Ankylosing spondylitis

Ankylosing spondylitis, or AS, is a long-term inflammatory condition that most often affects the spine and the places where the spine meets the pelvis. It usually starts gradually, often in late teenage years or early adulthood, and brings persistent back pain and stiffness. Many people notice that their discomfort is worse in the morning or after being still, but it tends to improve once they start moving.

Symptoms

• Chronic lower back pain and stiffness, especially after resting
• Pain that eases with activity but not with rest
• Reduced flexibility of the spine and, in advanced stages, a forward-stooped posture
• Pain in the buttocks, sometimes shifting from side to side
• Swelling or pain in other joints, like the hips, shoulders or knees
• Pain at spots where tendons or ligaments attach to bone, such as the heel or under the foot
• Tiredness, and in some cases, redness or pain in the eyes from inflammation

Causes and Risk Factors

• While the exact cause is not known, immune system activity plays a big part
• The HLA-B27 gene is linked to a higher risk, but not everyone with this gene gets AS
• Having a family member with AS or similar conditions increases your risk
• AS affects more men than women and usually begins between ages 15 and 40

How Ankylosing Spondylitis is Diagnosed

Our team looks at a combination of your symptoms, a physical exam, imaging and blood tests. During an exam, we check your spinal movement, how well your chest expands and any spots that are tender. X-rays of the pelvis may show early changes in the joints, and MRI can give a clearer picture when changes are just beginning. Blood samples might show signs of inflammation, and genetic testing for HLA-B27 can support the diagnosis, though it is not used alone. Confirming AS usually involves referring you to a rheumatologist, who will help create a plan for your care.

Living with Ankylosing Spondylitis

AS varies from person to person. Some experience slow changes, while others have more rapid symptoms. Early detection and treatment make a difference. The main goals are to reduce inflammation, ease pain, keep you moving and prevent problems down the road. This often involves regular exercise, physical therapy and medications to lower inflammation. Some people may need advanced medications that target specific parts of the immune system. It is also important to watch for and manage any related health concerns, such as breathing changes or episodes of eye inflammation.

If you have ongoing back pain, a family history of AS or repeated episodes of eye inflammation, reach out to your primary care provider. TidalHealth is here to help with answers, evaluations and guidance about what to do next.

What causes ankylosing spondylitis?

The exact cause is not fully understood. Ankylosing spondylitis is an inflammatory condition tied to how the immune system works. Genetics are important, especially if you have the HLA-B27 gene, but not everyone with this gene gets AS. Family history, environmental and other genetic factors also play a role.

What symptoms should I watch for?

Common symptoms include long-lasting low back pain and stiffness that usually begin in young adulthood. These symptoms are often worse in the morning or after you have been still and typically get better once you start moving. Other things to watch for are pain in your hips, shoulders, heels, tiredness and, at times, eye inflammation causing redness or discomfort.

How is AS different from mechanical back pain?

Inflammatory back pain from AS often begins earlier in life, improves with activity and gets worse if you rest. Mechanical back pain, which may result from an injury, usually behaves in the opposite way and gets better with rest. Your healthcare provider uses your story, an exam, blood work and imaging to figure out which type you have.

Can ankylosing spondylitis be cured?

There is currently no cure for AS. However, many people find real relief with the right treatments, which help control inflammation, ease symptoms and slow or prevent changes to the spine and joints.

What treatments are available?

Treatment is highly individualized and is often managed with help from a rheumatologist. The mainstays of care are regular exercise and physical therapy, medications like nonsteroidal anti-inflammatory drugs (NSAIDs) and sometimes biologic medicines if symptoms do not respond enough to other treatments.

Is exercise safe and helpful?

Yes. Regular exercise and posture training are very helpful. Physical therapy supports flexibility, helps reduce stiffness and can make a real difference in your posture and chest movement.

Will AS affect my ability to work or have children?

Many people with AS continue to work and have healthy families. Since symptoms and abilities differ from person to person, the right treatment and, if needed, adjustments at work make it possible to stay active and productive. If you are thinking about starting a family, talk with your care team for support and planning.

When should I see a specialist?

If you have persistent back pain that began before age 40, experience stiffness that improves with movement, have repeated episodes of eye redness or there is a family history of AS, you may benefit from seeing a specialist. TidalHealth’s team can help confirm a diagnosis and guide your long-term care.

What complications should I be aware of?

Possible complications include reduced movement in your spine, a fixed forward posture, changes in breathing due to chest restriction, chronic pain, inflammation in the eyes and in rare cases, involvement of the heart or lungs. Catching AS early and following your treatment plan can help reduce the chances of serious complications.

If you are worried about possible symptoms of ankylosing spondylitis, TidalHealth is here to listen, help with testing and support you every step of the way.