Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentComplicationsPreventionLiving With ASOutlookNext in Ankylosing Spondylitis GuideThe 3 Stages of Ankylosing Spondylitis
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Complications
Prevention
Living With AS
Outlook
Next in Ankylosing Spondylitis Guide
Ankylosing spondylitis(AS) is a type ofinflammatory arthritisthat causesinflammationof the spine. It is an autoimmune disease, in which the immune system causes damage to the body’s own tissues. If AS is not adequately treated, it could lead to fusion of the vertebrae (the small bones of the spine).
AS is a progressive condition, which means it will get worse over time. Even so, the disease is manageable, and spinal fusion and other disease complications might be preventable.
This article will cover AS symptoms, stages, causes, diagnosis, treatment, and more.
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Ankylosing Spondylitis Symptoms
The progression of AS symptoms can be measured in three stages—early, progressing, and advanced.As the disease progresses, you will experience different or worsening symptoms.
Early Stage
In the earliest stage of AS, symptoms will come on gradually and worsen with time.
Some of the earliest symptoms are:
Additional early symptoms of AS include:
Progressing Stage
As AS progresses, you might experience more pain and stiffness on both sides of the spine.
Some people with AS might also have severe symptoms affecting different body systems, including:
Advanced Stage
In advanced AS, a new bone formation called ankylosis occurs and causes the spinal column to fuse.Spinal fusion leads to limited spine mobility,kyphosis(the spine bending forward), and an increased risk for spinal fractures.
Sex DifferencesAnkylosing spondylitis was previously believed to primarily affect males, although newer studies have found all sexes are equally affected.AS might cause differentsymptoms in femalesand has a different progression. Females report more peripheral arthritis symptoms, fatigue, enthesitis, and comorbid conditions like IBD.Females also have a longer delay in diagnosis than males.(Note that when citing research, the terms for sex and gender from the source are used.)
Sex Differences
Ankylosing spondylitis was previously believed to primarily affect males, although newer studies have found all sexes are equally affected.AS might cause differentsymptoms in femalesand has a different progression. Females report more peripheral arthritis symptoms, fatigue, enthesitis, and comorbid conditions like IBD.Females also have a longer delay in diagnosis than males.(Note that when citing research, the terms for sex and gender from the source are used.)
Ankylosing spondylitis was previously believed to primarily affect males, although newer studies have found all sexes are equally affected.AS might cause differentsymptoms in femalesand has a different progression. Females report more peripheral arthritis symptoms, fatigue, enthesitis, and comorbid conditions like IBD.
Females also have a longer delay in diagnosis than males.
(Note that when citing research, the terms for sex and gender from the source are used.)
What Causes Ankylosing Spondylitis?
Anyone can get AS, but certain risk factors might increase the likelihood of the disease.
If other family members have AS or another autoimmune disease, you are more likely to get the disease. AS is also linked to theHLA-B27 mutated gene,which runs in families. HLA-B27 has been detected in 90% of people with AS.While this gene is a risk factor, it is possible to have it and never develop the condition.
Additional risk factors for AS are:
What Triggers AS Symptoms?
AS causes bothlocalized and generalized flares. Localized flares affect one primary area (usually the back) and cause pain, stiffness, and fatigue. Generalized flares are more severe and affect multiple areas of the body (i.e., the back, hips, knees, and ankles).
Triggers that might lead to a local or generalized AS flare-up include:
Different Types of Arthritis and Pain Characteristics
Tests Used to Diagnose Ankylosing Spondylitis
Indiagnosing AS, a healthcare provider will ask about your symptoms, medical history, and family history. A physical exam of the spine, peripheral joints, and entheses will be done to look for areas of pain, tenderness, stiffness, and swelling.
The healthcare provider will also request imaging to look for damage to bones and soft tissues of the spine. This might include an X-ray and magnetic resonance imaging (MRI).
Blood work used to diagnose AS might include HLA-B27 genetic testing,blood marker inflammation testing, and tests to rule out other conditions, such asrheumatoid factor testingto rule outrheumatoid arthritis, a type of inflammatory arthritis affecting the linings of joints.
Misdiagnosis
AS is sometimes misdiagnosedbecause it causes symptoms that can be found in other joint and muscle diseases.
Conditions that mimic ASinclude:
What Is the Typical Age of Diagnosis?
The onset of AS typically peaks in young adults in their 20s and 30s, with an average age of onset of 26 worldwide.
Even though diagnoses are common in young adulthood, anyone can develop AS, including children and older adults. It is rare, but some people can have a new symptom onset of AS after age 45.
Early-Onset Arthritis: Types, Symptoms, and Treatment
Ankylosing Spondylitis Treatment
The main goals of treating AS are to relieve pain and stiffness and prevent or delay disease complications, including spinal deformity. A multifaceted approach, including medications, diet changes, lifestyle changes, and surgery as a last resort, can help you accomplish this.
Medication
Medications to treat AS includenonsteroidal anti-inflammatory drugs(NSAIDs), conventionaldisease-modifying anti-rheumatic drugs(DMARDs), and biologic DMARDs.
Anti-Inflammatory Diet
Some foods, including junk and processed foods, can produce inflammation, which can lead to increased AS symptoms. You will want to reduce or eliminate these types of food and include more anti-inflammatory foods.
Examples ofanti-inflammatory foodsare:
What Are the Best Anti-Inflammatory Foods?
Surgery
Most people with AS will never need surgery. Surgery is recommended if you have spine, hip, or other joint damage that needs repairing or replacement.
An Overview of Ankylosing Spondylitis Surgery
Lifestyle Changes
Your lifestyle choices might help you to manage AS. Some lifestyle choices that might help are:
Specialists Who Treat AS
A primary care provider may be the first medical professional you reach out to when you first experience symptoms of AS. They may request testing and make the diagnosis or refer you to arheumatologistif they suspect AS.
A rheumatologist is a physician who specializes in diagnosing and treating conditions that attack the muscles and joints.
Additional specialists you might need to see as your AS progresses are:
Complications of Ankylosing Spondylitis
AS might lead to spinal fusion and immobility. As the disease gets worse, the spine will lose flexibility, and back pain will become more intense.
Additional disease complications of AS are:
Can You Prevent Ankylosing Spondylitis?
Autoimmune diseases like AS are generally not preventable. Reducing some of your risk factors might be possible. For example, you can avoid smoking and practice a healthy lifestyle to reduce risk.
But even with mitigating risk factors, having a family history and genetic disposition can still increase the risk of AS. Let your healthcare provider know if you have a family history of the condition or other risk factors.
Living With Ankylosing Spondylitis
Living With AS has ups and downs and can cause more than just physical symptoms. It can also affect your emotional health and limit your social life.
Even so, you can do plenty to ensure a happy and healthy life with AS, including seeking support from family, friends, a support group, or a mental health professional. There are also things you can do to better cope, including being active and managing stress.
Outlook for Ankylosing Spondylitis
Ankylosing spondylosis symptoms will worsen over time. The disease is rarely disabling or life-threatening, but symptoms can interfere with your ability to enjoy life.
Make sure you follow your treatment plan and take advantage of all the resources your doctor provides. Pain and inflammation are manageable, and disease complications and disability can be avoided.
16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Raychaudhuri SP, Deodhar A.The classification and diagnostic criteria of ankylosing spondylitis.J Autoimmun. 2014;48-49:128-133. doi:10.1016/j.jaut.2014.01.015Spondylitis Association of America.Most common symptoms.Li T, Zhou L, Zhao H, et al.Fatigue in ankylosing spondylitis is associated with psychological factors and brain gray matter.Front Med (Lausanne). 2019;6:271. Published 2019 Nov 21. doi:10.3389/fmed.2019.00271Poddubnyy D.Classification vs diagnostic criteria: the challenge of diagnosing axial spondyloarthritis.Rheumatology (Oxford). 2020;59(Suppl4):iv6-iv17. doi:10.1093/rheumatology/keaa250Haroon N.Ankylosis in ankylosing spondylitis: current concepts.Clin Rheumatol. 2015;34(6):1003-1007. doi:10.1007/s10067-015-2956-4Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE.Gender differences in axial spondyloarthritis: women are not so lucky.Curr Rheumatol Rep. 2018;20(6):35. doi:10.1007/s11926-018-0744-2Akassou A, Bakri Y.Does HLA-B27 status influence ankylosing spondylitis phenotype?Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544117751627. doi:10.1177/1179544117751627Spondlyitis Association of America.Overview of ankylosing spondylitis.Barnett R, Ng S, Sengupta R.Understanding flare in axial spondyloarthritis: novel insights from daily self-reported flare experience.Rheumatol Adv Pract. 2021;5(3):rkab082. doi:10.1093/rap/rkab082Boel A, López-Medina C, van der Heijde DMFM, van Gaalen FA.Age at onset in axial spondyloarthritis around the world: data from the Assessment in SpondyloArthritis International Society Peripheral Involvement in Spondyloarthritis study.Rheumatology(Oxford). 2022;61(4):1468-1475. doi:10.1093/rheumatology/keab544Spondylitis Association of America.Diet’s effect on spondylitis symptoms.Giannotti E, Trainito S, Arioli G, Rucco V, Masiero S.Effects of physical therapy for the management of patients with ankylosing spondylitis in the biological era.Clin Rheumatol.2014;33(9):1217-1230. doi:10.1007/s10067-014-2647-6Farouk, H.M., Abdel-Rahman, M.A. Hassan, R.M.Relationship between smoking, clinical, inflammatory, and radiographic parameters in patients with ankylosing spondylitis.Egypt Rheumatol Rehabil.2021;48(26). doi:10.1186/s43166-021-00076-zNational Institute of Arthritis and Musculoskeletal and Skin Diseases.Ankylosing spondylitis: diagnosis, treatment, and steps to take.Dönmez S, Pamuk ÖN, Pamuk GE, Aydoğdu E, Inman R.Secondary amyloidosis in ankylosing spondylitis.Rheumatol Int. 2013;33(7):1725-1729. doi:10.1007/s00296-012-2646-3University of Washington Medicine.Ankylosing spondylitis.
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Raychaudhuri SP, Deodhar A.The classification and diagnostic criteria of ankylosing spondylitis.J Autoimmun. 2014;48-49:128-133. doi:10.1016/j.jaut.2014.01.015Spondylitis Association of America.Most common symptoms.Li T, Zhou L, Zhao H, et al.Fatigue in ankylosing spondylitis is associated with psychological factors and brain gray matter.Front Med (Lausanne). 2019;6:271. Published 2019 Nov 21. doi:10.3389/fmed.2019.00271Poddubnyy D.Classification vs diagnostic criteria: the challenge of diagnosing axial spondyloarthritis.Rheumatology (Oxford). 2020;59(Suppl4):iv6-iv17. doi:10.1093/rheumatology/keaa250Haroon N.Ankylosis in ankylosing spondylitis: current concepts.Clin Rheumatol. 2015;34(6):1003-1007. doi:10.1007/s10067-015-2956-4Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE.Gender differences in axial spondyloarthritis: women are not so lucky.Curr Rheumatol Rep. 2018;20(6):35. doi:10.1007/s11926-018-0744-2Akassou A, Bakri Y.Does HLA-B27 status influence ankylosing spondylitis phenotype?Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544117751627. doi:10.1177/1179544117751627Spondlyitis Association of America.Overview of ankylosing spondylitis.Barnett R, Ng S, Sengupta R.Understanding flare in axial spondyloarthritis: novel insights from daily self-reported flare experience.Rheumatol Adv Pract. 2021;5(3):rkab082. doi:10.1093/rap/rkab082Boel A, López-Medina C, van der Heijde DMFM, van Gaalen FA.Age at onset in axial spondyloarthritis around the world: data from the Assessment in SpondyloArthritis International Society Peripheral Involvement in Spondyloarthritis study.Rheumatology(Oxford). 2022;61(4):1468-1475. doi:10.1093/rheumatology/keab544Spondylitis Association of America.Diet’s effect on spondylitis symptoms.Giannotti E, Trainito S, Arioli G, Rucco V, Masiero S.Effects of physical therapy for the management of patients with ankylosing spondylitis in the biological era.Clin Rheumatol.2014;33(9):1217-1230. doi:10.1007/s10067-014-2647-6Farouk, H.M., Abdel-Rahman, M.A. Hassan, R.M.Relationship between smoking, clinical, inflammatory, and radiographic parameters in patients with ankylosing spondylitis.Egypt Rheumatol Rehabil.2021;48(26). doi:10.1186/s43166-021-00076-zNational Institute of Arthritis and Musculoskeletal and Skin Diseases.Ankylosing spondylitis: diagnosis, treatment, and steps to take.Dönmez S, Pamuk ÖN, Pamuk GE, Aydoğdu E, Inman R.Secondary amyloidosis in ankylosing spondylitis.Rheumatol Int. 2013;33(7):1725-1729. doi:10.1007/s00296-012-2646-3University of Washington Medicine.Ankylosing spondylitis.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Raychaudhuri SP, Deodhar A.The classification and diagnostic criteria of ankylosing spondylitis.J Autoimmun. 2014;48-49:128-133. doi:10.1016/j.jaut.2014.01.015Spondylitis Association of America.Most common symptoms.Li T, Zhou L, Zhao H, et al.Fatigue in ankylosing spondylitis is associated with psychological factors and brain gray matter.Front Med (Lausanne). 2019;6:271. Published 2019 Nov 21. doi:10.3389/fmed.2019.00271Poddubnyy D.Classification vs diagnostic criteria: the challenge of diagnosing axial spondyloarthritis.Rheumatology (Oxford). 2020;59(Suppl4):iv6-iv17. doi:10.1093/rheumatology/keaa250Haroon N.Ankylosis in ankylosing spondylitis: current concepts.Clin Rheumatol. 2015;34(6):1003-1007. doi:10.1007/s10067-015-2956-4Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE.Gender differences in axial spondyloarthritis: women are not so lucky.Curr Rheumatol Rep. 2018;20(6):35. doi:10.1007/s11926-018-0744-2Akassou A, Bakri Y.Does HLA-B27 status influence ankylosing spondylitis phenotype?Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544117751627. doi:10.1177/1179544117751627Spondlyitis Association of America.Overview of ankylosing spondylitis.Barnett R, Ng S, Sengupta R.Understanding flare in axial spondyloarthritis: novel insights from daily self-reported flare experience.Rheumatol Adv Pract. 2021;5(3):rkab082. doi:10.1093/rap/rkab082Boel A, López-Medina C, van der Heijde DMFM, van Gaalen FA.Age at onset in axial spondyloarthritis around the world: data from the Assessment in SpondyloArthritis International Society Peripheral Involvement in Spondyloarthritis study.Rheumatology(Oxford). 2022;61(4):1468-1475. doi:10.1093/rheumatology/keab544Spondylitis Association of America.Diet’s effect on spondylitis symptoms.Giannotti E, Trainito S, Arioli G, Rucco V, Masiero S.Effects of physical therapy for the management of patients with ankylosing spondylitis in the biological era.Clin Rheumatol.2014;33(9):1217-1230. doi:10.1007/s10067-014-2647-6Farouk, H.M., Abdel-Rahman, M.A. Hassan, R.M.Relationship between smoking, clinical, inflammatory, and radiographic parameters in patients with ankylosing spondylitis.Egypt Rheumatol Rehabil.2021;48(26). doi:10.1186/s43166-021-00076-zNational Institute of Arthritis and Musculoskeletal and Skin Diseases.Ankylosing spondylitis: diagnosis, treatment, and steps to take.Dönmez S, Pamuk ÖN, Pamuk GE, Aydoğdu E, Inman R.Secondary amyloidosis in ankylosing spondylitis.Rheumatol Int. 2013;33(7):1725-1729. doi:10.1007/s00296-012-2646-3University of Washington Medicine.Ankylosing spondylitis.
Raychaudhuri SP, Deodhar A.The classification and diagnostic criteria of ankylosing spondylitis.J Autoimmun. 2014;48-49:128-133. doi:10.1016/j.jaut.2014.01.015
Spondylitis Association of America.Most common symptoms.
Li T, Zhou L, Zhao H, et al.Fatigue in ankylosing spondylitis is associated with psychological factors and brain gray matter.Front Med (Lausanne). 2019;6:271. Published 2019 Nov 21. doi:10.3389/fmed.2019.00271
Poddubnyy D.Classification vs diagnostic criteria: the challenge of diagnosing axial spondyloarthritis.Rheumatology (Oxford). 2020;59(Suppl4):iv6-iv17. doi:10.1093/rheumatology/keaa250
Haroon N.Ankylosis in ankylosing spondylitis: current concepts.Clin Rheumatol. 2015;34(6):1003-1007. doi:10.1007/s10067-015-2956-4
Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE.Gender differences in axial spondyloarthritis: women are not so lucky.Curr Rheumatol Rep. 2018;20(6):35. doi:10.1007/s11926-018-0744-2
Akassou A, Bakri Y.Does HLA-B27 status influence ankylosing spondylitis phenotype?Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544117751627. doi:10.1177/1179544117751627
Spondlyitis Association of America.Overview of ankylosing spondylitis.
Barnett R, Ng S, Sengupta R.Understanding flare in axial spondyloarthritis: novel insights from daily self-reported flare experience.Rheumatol Adv Pract. 2021;5(3):rkab082. doi:10.1093/rap/rkab082
Boel A, López-Medina C, van der Heijde DMFM, van Gaalen FA.Age at onset in axial spondyloarthritis around the world: data from the Assessment in SpondyloArthritis International Society Peripheral Involvement in Spondyloarthritis study.Rheumatology(Oxford). 2022;61(4):1468-1475. doi:10.1093/rheumatology/keab544
Spondylitis Association of America.Diet’s effect on spondylitis symptoms.
Giannotti E, Trainito S, Arioli G, Rucco V, Masiero S.Effects of physical therapy for the management of patients with ankylosing spondylitis in the biological era.Clin Rheumatol.2014;33(9):1217-1230. doi:10.1007/s10067-014-2647-6
Farouk, H.M., Abdel-Rahman, M.A. Hassan, R.M.Relationship between smoking, clinical, inflammatory, and radiographic parameters in patients with ankylosing spondylitis.Egypt Rheumatol Rehabil.2021;48(26). doi:10.1186/s43166-021-00076-z
National Institute of Arthritis and Musculoskeletal and Skin Diseases.Ankylosing spondylitis: diagnosis, treatment, and steps to take.
Dönmez S, Pamuk ÖN, Pamuk GE, Aydoğdu E, Inman R.Secondary amyloidosis in ankylosing spondylitis.Rheumatol Int. 2013;33(7):1725-1729. doi:10.1007/s00296-012-2646-3
University of Washington Medicine.Ankylosing spondylitis.
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