Ankylosing spondylitis
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What is Ankylosing Spondylitis?
Ankylosing spondylitis (AS) is an autoimmune disease primarily affecting the spine and sacroiliac joints (where the spine meets the pelvis). Over time, inflammation can cause the vertebrae to fuse together, leading to reduced flexibility, chronic pain, and stiffness.
If left untreated, AS can lead to severe spinal stiffness, posture changes (hunched back), and difficulty breathing due to rib cage involvement. AS can also affect the eyes, heart, and other joints, making early diagnosis and treatment crucial.
What are the Most Common Signs and Symptoms of Ankylosing spondylitis?
Ankylosing spondylitis (AS) symptoms typically develop gradually and worsen over time. Common signs include:
- Chronic Lower Back & Hip Pain – Persistent pain that improves with movement but worsens with rest.
- Morning Stiffness – Lasting longer than 45–60 minutes, making it difficult to get out of bed.
- Sacroiliac Joint Pain – Pain in the buttocks and lower back, often switching sides.
- Reduced Spinal Flexibility – Difficulty bending forward or twisting the spine.
- Postural Changes – Severe cases may lead to hunched posture (kyphosis).
- Fatigue – Chronic inflammation can cause severe tiredness and low energy levels.
- Enthesitis (Tendon & Ligament Pain) – Pain where tendons and ligaments attach to bones, commonly in the heel, Achilles tendon, or ribs.
- Eye Inflammation (Uveitis/Iritis) – Red, painful, light-sensitive eyes, a common extra-articular symptom of AS.
- Breathing Difficulties – Inflammation can stiffen the rib cage, making it harder to take deep breaths.
How is Ankylosing Spondylitis Diagnosed?
AS is often misdiagnosed as mechanical back pain or sciatica. Diagnosis requires a skilled rheumatologist and a combination of clinical evaluation, imaging, and lab tests:
- Persistent Back Pain & Stiffness – Lasting more than 3 months and improving with activity.
- Physical Examination – Checking spinal mobility, posture, and sacroiliac joint tenderness.
- Blood Tests
- HLA-B27 Gene Test – Many AS patients carry this gene, though not all.
- ESR & CRP – Markers of inflammation.
- Imaging (X-rays, MRI, CT Scan)
- X-rays may show early spinal inflammation and fusion of vertebrae.
- MRI pelvis detects early sacroiliitis (inflammation in sacroiliac joints) before damage occurs.
Early detection is critical to prevent severe spinal fusion and complications.
What Are Our Treatment Options for Patients with Ankylosing Spondylitis?
At Rheumatologist OnCall, we aim to reduce inflammation, improve mobility, and prevent disability.
Medications
- NSAIDs (Ibuprofen, Naproxen, Indomethacin) – First-line treatment for reducing pain and inflammation.
- Biologics – Used for moderate-to-severe AS to slow disease progression:
- TNF inhibitors (e.g., Humira, Enbrel, Remicade).
- IL-17 inhibitors (e.g., Cosentyx, Taltz).
- JAK Inhibitors (Upadacitinib, Tofacitinib) – Newer oral medications for AS.
Lifestyle & Holistic Approaches
- Anti-Inflammatory Diet – We guide patients in implementing a science-backed nutrition plan for inflammation control through our online course and coaching program.
- Supplements – We recommend evidence-based supplements to support joint health and mobility.
- Exercise & Physical Therapy
- Posture correction & mobility exercises to prevent spinal stiffness.
- Low-impact activities like swimming, yoga, and stretching.
- Mindfulness & Stress Reduction – Chronic pain can impact mental health, so we integrate stress management techniques, meditation, and breathing exercises.
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Watch More About Ankylosing Spondylitis
Why Choose Rheumatologist OnCall for Your Ankylosing Spondylitis Care?
At Rheumatologist OnCall, we offer expert, personalized, and accessible care for autoimmune diseases. Our approach is different because we provide:
Expert Rheumatologists
Board-certified specialists with years of experience in treating AS.
Virtual & In-Person Consultations
Skip long wait times and get care from the comfort of your home or visit our clinic in Irvine, CA.
Holistic & Whole-Body Treatment
We integrate evidence-based medicine, lifestyle modifications, and precision medicine to prevent flares and long-term damage.
Fast & Affordable Access
Direct access to specialists without insurance barriers.
Early diagnosis and treatment help prevent future flares and joint damage.
Frequently Asked Questions about Ankylosing Spondylitis
Accordion Content
The earliest symptom is chronic lower back pain and stiffness that improves with movement but worsens with rest.
No, AS cannot be cured, but early treatment with biologics and exercise can prevent severe disability.
To prevent progression, patients should:
- Start biologic therapy early to control inflammation.
- Stay active – Exercise is crucial to maintaining spinal flexibility.
- Follow an anti-inflammatory diet – Omega-3s and antioxidants reduce inflammation.
Yes, AS can impact:
- Eyes – Uveitis (eye inflammation).
- Lungs – Chest stiffness leading to breathing difficulty.
Heart – Increased risk of heart disease.
The best exercises include:
- Stretching & yoga – Keeps the spine flexible.
- Swimming – Low-impact exercise that supports joints.
- Posture correction exercises – Prevents kyphosis (hunchback).
Watch More About Ankylosing Spondylitis Exercises ➡️ YouTube Video Link
Untreated AS can cause:
- Spinal fusion (leading to a stiff, immobile spine).
- Postural deformities (hunched back).
- Difficulty breathing (due to rib cage stiffness).
Frequent asked questions
What is ankylosing spondylitis?
Ankylosing spondylitis is an autoimmune disease that mainly affects the spine and sacroiliac joints, where the spine meets the pelvis. Over time, inflammation can cause chronic pain, stiffness, reduced flexibility, and, in severe untreated cases, fusion of the vertebrae.
What are the first symptoms of ankylosing spondylitis?
The earliest symptoms are usually chronic lower back pain and stiffness. The pain often improves with movement and becomes worse with rest. Morning stiffness lasting longer than 45 to 60 minutes is also a common early sign.
What are the most common signs of ankylosing spondylitis?
Common signs include chronic lower back and hip pain, morning stiffness, sacroiliac joint pain, reduced spinal flexibility, fatigue, tendon and ligament pain, posture changes, eye inflammation, and difficulty taking deep breaths if the rib cage becomes stiff.
Can ankylosing spondylitis cause hip or buttock pain?
Yes. Ankylosing spondylitis often affects the sacroiliac joints, which can cause pain in the lower back, hips, and buttocks. The pain may sometimes switch from one side to the other.
Can ankylosing spondylitis affect the eyes?
Yes. Ankylosing spondylitis can cause eye inflammation, also called uveitis or iritis. Symptoms may include red, painful, and light-sensitive eyes. Eye symptoms should be evaluated promptly by a medical professional.
Can ankylosing spondylitis affect breathing?
Yes. In more advanced cases, inflammation can stiffen the rib cage and make it harder to take deep breaths. This is one reason early diagnosis and treatment are important for preventing long-term complications.
How is ankylosing spondylitis diagnosed?
Ankylosing spondylitis is diagnosed through a combination of symptom review, physical examination, blood tests, and imaging. A rheumatologist may check spinal mobility, posture, sacroiliac joint tenderness, inflammation markers, HLA-B27 status, and imaging results such as X-rays or MRI.
What blood tests are used for ankylosing spondylitis?
Common blood tests include the HLA-B27 gene test and inflammation markers such as ESR and CRP. Many patients with ankylosing spondylitis carry HLA-B27, but not all do, so diagnosis is based on the full clinical picture rather than one test alone.
Can ankylosing spondylitis be mistaken for regular back pain?
Yes. Ankylosing spondylitis is often misdiagnosed as mechanical back pain or sciatica. Back pain that lasts more than three months, improves with activity, worsens with rest, and comes with prolonged morning stiffness should be evaluated by a rheumatologist.
What imaging tests help diagnose ankylosing spondylitis?
X-rays, MRI, and CT scans may be used. X-rays can show spinal inflammation or vertebral fusion, while MRI of the pelvis can detect early sacroiliitis before permanent damage occurs.
What treatments are used for ankylosing spondylitis?
Treatment may include NSAIDs such as ibuprofen, naproxen, or indomethacin to reduce pain and inflammation. For moderate-to-severe disease, biologic medications such as TNF inhibitors and IL-17 inhibitors may be used, along with newer oral JAK inhibitors in selected patients.
What are the newest treatment options for ankylosing spondylitis?
Newer targeted treatment options include IL-17 inhibitors, such as Cosentyx and Taltz, and JAK inhibitors, such as upadacitinib and tofacitinib. These medications are used for selected patients and should be prescribed and monitored by a rheumatologist.
What exercises are best for ankylosing spondylitis?
Helpful exercises include stretching, yoga, swimming, posture correction exercises, and mobility work. Low-impact movement can help maintain spinal flexibility, reduce stiffness, support posture, and protect long-term function.
What happens if ankylosing spondylitis is left untreated?
Untreated ankylosing spondylitis can lead to spinal fusion, severe stiffness, postural deformity, reduced mobility, rib cage stiffness, and breathing difficulty. It may also affect the eyes, heart, and other joints, which makes early diagnosis and treatment important.
Can Rheumatologist OnCall help with ankylosing spondylitis?
Yes. Rheumatologist OnCall provides expert care for ankylosing spondylitis through virtual and in-person consultations. The practice offers personalized treatment plans, medication guidance, lifestyle and holistic support, and direct access to rheumatology specialists without long wait times.
