A Pain in the Back

Explaining ankylosing spondylitis and how to treat it

/ Author:  / Reviewed by: Joseph V. Madia, MD

Arthritis comes in many forms. One of these may have a funny sounding name, but the pain it brings is no laughing matter. It is called ankylosing spondylitis, and it is a pain in the back.

Ankylosing spondylitis is a type of arthritis that mainly affects the the spine, but can also affect other joints. It causes joints to become inflamed, leading to pain and discomfort. In some cases, this inflammation causes new bone to form, making the spine stiff and immobile.

At the moment, there is no cure for ankylosing spondylitis. However, there are ways to treat the disease.

As with other forms of arthritis, ankylosing spondylitis can be treated medically (with drugs), through physical therapy, and by making certain lifestyle changes.

If you have ankylosing spondylitis, the pain and stiffness may make you want to sit down and give up. But there is help out there.

Through learning about your disease and the ways to treat it, you can find the strength to stand up straight again and take on the day.

This article offers key information for understanding and dealing with ankylosing spondylitis.

What is ankylosing spondylitis?

Ankylosing spondylitis is a form of inflammatory arthritis. While inflammation causes pain and stiffness primarily in the spine, it can also affect other parts of the body such as the ankles, heels, ribs, hips, shoulders, and hands. In some rare instances, the eyes can be affected.

Even the lungs and heart can become involved in ankylosing spondylitis.

Who is at risk of developing ankylosing spondylitis?

Most forms of arthritis develop in people in their older years. In contrast, the onset of ankylosing spondylitis generally happens in younger people between 17 and 45 years of age. However, the disease can affect anyone, from children to elderly adults.

Ankylosing spondylitis is more common in men, but women can also develop the disease.

People who have a certain genetic marker (called HLA-B27), a family history of ankylosing spondylitis, or frequent gastrointestinal infections also face a higher risk of this painful condition.

What are the signs and symptoms of ankylosing spondylitis?

At first, you may not notice the signs of ankylosing spondylitis. They can develop gradually, so you may not think they were caused by anything more than a bad night's rest.

But over time, they can get worse.

The earliest symptoms of the disease may include pain and stiffness in the lower back and hips. You are especially likely to feel these symptoms in the morning and after long periods of not moving.

The parts of the body most commonly affected by ankylosing spondylitis include:

  • the sacroiliac joint (the joint between the pelvis and the spine)
  • lower back vertebrae (small bones that make up the spine)
  • the place where ligaments and muscle attach to bone, usually in the spine
  • the cartilage between the breastbone and ribs
  • the hips
  • the shoulder joints

For most people, ankylosing spondylitis comes in painful episodes - or 'flares' - followed by temporary periods where symptoms subside. In other words, over the course of having the disease, symptoms can get better, get worse, or completely stop at irregular intervals.

Typically, the pain improves when patients are active and exercising.

In some cases, the inflammation of ankylosing spondylitis can make joints fuse together. This happens when ligaments turn into bone, causing the spinal bones to join. This fusing can affect the flexibility of the spine, giving some patients a hunched-over posture. If a patient has a severe case, she may not even be able to lift her head enough to look forward.

Ankylosing spondylitis can also lead to iritis or uveitis, conditions in which the eye becomes inflamed. In fact, about one third of ankylosing spondylitis patients will experience iritis or uveitis at least once. The symptoms of eye inflammation include:

  • eye pain
  • red and watery eyes
  • blurred vision
  • sensitivity to bright light

In rare cases, people with ankylosing spondylitis may experience bowel inflammation, which is related to Crohn's disease and ulcerative colitis.

Talk to your doctor if you are experiencing any of the common symptoms of ankylosing spondylitis - such as lower back pain and stiffness or pain from deep breathing. If you are experiencing eye pain, sensitivity to light, or blurred vision, it is time to see a health care professional immediately.

What causes ankylosing spondylitis?

As of yet, researchers have not pinpointed a specific cause of ankylosing spondylitis. However, it appears that genetic factors - specifically the gene called HLA-B27 - may play a role. However, less than five percent of those with the HLA-B27 gene go on to develop ankylosing spondylitis.

People who have both the HLA-B27 gene and a family history of ankylosing spondylitis have a much higher risk of developing the disease than those who have only the HLA-B27 gene. This higher risk suggests that there are other genes besides HLA-B27 involved in ankylosing spondylitis and related diseases.

Some researchers have suggested that some sort of infection is involved in triggering ankylosing spondylitis. Yet, more research is needed to come to that conclusion.

How is ankylosing spondylitis diagnosed?

Your normal doctor may suspect you have ankylosing spondylitis, but a rheumatologist (an expert in arthritis and rheumatic diseases) will most likely be the one who diagnoses you.

Diagnosis generally involves a thorough physical exam, which includes x-rays, a medical history, looking at family history of ankylosing spondylitis, and blood tests.

In a physical exam, your rheumatologist is looking for key signs of ankylosing spondylitis. These include:

  • onset of disease that is usually before 35 years of age
  • chronic pain, or pain that lasts for more than three months
  • back pain and stiffness that worsens and leads to immobility, especially at night and in the early morning
  • back pain and stiffness that improves with physical activity and exercise
  • improved pain after taking non-steroidal anti-inflammatory drugs (NSAIDs)

Your doctor will be looking for pain and inflammation in the areas of the body associated with ankylosing spondylitis, including the back, pelvic bones, sacroiliac joints, chest, and heels.

Your doctor may use different imaging tests to look for changes in your joints and bones. These tests include X-rays, computerized tomography (CT), and magnetic resonance imaging (MRI).

Blood tests may also be used in the diagnosis process. While no blood test can spot ankylosing spondylitis, some can look for signs of inflammation. However, inflammation can be caused by a variety of health problems.

Blood tests can also show if you have the HLA-B27 gene, indicating whether you have a higher risk for the disease.

What are the treatment options for ankylosing spondylitis?

Because there is no cure for ankylosing spondylitis, the main purpose of treatment is to reduce pain and stiffness and stop or delay complications and spinal deformity. It is best to get treatment before the disease has had time to cause permanent damage to your joints.

Treatment for ankylosing spondylitis generally involves a combination of drug treatment and physical therapy. If you have severe pain or joint damage, your doctor may recommend surgery.

Drug Treatment

Non-steroidal anti-inflammatory drugs, or NSAIDs, are the most commonly prescribed drugs for treating ankylosing spondylitis. These drugs are used to reduce inflammation and relieve pain and stiffness.

NSAIDs used in the treatment of ankylosing spondylitis include:

When NSAIDs do not work, doctors sometimes prescribe tumor necrosis factor (TNF) inhibitors. These drugs block a cell protein called TNF, which promotes inflammation in rheumatic diseases like ankylosing spondylitis. Blocking this protein can help relieve pain and stiffness while reducing tender or swollen joints. TNF inhibitors are injected into the skin.

TNF inhibitors used to treat ankylosing spondylitis include:

As with most medications, these drugs come with some side effects. NSAIDs can cause gastrointestinal bleeding. TNF inhibitors can reactivate latent tuberculosis (a type of lung infection) and may lead to certain neurological problems. Be aware of these potential problems, and notify your doctor if you experience these side effects.

Physical Therapy

The pain and stiffness of ankylosing spondylitis may come and go, but your symptoms will become especially bad if you are inactive. That is why it is important to get up and get moving.

Physical therapy can help on a variety of levels, from relieving pain to improving your physical strength and flexibility. A physical therapist can guide you through exercises designed specifically to treat your condition.

Ankylosing spondylitis can make your joints stiff and ruin your posture. Range-of-motion and flexibility exercises can help you stay flexible and maintain good posture.

Certain breathing exercises preserve and improve your lung capacity.

If your ankylosing spondylitis gets to the point where you start to hunch forward, there are various exercises to maintain a good posture. Abdominal and back exercises, as well as sleeping and walking correctly, can help you stay upright.


Hopefully, it will not come to this for you, but some patients require surgery to treat severe pain and joint damage. Some patients experience such terrible hip joint damage that they need their hip replaced.

Other Ways to Manage Symptoms

Alternative treatments can also help in your search for relief. Some patients use massage and acupuncture to deal with pain. Mindfulness exercises have been shown to reduce stress and fatigue in patients with ankylosing spondylitis and other rheumatic diseases.

It is important, though, to keep in mind that these alternative therapies have had little testing. More research needs to be done before they can be considered safe and effective.

Now what?

Ankylosing spondylitis is a chronic disease, meaning that it can last a lifetime. In the beginning, you may have only mild symptoms that you feel you can handle. This may be true, but it is also crucial that you see a rheumatologist at least once a year. An arthritis expert can help you keep your symptoms under control and spot any underlying problems that may arise as a result of ankylosing spondylitis.