to ease with movement but can worsen with rest. It may wake you in the second half of the night.
Morning stiffness: Stiffness that lasts after waking and improves as you get moving. Resting for long periods can bring it back. Many people with ankylosing spondylitis notice this most in the early hours.
Alternating buttock pain: Deep, dull ache in one buttock that may switch sides. This often reflects irritation of joints at the base of the spine. It is a common early clue in ankylosing spondylitis.
Reduced flexibility: Difficulty bending or twisting the spine. You may find it harder to touch your toes or turn your head to check a blind spot. Over time, ankylosing spondylitis can make posture feel more rigid.
Chest discomfort: Soreness where the ribs meet the spine or breastbone. Taking a deep breath can feel tight or painful. This can make aerobic activity feel harder during a flare.
Neck pain: Aching or stiffness in the neck. It can make looking over your shoulder or down at a phone uncomfortable. Symptoms may ebb and flow with flares.
Heel pain: Tenderness at the back or bottom of the heel. Stepping out of bed or after sitting can be especially sore. This comes from irritation where tendons and ligaments attach to bone.
Swollen joints: Pain, warmth, or swelling in hips, knees, or shoulders. These joints may feel weak or unstable during a flare. In ankylosing spondylitis, this happens less often than back symptoms but can be significant.
Fatigue: Unusual tiredness that doesn’t match your activity. Broken sleep from pain and body-wide inflammation can drain energy. This fatigue can affect concentration and mood.
Eye symptoms: Sudden eye pain, redness, and sensitivity to light. Vision may blur and the eye can feel tender. This eye inflammation is linked to ankylosing spondylitis.
Night wakening: Pain that wakes you in the early morning hours. Getting up to move often helps more than staying in bed. This pattern is common when back pain is driven by inflammation.
How people usually first notice
Types of Ankylosing spondylitis
Ankylosing spondylitis has a few recognized clinical variants that can look a bit different in daily life. Some focus mostly on the spine and pelvis, while others involve joints in the arms or legs or bring eye inflammation into the picture. People may notice different sets of symptoms depending on their situation. When reading about types of ankylosing spondylitis, it’s helpful to remember that signs can overlap and shift over time.
Axial-predominant AS
Back and buttock pain with morning stiffness is front and center. It often improves with movement, not rest. Flare-ups may wake people at night and ease after a warm shower.
Peripheral-predominant AS
Knees, ankles, heels, or shoulders get swollen and tender. You might notice heel pain from inflamed tendon attachments. Hands are less commonly involved than in rheumatoid arthritis.
Radiographic AS
X‑rays show characteristic changes in the sacroiliac joints and spine. Symptoms mirror axial disease, but the structural changes help confirm the diagnosis. This is sometimes contrasted with nonradiographic disease when X‑rays look normal.
Nonradiographic axial SpA
Symptoms focus on the spine and sacroiliac joints, but standard X‑rays look normal. MRI may show inflammation, and symptoms can be just as bothersome as radiographic AS. Some people later develop X‑ray changes, while others do not.
Acute anterior uveitis
Sudden eye pain, redness, and light sensitivity can occur. Vision may blur, usually in one eye at a time. Prompt eye care helps prevent complications.
Enthesitis focus
Pain where tendons and ligaments attach to bone—often the heels, knees, or pelvis—stands out. Morning stiffness and pain with first steps or after sitting are common. Daily life often makes the differences between symptom types clearer.
Dactylitis pattern
A whole finger or toe becomes swollen and sore, sometimes called a “sausage digit.” It can make gripping or walking uncomfortable. This pattern often comes and goes with flares.
Juvenile-onset form
Symptoms begin in childhood or the teen years, often with more peripheral joint swelling at first. Back pain and stiffness may appear later. Early recognition can help keep school, sports, and sleep on track.
Did you know?
People with certain HLA‑B27 gene types are more likely to develop ankylosing spondylitis, with early back pain, morning stiffness, and eye inflammation (uveitis). Variants in ERAP1 and IL23R can heighten immune signaling, linking to flares, fatigue, and more severe spinal inflammation.
Causes and Risk Factors
Ankylosing spondylitis risk is shaped by genes, especially a marker called HLA-B27. Risk factors for ankylosing spondylitis include a family history, being assigned male at birth, and younger adult age. Most people who carry HLA-B27 do not develop the disease.
Doctors distinguish between risk factors you can change and those you can’t. Smoking is a changeable risk, and chronic bowel diseases like Crohn’s disease or ulcerative colitis also raise risk.
Environmental and Biological Risk Factors
It can be unsettling to wonder why ankylosing spondylitis shows up in some people and not others. Knowing early symptoms of ankylosing spondylitis and who faces higher risk can help you seek care sooner. Doctors often group risks into internal (biological) and external (environmental). Below are factors tied to a greater chance of developing this condition.
Male sex at birth: People assigned male at birth are more likely to develop ankylosing spondylitis. They often show typical spine changes earlier than those assigned female at birth. Differences likely reflect interactions between hormones and immune signals.
Young adult age: Risk is higher from the late teens through the 30s than in older adults. Many first notice persistent back stiffness or nighttime pain during this window. Earlier recognition can speed diagnosis and care.
Inflammatory bowel disease: People with Crohn’s disease or ulcerative colitis have a higher chance of ankylosing spondylitis. Shared immune pathways between gut and spine appear to link these conditions. Coordinated care can help catch spine symptoms early.
Recurrent uveitis: Episodes of sudden, painful red eye with light sensitivity are linked with a greater likelihood of ankylosing spondylitis. This eye inflammation can precede back symptoms by years. Eye and spine teams often coordinate when this pattern appears.
Psoriasis: Having psoriasis is associated with a higher rate of spondyloarthritis, including ankylosing spondylitis. Skin and joint inflammation can travel together through overlapping immune signals. Screening for back symptoms is often advised.
Gut microbiome changes: Imbalances in gut bacteria and low-grade intestinal inflammation are found more often in people with ankylosing spondylitis. These changes can stimulate immune activity near the spine and tendon attachments. Researchers are still learning how strong this link is.
Genetic Risk Factors
Ankylosing spondylitis often runs in families and is strongly linked to certain immune system genes, especially a gene called HLA‑B27. These genetic risk factors for ankylosing spondylitis raise the chance of developing the condition but do not determine it on their own. Other genes that shape immune signaling also add to risk, and the mix of genes can differ by ancestry. Carrying a genetic change doesn’t guarantee the condition will appear.
HLA-B27 gene: Most people with ankylosing spondylitis carry HLA‑B27, yet many HLA‑B27–positive individuals never develop the condition. This immune gene influences how the body presents protein fragments to defense cells.
HLA-B27 subtypes: Some HLA‑B27 subtypes raise risk more than others, and which subtypes are common varies by ancestry. This partly explains differences in ankylosing spondylitis rates between populations.
Family history: Having a parent or sibling with ankylosing spondylitis increases your chance compared with people without a family history. Families often share HLA‑B27 and other risk variants, which can add up.
ERAP1 and ERAP2: Variants in ERAP1 or ERAP2, genes that trim protein pieces for HLA molecules, can raise risk. Their impact is strongest when HLA‑B27 is also present, pointing to gene–gene interactions.
IL-23 pathway genes: Changes in IL23R and related genes that guide the IL‑23/IL‑17 immune pathway are linked to ankylosing spondylitis. These variants can tilt immune responses toward inflammation at the spine and where tendons and ligaments attach to bone. They add small but meaningful risk.
Other HLA genes: Beyond HLA‑B27, other HLA region genes contribute to risk in smaller ways. Together they fine‑tune how the immune system recognizes the body’s own proteins.
Shared immune genes: Some of the same genetic variants appear in psoriasis and inflammatory bowel disease. This shared biology helps explain why these conditions sometimes occur together.
Polygenic background: Dozens of additional genetic differences each add a tiny effect, and the total combination matters. Research is exploring polygenic scores to estimate risk, but these tools are not yet used widely in clinics.
Lifestyle Risk Factors
Lifestyle habits do not cause ankylosing spondylitis, but they can shape pain, stiffness, flare frequency, and long-term complications such as bone loss and heart risk. Understanding how lifestyle affects ankylosing spondylitis helps you focus on changes that support mobility and daily function. The elements below highlight practical, modifiable lifestyle risk factors for ankylosing spondylitis and their real effects on symptoms and progression.
Physical inactivity: Limited movement allows stiffness to build and reduces spinal mobility. Regular low-impact exercise improves posture, chest expansion, and pain control.
Smoking: Smoking is linked to higher disease activity and faster spinal damage in ankylosing spondylitis. Quitting can improve breathing mechanics and treatment response.
Sedentary posture: Long periods of sitting increase stiffness and can promote forward stooping. Frequent movement breaks and extension-focused routines help maintain alignment.
High-impact strain: Heavy lifting and repetitive twisting can aggravate enthesitis and provoke flares. Choosing joint-sparing activities lowers injury risk and pain spikes.
Excess body weight: Added mechanical load and adipose-driven inflammation can worsen pain and mobility in ankylosing spondylitis. Weight reduction may enhance biologic response and daily function.
Pro-inflammatory diet: Diets high in ultra-processed foods, sugars, and saturated fats may amplify systemic inflammation and symptom intensity. A Mediterranean-style pattern has been associated with lower disease activity and cardiometabolic risk in spondyloarthritis.
Low calcium/vitamin D: Inadequate intake raises the risk of osteoporosis, which is already elevated in ankylosing spondylitis. Adequate calcium and vitamin D support bone strength and reduce fracture risk.
Alcohol excess: Heavy drinking disrupts sleep and can worsen inflammation and fatigue. It also increases liver and gut risks when combined with NSAIDs or methotrexate.
Poor sleep: Fragmented or short sleep heightens pain sensitivity and fatigue in ankylosing spondylitis. Consistent, restorative sleep can ease morning stiffness and improve coping.
Unmanaged stress: Psychological stress can amplify immune activity and pain perception, fueling flares. Structured relaxation or mindfulness may reduce perceived disease activity.
Skipping physiotherapy: Not doing targeted spine and chest expansion exercises leads to loss of extension and flexibility. Regular physiotherapy helps preserve mobility and respiratory capacity.
Gut-related triggers: In some people, certain foods worsen gut inflammation that can mirror joint symptoms. A supervised elimination or low-FODMAP approach may reduce GI-linked flares.
Risk Prevention
You can’t fully prevent ankylosing spondylitis, but you can lower risks that may influence how it shows up and how fast it progresses. Prevention is about lowering risk, not eliminating it completely. For many, this means protecting spine and joint health, avoiding known aggravators like smoking, and spotting early symptoms of ankylosing spondylitis so care can start sooner. Small, steady habits add up over time.
No smoking: Quitting smoking lowers the chance of developing ankylosing spondylitis and reduces flare intensity if it occurs. Smoking also worsens lung and spine health, making stiffness and pain harder to manage.
Regular movement: Daily activity helps calm inflammation and keeps the spine, hips, and chest wall flexible. Aim for a mix of walking, stretching, and gentle strength work most days of the week.
Targeted exercises: Focused back, hip, and core exercises support posture and protect the sacroiliac joints. A physical therapist can tailor a routine if you’re at higher risk or already have mild symptoms.
Posture habits: Sitting upright, changing positions often, and using supportive chairs can reduce strain on the lower back and neck. Good sleep posture with a medium-firm mattress may also help.
Healthy weight: Keeping weight in a balanced range reduces stress on the spine and hips. It may also lower overall inflammation linked to ankylosing spondylitis.
Early recognition: Learn the early symptoms of ankylosing spondylitis—back pain that’s worse in the morning, improves with movement, and lasts over 3 months. Early assessment can lead to treatments that slow progression.
Family risk talk: If ankylosing spondylitis runs in your family, discuss your personal risk and any persistent back symptoms with a clinician. They may suggest earlier evaluation or monitoring.
Bone health: Weight-bearing exercise, enough calcium-rich foods, and checking vitamin D levels can protect against bone loss that sometimes accompanies ankylosing spondylitis. Your doctor may recommend a bone density scan if needed.
Stress and sleep: Consistent sleep and stress management can help steady the immune system. Relaxation techniques, paced breathing, or short daily movement breaks may reduce flare triggers.
Work ergonomics: Adjust your workspace so screens are at eye level and your lower back is supported. Taking brief standing or stretch breaks every 30–60 minutes can limit stiffness.
How effective is prevention?
Ankylosing spondylitis is a genetic/inflammatory condition, so there’s no way to fully prevent it from starting. Prevention here means lowering flare frequency, stiffness, and long‑term spinal damage. Early diagnosis, regular exercise that keeps the spine and hips flexible, smoking avoidance, and staying on prescribed anti‑inflammatory or biologic medicines can meaningfully reduce pain and slow progression. These steps lower risk, not eliminate it, and work best when started early and tailored with your rheumatology team.
Transmission
Ankylosing spondylitis isn’t contagious, so you can’t catch it from someone or pass it on through coughing, kissing, or sharing utensils. It can run in families: certain genes, especially a marker called HLA-B27, raise the chance of developing it, but they don’t guarantee it. In other words, genetic transmission of ankylosing spondylitis is about inherited risk, not the disease itself being directly passed down, and many people with the gene never develop symptoms. If a parent or sibling has ankylosing spondylitis, your risk is higher than average, but most relatives will not develop the condition.
When to test your genes
Ankylosing spondylitis is usually diagnosed clinically and by imaging, but genetic testing for HLA‑B27 can help when symptoms suggest AS (inflammatory back pain before age 45, stiffness improving with movement, uveitis) or when a close relative has AS. Test if diagnosis is uncertain or results would change treatment.
Diagnosis
Back pain that lingers for months, morning stiffness that eases as you move, or pain deep in the buttocks can be early symptoms of ankylosing spondylitis. Doctors usually begin by asking about your symptoms and examining how your spine and hips move, then use imaging to look for inflammation where the spine meets the pelvis. The diagnosis of ankylosing spondylitis brings together your story, exam findings, blood tests, and scans—no single test confirms it on its own. This approach helps separate inflammatory back pain from more common mechanical back strain.
History and symptoms: Clinicians look for back pain lasting longer than 3 months, morning stiffness improving with activity, and pain that can wake you at night. Alternating buttock pain and past episodes of eye inflammation can add important clues. Family history of similar problems may also matter.
Physical exam: The provider checks how far your spine bends and twists and whether your hips and pelvis are tender. Reduced chest expansion and limited forward bend are features that support an inflammatory cause. Findings are combined with your symptoms rather than used alone.
Blood tests: Markers of inflammation, such as CRP or ESR, may be higher during active disease. Testing for the HLA-B27 genetic marker can support the diagnosis but isn’t required. A negative HLA-B27 does not rule out ankylosing spondylitis.
Pelvic X-rays: X-rays look for changes in the sacroiliac joints where the spine meets the pelvis. These changes build slowly, so early X-rays can be normal. Repeat imaging over time may be needed if suspicion stays high.
MRI scanning: MRI can show active inflammation in the sacroiliac joints and spine before X-rays change. This helps with earlier diagnosis and with unclear cases. MRI findings are weighed alongside symptoms and exam results.
NSAID response: A strong, quick response to anti-inflammatory medicines can suggest inflammatory back pain. This supports the overall picture but cannot confirm ankylosing spondylitis by itself. Your doctor will still rely on exam and imaging.
Exclude other causes: Tests and imaging help rule out mechanical back strain, infections, and other types of arthritis. This step prevents misdiagnosis and guides the right treatment. Findings are interpreted in context with your history.
Specialist assessment: Rheumatology specialists apply established criteria that combine symptoms, imaging, and labs. This structured approach clarifies how ankylosing spondylitis is diagnosed across different stages of disease. Follow-up visits may be needed as features evolve.
Stages of Ankylosing spondylitis
Ankylosing spondylitis does not have defined progression stages. The condition can flare and then quiet down, and how quickly it changes varies a lot from person to person. Diagnosis usually pulls together early symptoms of ankylosing spondylitis, a physical exam, and imaging such as X-rays or MRI to check the sacroiliac joints and spine, plus blood tests for inflammation and sometimes a gene marker called HLA-B27. Different tests may be suggested to help track changes over time, and your care team may repeat scans or exams if symptoms shift.
Did you know about genetic testing?
Did you know genetic testing can help clarify your risk for ankylosing spondylitis and explain why back pain or stiffness started early? Finding markers like HLA‑B27 doesn’t give a diagnosis by itself, but it can guide earlier monitoring, imaging, and treatments that reduce inflammation and protect your spine. It can also help families understand who might benefit from checkups sooner, so problems are caught before they limit movement.
Outlook and Prognosis
Many living with ankylosing spondylitis wonder how it will shape day-to-day life over time—commutes, sleep, exercise, and plans for family or work. Many people ask, “What does this mean for my future?”, and the honest answer is that it varies. For many, pain and stiffness come in waves, with flare-ups followed by calmer periods. Early care can make a real difference, especially when treatment starts before significant joint damage, and staying active often helps keep the spine and hips flexible.
Doctors call this the prognosis—a medical word for likely outcomes. Most people with ankylosing spondylitis have a normal life expectancy, though a small group may face higher risks tied to severe spinal stiffness, limited chest expansion, smoking, or certain heart and gut complications. Some people experience ongoing back and buttock pain, while others notice milder symptoms that stay manageable for years. Looking at the long-term picture can be helpful. With consistent treatment—usually a mix of medication, movement, posture work, and sleep support—many people maintain work, parenting, travel, and hobbies, and the risk of new bone fusion slows.
The outlook is not the same for everyone, but patterns do emerge: early symptoms of ankylosing spondylitis often start in young adulthood, and faster progression is more likely in those who are male, smoke, or have high inflammation on blood tests or imaging. In medical terms, the long-term outlook is often shaped by both genetics and lifestyle. If the neck or upper spine becomes very stiff, falls and fractures become more dangerous, so prevention and bone health matter. Talk with your doctor about what your personal outlook might look like.
Long Term Effects
Ankylosing spondylitis can shape daily comfort and movement over the years, often in cycles of flares and quieter periods. Many remember the early symptoms of ankylosing spondylitis as morning stiffness and a deep ache in the lower back that eased with activity. Long-term effects vary widely, and they don’t progress the same way for everyone. For some, inflammation stays mostly manageable; for others, it can gradually limit flexibility and affect other joints or organs.
Chronic back stiffness: Persistent morning stiffness and deep aching in the lower back can last for years. Stiffness often eases with movement but may return after rest.
Reduced spinal flexibility: Inflammation around the spine can limit bending and twisting. Over time, ankylosing spondylitis may make it harder to look over a shoulder or reach the floor.
Spinal fusion risk: New bone can form between vertebrae and gradually fuse them. This can reduce range of motion and make the spine feel rigid.
Posture changes: Ongoing stiffness can lead to a forward-stooped posture. In some, the upper back curves more than usual, which can affect balance and comfort.
Chest expansion limits: Rib and spine inflammation can restrict the chest from expanding fully. Breathing may feel shallow during flares or with advanced stiffness.
Hip and shoulder arthritis: Large joints like the hips and shoulders can become inflamed and painful. This may limit walking distance, stair climbing, or lifting.
Eye inflammation flares: Recurrent uveitis can cause eye pain, redness, and light sensitivity. Prompt care usually settles episodes, but repeated flares can affect vision.
Bone loss and fractures: Chronic inflammation and reduced activity can lower bone density. This raises the risk of vertebral compression fractures, especially if the spine is fused.
Heel and tendon pain: Inflammation where tendons and ligaments attach to bone can cause heel or arch pain. Standing for long periods or first steps in the morning may be uncomfortable.
Fatigue and sleep issues: Systemic inflammation can drive deep tiredness that does not match activity levels. Night pain and stiffness can disrupt sleep and daytime focus.
Heart or gut involvement: A small number develop heart rhythm issues or aortic inflammation. Some people also experience bowel inflammation related to ankylosing spondylitis.
How is it to live with Ankylosing spondylitis?
Living with ankylosing spondylitis often means planning your day around stiffness and fatigue, especially in the morning or after sitting still, then keeping your body moving to stay comfortable. Flares can make simple things—tying shoes, driving long distances, sleeping through the night—feel harder, while good stretches, heat, medication, and steady exercise can return a sense of control. Many find work and social life remain doable with pacing, ergonomic tweaks, and honest communication about needs. For loved ones, understanding that pain and energy levels can shift day to day makes support more effective and relationships stronger.
Treatment and Drugs
Ankylosing spondylitis treatment aims to reduce pain, protect flexibility, and prevent long‑term spine damage, so care usually combines medication, movement, and ongoing check-ins. Anti‑inflammatory drugs are often the first step to ease back and hip pain, and if symptoms persist, targeted medicines that calm the immune system—such as TNF or IL‑17 blockers—may be added by a rheumatology specialist. Physical therapy focuses on posture, daily stretching, and breathing exercises to keep the spine and chest moving; some may also benefit from heat, short courses of steroids for flares, or carefully chosen pain relievers. Alongside medical treatment, lifestyle choices play a role, including regular low‑impact activity (like swimming or walking), not smoking, good sleep, and ergonomic adjustments at work or school. Not every treatment works the same way for every person, so your doctor may adjust your plan over time to balance symptom control, side effects, and your goals.
Non-Drug Treatment
Ankylosing spondylitis can make stiff mornings, long drives, and desk time feel harder than they should. Alongside medicines, non-drug therapies can maintain flexibility, protect posture, and lower day-to-day pain. Many people first notice the early symptoms of ankylosing spondylitis in young adulthood, and building supportive routines early often pays off. The approaches below focus on movement, comfort, and habits you can sustain.
Daily stretching: Gentle stretches keep the spine and hips moving. Short sessions morning and evening can ease stiffness and protect posture.
Physical therapy: A therapist teaches targeted moves and safe progressions. You’ll get a home plan tailored to your stiffness, pain, and goals.
Posture training: Practice neutral alignment for standing, sitting, and walking. Small adjustments during work and chores can reduce strain on the back and neck.
Aerobic exercise: Low-impact options like walking, cycling, or swimming build endurance without pounding joints. Aim for most days, letting symptoms guide pace.
Strength training: Strong core, back, and hip muscles support the spine. Use light to moderate resistance 2–3 days a week with good form.
Aquatic therapy: Warm-water exercise reduces load on joints while you move more freely. Many find it easier to start in a pool on stiff days.
Breathing exercises: Deep breathing expands the chest and helps keep rib joints flexible. Practice a few minutes daily, especially after stretching.
Heat and cold: Warm packs or showers relax tight muscles before activity. Cold packs can calm hot, sore spots after flares or exercise.
Ergonomic setup: Supportive chairs, monitor height, and break reminders protect posture at work. Consider a sit-stand routine and a footrest if helpful.
Sleep support: A medium-firm mattress and a thin pillow can encourage neutral alignment. Side sleeping with a pillow between knees may ease morning pain.
Activity pacing: Break tasks into chunks with planned rests to prevent flare-ups. Rotate positions—sit, stand, walk—to avoid long periods of stillness.
Weight management: Reaching a healthy weight lowers strain on the back and hips. Balanced eating also supports energy for regular exercise.
Smoking cessation: Quitting supports lung function and may slow spinal changes. Ask about counseling and nicotine replacement to boost success.
Mind-body therapies: Techniques like mindfulness or gentle yoga can reduce pain sensitivity and stress. They also support better sleep and coping.
Occupational therapy: An occupational therapist suggests joint-sparing ways to do daily tasks. Simple tools and habit tweaks can make work and home activities easier.
Education and support: Learning about ankylosing spondylitis helps you spot patterns and make choices that fit your life. Peer groups or classes can offer practical tips and encouragement.
Did you know that drugs are influenced by genes?
Genes help explain why one person with ankylosing spondylitis responds well to NSAIDs or biologics while another needs a different dose or a different drug. Variations in immune and drug‑processing genes can affect effectiveness and side‑effects, guiding more personalized treatment.
Pharmacological Treatments
Medicines for ankylosing spondylitis aim to ease pain and stiffness, calm inflammation, and help you stay active. For many, treatment starts when early symptoms of ankylosing spondylitis—like morning stiffness—begin to disrupt daily routines. Options range from over-the-counter pain relievers to targeted biologics and newer pill therapies, chosen based on your symptom pattern, other health conditions, and safety considerations. Not everyone responds to the same medication in the same way.
NSAIDs: Ibuprofen, naproxen, indomethacin, or diclofenac can reduce pain and morning stiffness. Some people take them regularly during flares or as maintenance when symptoms are active. They can irritate the stomach or affect kidneys, so use the lowest effective dose and ask about stomach protection if needed.
COX-2 inhibitors: Celecoxib (and etoricoxib in the EU) may offer similar pain relief with less stomach irritation than traditional NSAIDs. They can still raise cardiovascular risk in some people. Your doctor will weigh benefits and risks based on your history.
TNF inhibitors: Adalimumab, etanercept, infliximab, certolizumab pegol, and golimumab target the inflammatory pathway driving spinal stiffness and pain. Many feel better mobility and less fatigue within weeks. Screening for infections (like TB) and keeping vaccines up to date is important.
IL-17 inhibitors: Secukinumab, ixekizumab, and in some regions bimekizumab can ease axial pain and help skin psoriasis if present. They may not be ideal for those with active inflammatory bowel disease. Common issues include mild injection-site reactions and a small increase in infection risk.
JAK inhibitors: Upadacitinib (US/EU) and filgotinib (EU) are once-daily pills that can improve pain, stiffness, and function, including in people who did not respond to biologics. They require lab monitoring and infection screening. Some may have higher risks such as shingles or blood clots, especially with certain risk factors.
Sulfasalazine: This pill can help if you have swollen joints in the arms or legs but usually doesn’t relieve spine symptoms. It’s considered when peripheral arthritis is part of ankylosing spondylitis. Regular blood tests help monitor for rare liver or blood side effects.
Steroid injections: Targeted steroid shots into a painful joint or tendon attachment can give short-term relief. They are not a long-term solution for the spine itself. Injections are spaced out to reduce local side effects.
Pain relievers: Acetaminophen (paracetamol) and topical NSAID gels or creams can help on high-pain days. They are often used alongside other treatments for extra relief. Be careful not to double up on NSAIDs if you already take an oral NSAID.
Biosimilars: Lower-cost versions of several TNF inhibitors are widely available and work comparably to the original biologics. They can improve access while maintaining similar safety and effectiveness. If a switch is proposed, discuss timing and monitoring so the transition is smooth.
Genetic Influences
Ankylosing spondylitis has a strong genetic component, which helps explain why it can run in families. Family history is one of the strongest clues to a genetic influence. The best-known risk gene is HLA-B27; carrying it raises the chance of developing ankylosing spondylitis, but many people with HLA-B27 never develop symptoms, and some living with the condition do not have this gene. Other genes also contribute, so genetics act more like dimmer switches than an on–off switch. Because of this, a positive HLA-B27 result can support a diagnosis, yet genetic testing for ankylosing spondylitis cannot confirm the condition on its own. If ankylosing spondylitis affects a parent or sibling, your personal risk is higher than average, but immune system and lifestyle factors still play a role.
How genes can cause diseases
Humans have more than 20 000 genes, each carrying out one or a few specific functiosn in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the bodies cells to begin lultiplying uncontrollably and develop into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified, that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call this hotspots “Genetic Variations” or “Variants” in short. In many cases, studies have been able to show, that having the genetic Letter “G” in the position makes you healthy, but heaving the Letter “A” in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
Pharmacogenetics — how genetics influence drug effects
Treatment choices for ankylosing spondylitis can be shaped by your genes, especially when it comes to pain relievers and anti-inflammatory medicines. Genes can influence how quickly you clear certain nonsteroidal anti-inflammatory drugs (NSAIDs), which can change both pain relief and the chance of stomach or kidney side effects. For example, differences in a liver‑enzyme gene called CYP2C9 may make medicines like ibuprofen, meloxicam, or celecoxib linger longer; in that case, a lower dose or a different drug may be safer. For biologic therapies such as TNF and IL‑17 blockers, there isn’t a genetic test that routinely guides which one to start, and while HLA‑B27 has been linked to ankylosing spondylitis itself, its value for predicting response is still uncertain. The same is true for newer options like JAK inhibitors—no established pharmacogenetic rules exist yet. If you’ve wondered about genetic testing to guide ankylosing spondylitis treatment, talk with your rheumatology team; in some cases, testing for NSAID metabolism can help tailor dosing and monitoring alongside your overall health history.
Interactions with other diseases
People living with ankylosing spondylitis often have other immune-related conditions, especially inflammatory bowel disease and psoriasis; on weeks when the gut acts up, morning back stiffness may feel worse. Doctors call it a “comorbidity” when two conditions occur together. Eye inflammation (uveitis) is also common and can bring sudden eye pain and light sensitivity, and these flares can track with ankylosing spondylitis activity. Inflammatory bowel disease can both overlap with and be affected by treatment choices; anti-inflammatory pain medicines may irritate the bowel, while some targeted therapies help both conditions and others can worsen gut inflammation, so plans are individualized. Ongoing inflammation in ankylosing spondylitis is also linked to a higher risk of osteoporosis and heart and blood vessel disease, making fracture prevention and cardiovascular risk checks important. If you notice early symptoms of ankylosing spondylitis alongside persistent digestive or eye problems, see your care team so they can coordinate care and tailor medicines safely.
Special life conditions
You may notice new challenges in everyday routines. During pregnancy, ankylosing spondylitis can bring stiffer mornings and more back or pelvic pain as weight shifts; some find symptoms ease in mid-pregnancy and return after delivery. Certain medicines aren’t recommended while pregnant or chestfeeding, so talk with your doctor before changing treatments, and let your obstetric and anesthesia teams know about AS in case spinal anesthesia is difficult. In children and teens, early symptoms of ankylosing spondylitis may look like heel pain, fatigue, or stiffness after rest rather than classic low back pain, and growth, school sports, and posture need close attention.
Older adults with long-standing ankylosing spondylitis may face more limited spine movement, hip arthritis, or osteoporosis, which raises fall and fracture risk; gentle, regular activity and bone health checks can help. Competitive athletes and people with physically demanding jobs can often stay active, but may need to adjust training, favor low-impact exercise, and protect the neck and spine during contact or high-velocity sports. Not everyone experiences changes the same way, but coordinating care with rheumatology, physical therapy, and, when relevant, pregnancy or pediatric teams can keep goals and safety aligned.
History
Throughout history, people have described stiff backs and aching hips that eased with movement, then flared again after rest. In one family, a grandparent remembered “stooping more each winter,” while a younger relative noticed mornings felt locked until a hot shower loosened things. These lived experiences mirror what we now recognize as ankylosing spondylitis.
Ancient skeletal remains show telltale signs of spine and pelvic joints gradually fusing, suggesting the condition has been present for centuries. Early medical writings noted young adults, often men, developing persistent low back pain and a forward-leaning posture. At the time, causes were unclear, and many were told it was simply “strain” or “rheumatism,” especially when symptoms came and went.
First described in the medical literature as a pattern of inflammatory back pain with gradual stiffening of the spine, ankylosing spondylitis was initially understood by its outward features. Doctors observed that exercise often brought relief while rest worsened stiffness—an unusual pattern compared with mechanical back pain. As X‑rays became common in the 20th century, characteristic changes in the sacroiliac joints at the base of the spine helped solidify the diagnosis, though many people waited years before these changes appeared on imaging.
With each decade, advances in laboratory testing and imaging refined the picture. The discovery of a common genetic marker, called HLA‑B27, linked immune function to the disease in many—though not all—people with ankylosing spondylitis. This helped explain why the condition can run in families and why symptoms often begin in younger adulthood. Later, MRI scans revealed early inflammation in joints and ligaments before bones showed damage, allowing earlier detection and care.
Over time, the way the condition has been understood has changed, including who is affected. Earlier reports focused mainly on men, which led to missed or delayed diagnoses in women and people with milder or different symptom patterns. Recognizing that ankylosing spondylitis exists across sexes and ethnic backgrounds has broadened awareness and improved equity in care.
Treatment history reflects this evolving understanding. Early management centered on rest, heat, and simple pain relievers. As the immune basis became clearer, anti‑inflammatory medicines, then biologic therapies that target specific immune signals, transformed outcomes for many people. Structured physical therapy and posture‑focused exercise programs also became core parts of care, helping maintain mobility and quality of life.
In recent decades, knowledge has built on a long tradition of observation. Today’s approach blends careful listening to early symptoms of ankylosing spondylitis, modern imaging to spot inflammation sooner, and therapies aimed at calming the immune system. This journey—from historical descriptions to targeted treatment—continues to shorten the path to diagnosis and support people in staying active in daily life.