What exactly happens in Ankylosing Spondylitis?
Understand what Ankylosing Spondylitis is, its causes, risk factors and symptoms. Get knowledge about its advanced stage, diagnoses and effective ways to live with Ankylosing Spondylitis.
Written by Dr. Sonia Bhatt
Last updated on 3rd Jul, 2025
Introduction
Ankylosing spondylitis (AS) is one type of arthritis disease that impacts the joints and ligaments of the spine, making it less flexible. It is an inflammatory disease that, with time, can cause the bones in the spine to meld with one another.
It develops in sacroiliac joints, the place between the bottom of the spine and the pelvis. Ankylosing Spondylitis may also affect peripheral joints like the knees, ankles, and hips. If ribs are affected by Ankylosing Spondylitis, it can become difficult for one to breathe deeply.
As this type of arthritis becomes worse, new development in the form of bone forms as part of the body's attempt to recover. The new bone gradually closes the gaps between vertebrae and finally fuses sections of vertebrae together. The fused vertebrae can alter the natural curves of the spine, which in turn causes an inflexible and hunched posture.
What are the causes and risk factors?
What exactly causes this painful disease, Ankylosing Spondylitis, is not known yet. However, some studies show that both the genes and environment may cause the development of the disease.
The disease usually occurs in the late adolescence or early adulthood. Family history, age and other conditions - Crohn’s disease, ulcerative colitis, or psoriasis, are some of the risk factors.
What are the early symptoms of ankylosing spondylitis?
The most typical symptom of ankylosing spondylitis is lower back and/or hip pain and stiffness. In early stages the person with ankylosing spondylitis may experience stiffness and pain in the lower back of the body, in the early morning which lasts at least for 30 minutes and then eases through the day or with activity. The pain may become worse during inactivity like sleep, which may wake you up at night. People with Ankylosing Spondylitis can also experience pain in either one or both buttocks and sometimes also at the backs of the thighs. People with this disease may also experience pain, stiffness and swelling in their knees or ankles.
In addition to the above symptoms, people with Ankylosing Spondylitis can also experience fatigue and general discomfort, like restricted movements in chest making it difficult to breathe, painful and red eyes, cardiovascular problems, such as inflammation of the aorta, aortic valve disease, and ischemic heart disease. Fatigue is one of the most common symptoms of ankylosing spondylitis. People with fatigue caused by Ankylosing Spondylitis may experience: generalized tiredness, lack of energy, brain fog, heavy limbs and muscle weakness, etc. With time, the symptoms spread to other areas of the spine or body.
What are the Common Symptoms of Ankylosing Spondylitis beyond back pain?
The other symptoms of Ankylosing Spondylitis other than back pain are early morning stiffness, and a stooped posture, eye inflammation, digestive illness, cardiovascular.
Eye Inflammation (Uveitis) - Uveitis may cause eye pain, light sensitivity, and increased floaters, or spots in the vision. The most noticeable symptom of uveitis is redness in the front of the eye. The other symptoms are – inflammation of the iris of the eye, eye swelling, eye pain, sensitivity to light, blurred or cloudy vision, decreased vision, dark spot in the vision.
Digestive involvement – People with Ankylosing Spondylitis can experience inflammation of the gastrointestinal tract. This can further cause stomach pain, diarrhea, and digestive problems. It may also increase the risk of inflammatory bowel disease, ulcerative colitis, or Crohn’s disease may develop.
Cardiovascular Symptoms – People with Ankylosing Spondylitis may also have an increased risk of developing heart problems, such as: aortitis, aortic valve disease, conduction problems, ischemic heart disease, and cardiomyopathy. Mitral insufficiency in AS is rare, but can cause cardiac failure.
What happens in a severe or advanced stage?
In the advanced stage of Ankylosing Spondylitis, the spine becomes fused. This happens because new bone grows between some small bone of the spine, joining them together. Fusion in the spine not only restricts the movement but can also put one in high risk of fracture. This can also make the spine to curve forward, causing one to have a hunched-over posture. In the advanced stage of Ankylosing Spondylitis, it can also damage the nerves at the base of the spine, which may lead to neurological problems.
Are the symptoms variable?
The variability of symptoms in Ankylosing Spondylitis (AS) can differ significantly from person to person, and even in the same person over time. This variability includes fluctuations in the severity, location, and type of symptoms. Here are key aspects of the variability of AS symptoms:
Intensity: The amount of pain caused by ankylosing spondylitis to an individual can vary day-to-day or week-to-week. Some days may have significant discomfort, while on other days the pain would be manageable.
Location: Although AS commonly affects the lower back and sacroiliac joints, the pain can shift to other areas like the hips, shoulders, knees, or peripheral joints over time.
Patterns: The pain may be worse in the morning or after long periods of inactivity, but it might improve with movement or exercise. On other days, pain may persist regardless of activity levels.
Remission: Symptoms may temporarily subside, with little to no discomfort. These periods can vary in length and may be spontaneous or triggered by treatment.
Eye Inflammation (Uveitis): Eye inflammation can occur sporadically and without warning, often flaring up and subsiding. It may happen several times a year or rarely, depending on the individual.
Diagnostic Considerations:
To diagnose Ankylosing Spondylitis, the doctors may ask for medical history, like, how long the pain persist, where is the pain, what makes the pain better or worse, does anyone in the family have history of back pain, joint pain, arthritis, etc., before conducting physical examination.
Physical Exam: The physical exam may include –
Examining the joints, spine, pelvis, heels, and chest.
Checking flexibility like how one moves and bends in different position
Observing deep breathing to check for rib stiffness and inflammation.
Imaging Studies: Imaging studies is also used to help diagnose ankylosing spondylitis.
Imaging Studies
X-rays: X-rays help to identify joint changes. It is possible that a person may have disease for years before it can be visible on the x-ray. X-ray can also help to monitor the progression of the disease, or to rule out the causes for joint pain.
Magnetic Resonance Imaging (MRI): The images produced in MRI are analysed by computer to produce an image of the joint. MRI can help to diagnose Ankylosing Spondylitis in its early stages.
Lab Tests: At present, there is no known lab test that can diagnose Ankylosing Spondylitis. The doctors may ask for a blood test for HLA-B27 gene, which is present in people with this disease. It is possible that an individual may have HLA-B27 gene but never develop ankylosing spondylitis. The doctors may also ask to check blood count and markers of inflammation to understand the extent of this disease.
How to live with Ankylosing Spondylitis?
Self-care can help one to manage this type of Spondylitis and improve health. Learning about the disease, its treatment, communicating with the health care team, reaching out for support to overcome the effects of Ankylosing Spondylitis are a few measures to follow.
Changes in lifestyle and activities can also help to cope up with the disease.
Exercise: Exercise is important to maintain healthy and strong muscles, keeping good joint mobility and flexibility. Exercise can help improve the quality of sleep, reduce pain, keep a healthy weight and have a positive attitude.
Posture: Practising good posture helps to improve the posture. It can also avoid some complications that come along with Ankylosing Spondylitis.
Support device: Using a walker or cane as support can help to have safe movement, stability and reduce the pain.
Stress Management: It is only understandable that Ankylosing Spondylitis may have emotional impact besides physical. Managing stress that comes with the pain and limitation produced by this disease, can help one to cope up. Meditation, yoga, deep breathing, and listening to soft music are some of the ways to manage stress.
Healthy diet: Although there is no particular diet to be followed by people with Ankylosing Spondylitis, eating healthy food can help to manage weight, which in turn reduces the stress on the joints.
Smoking: Smoking weakens the effect of treatment of Ankylosing Spondylitis. It can also increase the risk of advancement of the disease. If any individual has ankylosing spondylitis in the chest, smoking can further compromise the function of the lungs.
Conclusions:
Ankylosing Spondylitis is a form of arthritis disease that affects the spine and ligament of the spine which makes it less flexible. There is no known cause for this disease and hence no cure. Along with pain and stiffness of muscles, ankylosing spondylitis can cause eye inflammation, digestive involvement, and cardiovascular symptoms. It is important to have this disease diagnosed at an early stage to choose the appropriate treatment. However, treatments are aimed at managing the symptoms. Along with the medical treatment, it is advisable that individuals diagnosed with this disease should follow self-care and changes in life-style to not only cope-up with ankylosing spondylitis, but also to live a good life with a positive attitude.
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