Ankylosing Spondylitis (AS)

If you often have back pain, especially in your lower back, one reason could be a condition called ankylosing spondylitis (AS). This is a type of arthritis that affects your spine. It causes swelling in the joints and ligaments where they connect to your bones. Over time, this swelling can cause stiffness and pain.

At Banner Health, we want to help you understand what’s going on in your body and find treatments that can help. Our specialists diagnose and treat AS and other types of arthritis using medicines, physical therapy and exercise plans. Learn more about this condition and how to feel better.

What is ankylosing spondylitis?

Ankylosing spondylitis (AS), also called axial spondyloarthritis, is a rare type of arthritis that mainly affects the spine. It is a long-term (chronic) condition that usually starts in the sacroiliac (SI) joints, where the base of the spine connects to the pelvis.

As the disease gets worse, AS can also affect the neck, shoulders, buttocks, hips and heels. Sometimes, the bones in your spine (called vertebrae) slowly stick together to try to heal inflamed areas. This can cause your back to feel stiff or less flexible. If the joints in your chest are affected, it might become harder to take deep breaths.

What causes ankylosing spondylitis?

Ankylosing spondylitis is an autoimmune disease. It happens when your immune system attacks your body instead of protecting it.

The exact cause of AS is unknown. Experts know that your genes influence the disease. Many people with AS carry the human leukocyte antigen-B (HLA-B27) gene. Over 90% of Caucasian people with AS also have a mutated HLA-B27 gene. Not everyone with this gene gets AS but it raises your risk.

Other factors that may increase your risk include:

• Family history of AS or other types of arthritis
• Younger than 40, usually starting in late adolescence or early adulthood
• Sex (it is more common in men than women)
• Have certain health conditions like Crohn’s disease, ulcerative colitis or psoriasis

What are the symptoms of ankylosing spondylitis?

Symptoms of ankylosing spondylitis can start slowly and might improve with activity or exercise. Over time, symptoms may become more constant.

Common symptoms include:

• Lower back pain and/or neck pain: This is often worse in the morning or after prolonged sitting.   
• Pain and stiffness in the hips and/or butt: You may feel this on one or both sides. 
• Limited flexibility: You may notice it is harder to bend or twist your back.
• Fatigue: Ongoing inflammation can make you feel tired all the time.

Other symptoms can include:

• Shortness of breath (dyspnea)
• Loss of appetite
• Unexplained weight loss
• Eye inflammation (iritis or uveitis)
• Abdominal (stomach) pains

Peripheral joint pain (enthesitis) in the hip, ankle, elbow, knee, heel or shoulder is also a potential symptom, but is more common in children with AS.

How is ankylosing spondylitis different from regular back pain?

Back pain is very common and most cases are not caused by ankylosing spondylitis. General back pain is usually mechanical in nature. It is often due to strain or injury. Symptoms tend to worsen with activity but improve with rest.

Symptoms of AS differ:

• Starts before age 45
• Develops gradually, not suddenly
• Gets better with exercise
• Worsens with rest
• Wakes you up at night, especially in the second half of the night

If your back pain matches this pattern, see your health care provider.

How ankylosing spondylitis is diagnosed

There is no single test for ankylosing spondylitis. Your health care provider will use a combination of tools to diagnose it, starting with a physical exam and questions about your symptoms. You might need to see a rheumatologist, a specialist who treats arthritis and similar conditions.

Tests may include:

• SI joint and spine X-rays to monitor changes in your spine over time
• MRI scans to detect early inflammation before damage shows up on X-rays
• Erythrocyte sedimentation rate (ESR or sed rate), a blood test that looks for signs of inflammation
• Genetic testing to check for the HLA-B27 gene

Getting a diagnosis can take time, especially in the early stages. That's why it’s important to keep track of your symptoms and share them with your provider.

Treatment options for ankylosing spondylitis

There is no cure for ankylosing spondylitis but treatment can help manage symptoms, lower inflammation and protect your joints. Treatment works best when started early, before permanent damage is done.

Medications

Your health care provider may recommend:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Medicines like naproxen sodium (Aleve) and Advil (ibuprofen) help reduce pain and inflammation.
• Disease-modifying anti-rheumatic medicines (DMARDs): These may be used if other joints are affected.
• Biologic medicines (tumor necrosis factor inhibitors and interleukin inhibitors): A type of DMARD that targets specific parts of your immune system to reduce inflammation and swelling.
• Corticosteroids: Short-term use of these powerful drugs is often used to help with inflammation.

Your provider will work with you to find the best medication plan based on your symptoms and health history. 

Physical therapy and exercise

Staying active is one of the most important parts of managing AS. It helps prevent stiffness and preserves range of motion in the neck and back. Low-impact activities like walking, swimming, yoga and tai chi can help with flexibility and improve posture.

A physical therapist can teach you exercises to:

• Improve flexibility
• Strengthen muscles that support your spine
• Improve posture
• Reduce stiffness

In addition to physical therapy, occupational therapists can recommend assistive devices. They can also provide tips for protecting joints and making daily activities easier.

Lifestyle changes

Small daily habits can make a difference in your quality of life:

• Practice good posture
• Quit smoking
• Sleep on a firm mattress 
• Use heat or cold therapy
• Take medications as prescribed
• Stay physically active
• Attend regular medical visits
• Listen to your body and rest when needed

Surgery

Surgery is rare but may be needed in severe cases. It is usually only considered when AS has advanced to a point where your mobility is heavily impacted. Several procedures are available for those who require it: 

• Joint replacement surgery (commonly in the hips and shoulders)
• Laminectomy to relieve pressure on the spinal cord or nerves
• Spinal reconstruction and fusion to stabilize the spine and reduce painful movement between the bones
• Internal bracing to correct severe spine deformities

Can ankylosing spondylitis lead to complications?

Yes, ankylosing spondylitis can cause complications, especially if it is not treated. 

Possible complications include:

• Fused vertebrae (bones in your spine joining together)
• Heart or lung issues
• Eye and vision problems
• Osteoporosis
• Kyphosis (forward curve of the spine)
• Nerve damage

When should you see a doctor?

See your health care provider or a Banner Health specialist if you have:

• Back pain lasting more than three months
• Morning stiffness that lasts more than 30 minutes
• Pain that improves with movement but not with rest
• Eye pain or vision changes
• Trouble taking breaths due to chest pain

Frequently asked questions

Is ankylosing spondylitis a form of arthritis?

Yes. It is a rare inflammatory arthritis that mainly affects the spine.

Can ankylosing spondylitis be cured?

There is no cure but treatment can help control symptoms and slow disease progression.

Is ankylosing spondylitis hereditary?

It can run in families, especially if you have the HLA-B27 gene.

Can exercise make ankylosing spondylitis worse?

No. In fact, regular physical activity is one of the best ways to manage symptoms. Medication and physical therapy can also help with symptoms.

How Banner Health can help

If you're experiencing ongoing back pain or stiffness, don’t ignore it. It might be more than just minor discomfort. At Banner Health, our team understands ankylosing spondylitis and how it can impact your daily life. We focus on early diagnosis, personalized treatment plans and ongoing support to keep you active.

You deserve to move freely, feel stronger and live with less pain. Schedule an appointment with a Banner Health provider today.