Ankylosing Spondylitis: Symptoms, Causes, Treatment & Complete Guide
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
Ankylosing spondylitis, also called axial spondyloarthritis, is an inflammatory disease that mainly affects the spine and can fuse vertebrae, reducing flexibility and causing a hunched posture. Symptoms often begin in early adulthood, with lower back and hip pain and stiffness that is worse after rest and improves with exercise. There is no cure, but early treatment works best.
What the research says
Waiting years for a diagnosis is common, and longer waits go with worse physical function. In 14 studies covering 2,581 patients with spondyloarthritis and uveitis and 13,972 without, the pooled mean delay to diagnosis was 6.08 years with uveitis and 5.41 years without; physical function scores (BASFI, where higher means worse) rose from 2.92 with a delay under 2 years to 4.17 with a delay over 10 years. (Lee et al., Sci Rep, 2023) [3]
Three advanced drug classes calm sacroiliac joint inflammation on MRI. Across 18 randomized trials, scores of sacroiliac joint inflammation (SPARCC) improved at 12–16 weeks with TNF inhibitors (weighted mean difference −3.29; 95% CI −4.25 to −2.34), IL-17 inhibitors (−4.66; 95% CI −6.22 to −3.09), and JAK inhibitors (−3.06; 95% CI −3.24 to −2.89), with no difference between the classes. (Hansmaennel et al., Clin Rheumatol, 2024) [4]
Mind-body exercise can help. In a meta-analysis of 15 studies, Tai Chi, yoga, Pilates and Qigong improved physical function (BASFI mean difference −0.76; 95% CI −1.01 to −0.50) and disease activity (BASDAI −0.76; 95% CI −0.94 to −0.57) in axial spondyloarthritis, with moderate-to-low certainty of evidence and no serious adverse events. (Wang et al., J Orthop Surg Res, 2024) [5]
Ankylosing Spondylitis at a Glance
Aspect | Summary |
What it is | Inflammatory disease that mainly affects the spine [1] |
Also called | Axial spondyloarthritis |
Two types | Radiographic (found on X-ray) and nonradiographic (found by symptoms, blood tests, MRI) [1] |
Typical onset | Late adolescence or early adulthood [1] |
Hallmark pain pattern | Worse in the morning and at rest; improves with exercise |
Known cause | Unknown; the HLA-B27 gene greatly increases risk [1] |
Main complications | Fused vertebrae, uveitis (eye inflammation), compression fractures, heart (aortic) issues [1] |
Treatment goal | Relieve pain and stiffness, maintain flexibility, slow spine changes [2] |
What Is Ankylosing Spondylitis?
Ankylosing spondylitis, also called axial spondyloarthritis, is a type of inflammatory disease that mainly affects the spine.
Over time, the inflammation can cause some of the bones in the spine — the vertebrae — to fuse together [1]. This fusing makes the spine less flexible and can lead to a hunched posture [1]. If the joints in the chest are affected, it may become harder to take deep breaths [1]. Symptoms often begin in early adulthood, and the condition can also cause inflammation in other parts of the body — most often in the eyes, called uveitis [1].
There is no cure for ankylosing spondylitis, but treatments can lessen symptoms, manage pain and possibly slow down the progression of the disease [1].
How does the spine fuse in ankylosing spondylitis?
In ankylosing spondylitis, the spine fuses because the body tries too hard to heal itself, which is why the name combines fusing and spine inflammation.
As ankylosing spondylitis progresses, the body forms new bone in an effort to heal inflamed areas. The new bone gradually bridges the gaps between vertebrae and eventually fuses sections of vertebrae together. Fused vertebrae can flatten the natural curves of the spine, which leads to stiffness and a hunched posture [1].
This explains the condition's name: "ankylosing" means fusing, and "spondylitis" means inflammation of the spine.
What are the two types of axial spondyloarthritis, including ankylosing spondylitis?
Ankylosing spondylitis belongs to axial spondyloarthritis, which has two types, and the naming matters because early disease often looks normal on X-ray while MRI catches it first.
Type | How It's Found | Key Detail |
Ankylosing spondylitis (radiographic axial spondyloarthritis) | Found on X-ray | X-ray changes may take years to develop [2] |
Nonradiographic axial spondyloarthritis | Cannot be seen on X-ray; found based on symptoms, blood tests and other imaging such as MRI [1] | Detected earlier in the disease process [2] |
The naming matters because early disease often looks normal on X-ray — the MRI is what catches it first.
What symptom pattern points to ankylosing spondylitis?
Early symptoms of ankylosing spondylitis might include back pain and stiffness, especially in the lower back and hips [1]. These symptoms may be worse in the morning or after periods of inactivity [1]. Neck pain and fatigue also are common. Other symptoms include vision changes or eye pain, skin rashes and stomach pain [1].
Symptom | The Pattern |
Back pain and stiffness | Especially in the lower back and hips |
Morning pattern | Worse in the morning or after periods of inactivity |
Exercise effect | Improves with exercise, worsens with rest — the opposite of most ordinary back pain |
Sleep disruption | Pain can awaken you from sleep at night [1] |
Course of symptoms | Come and go — periods of increased pain and stiffness followed by times when symptoms improve or go away [1] |
Neck and energy | Neck pain and fatigue are common |
Beyond the spine | Vision changes or eye pain, skin rashes, stomach pain |
The exercise-versus-rest pattern is the single most useful clue: ordinary mechanical back pain usually feels better with rest and worse with movement, while inflammatory back pain does the reverse.
Which areas does ankylosing spondylitis most commonly affect?
Ankylosing spondylitis most commonly affects the sacroiliac joints, the lower back vertebrae, the places where tendons and ligaments attach to bones, and the hip and shoulder joints.
The sacroiliac joints — the joints between the base of the spine and the pelvis [1]
The vertebrae in the lower back [1]
The places where tendons and ligaments attach to bones — mainly in the spine or along the back of the heel [1]
The cartilage between the ribs and the breastbone [1]
The hip and shoulder joints [1]
When should you see a doctor about ankylosing spondylitis?
See a healthcare professional about possible ankylosing spondylitis if you have slowly developing low back or buttock pain that is worse in the morning or wakes you at night.
And seek care from an eye specialist right away if you develop a red, painful eye, light sensitivity or blurry vision, since these can be signs of inflammation in the eye [1].
How is the HLA-B27 gene linked to ankylosing spondylitis?
The exact cause of ankylosing spondylitis isn't known, but genetic factors seem to be involved [1].
People who have a gene called HLA-B27 are at a greatly increased risk of developing ankylosing spondylitis. However, only some people with the gene develop the condition and not everyone with ankylosing spondylitis has this gene [1].
The gene is a risk amplifier, not a verdict: having it raises your odds substantially, but plenty of carriers never develop the disease — and plenty of patients don't carry it.
What are the risk factors for ankylosing spondylitis?
Risk Factor | Detail |
Younger age | The disease usually starts in late adolescence or early adulthood |
Genetics | Most people who have ankylosing spondylitis have the HLA-B27 gene — but many people who have this gene never develop ankylosing spondylitis [1] |
What complications can ankylosing spondylitis cause beyond the back?
In serious cases of ankylosing spondylitis, the body's long-term attempt to heal itself becomes the problem and can lead to complications beyond the back.
The body tries to heal the long-term inflammation by forming new bone. Over time, this new bone bridges the gaps between vertebrae and causes them to fuse together. The fused parts of the spine become stiff and less flexible. If the joints in the chest around the rib cage also become stiff, the stiffness can limit how much the lungs can expand and make deep breathing more difficult [1].
Other possible complications:
Complication | What Happens |
Uveitis (eye inflammation) | One of the most common complications — sudden eye pain, redness, light sensitivity and blurry vision. See a healthcare professional right away if these symptoms develop [1] |
Compression fractures | Weakened spine bones press together and worsen the hunched posture; vertebral fractures can also press on and possibly damage the spinal cord and nerves [1] |
Heart issues | The aorta — the body's largest artery — can become inflamed, swell, and change the shape of the aortic valve so it leaks and can't work as well (aortic regurgitation); this inflammation also increases the overall risk of heart disease [1] |
How Is Ankylosing Spondylitis Diagnosed?
To diagnose ankylosing spondylitis, your healthcare professional may ask about your medical history, family history and symptoms, and perform a physical exam to check your posture, flexibility, and areas of pain or stiffness. You may also be asked to take a deep breath to see if you have trouble expanding your chest [2].
Test | What It Shows |
X-rays | Changes in joints and bones — a sign of radiographic axial spondyloarthritis. Changes on X-ray might take years to develop, so early disease might not show [2] |
MRI | Detailed images of bones and soft tissues using radio waves and a strong magnetic field; can detect nonradiographic axial spondyloarthritis earlier in the disease process — but is much more expensive [2] |
ESR and CRP blood tests | Check markers of inflammation — but many different health issues can cause inflammation [2] |
HLA-B27 blood test | Tests for the gene — but many people who have the gene don't have ankylosing spondylitis, and people without the gene can have the disease [2] |
The honest summary: there are no specific lab tests to identify ankylosing spondylitis [2] — the diagnosis is built from the pattern of history, exam, imaging, and blood markers together.
Why should ankylosing spondylitis treatment start early?
The goal of treatment is to relieve pain and stiffness, maintain flexibility, and prevent or slow changes to the spine [2]. Ankylosing spondylitis treatment works best when it's started early before permanent damage is done [2].
Medicines
Medicine Class | How Given | Examples | Notes |
NSAIDs (nonsteroidal anti-inflammatory drugs) | Pill | Naproxen sodium (Aleve), ibuprofen (Advil, Motrin IB) | The most commonly used first-line medicines; relieve inflammation, pain and stiffness. Can irritate the stomach and may cause gastrointestinal bleeding [2] |
TNF blockers | Injected under the skin or through an IV | Adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade) [2] | Used if NSAIDs are not helpful |
IL-17 inhibitors | Injected under the skin or through an IV | Secukinumab (Cosentyx), ixekizumab (Taltz), bimekizumab (Bimzelx) [2] | Used if NSAIDs are not helpful |
JAK inhibitors | By mouth | Tofacitinib (Xeljanz), upadacitinib (Rinvoq) [2] | Another option; can reactivate untreated tuberculosis and make you more prone to infections |
An important shared caution on the advanced options: these medicines can reactivate untreated tuberculosis and make you more prone to infections [2].
Physical Therapy
Physical therapy is a very important part of the treatment plan and can help relieve pain while improving flexibility, posture and strength. A physical therapist can design specific exercises for your needs, including:
Surgery
Most people with ankylosing spondylitis or nonradiographic axial spondyloarthritis do not need surgery. Surgery may be recommended if you have severe pain or if a hip joint is so damaged that it needs to be replaced [2].
Which daily self-care practices help manage ankylosing spondylitis?
Three daily practices help manage ankylosing spondylitis: staying active, not smoking and practicing good posture.
Stay active. Exercise can help ease pain, maintain flexibility and improve your posture [2].
Do not smoke. If you smoke, try to stop. Smoking is generally bad for your health and can make breathing even harder for people with ankylosing spondylitis [2].
Practice good posture. Practice standing straight in front of a mirror. Standing straight can help you avoid some of the issues related to ankylosing spondylitis.
How can people cope with ankylosing spondylitis?
Living with ankylosing spondylitis can be challenging. The course of your condition can change over time, and you might have painful episodes and periods of less pain throughout your life. But most people can live productive lives despite a diagnosis of ankylosing spondylitis [2]. You might want to join an online or in-person support group of people with this condition, to share experiences and support.
How should you prepare for an ankylosing spondylitis appointment?
You might first bring your symptoms to the attention of your healthcare team. Your primary health professional may refer you to a rheumatologist — a specialist in inflammatory disorders [2].
What You Can Do
Make a list of:
Your symptoms, including any that may seem unrelated to the reason you made the appointment, and when they began
Key personal information, including major stresses, recent life changes and family medical history
All medicines, vitamins and other supplements you take and their doses
Questions to ask your healthcare professional
Take a family member or friend along, if possible, to help you remember the information you are given.
Basic questions to ask your healthcare team include:
What is likely causing my symptoms?
Other than the most likely cause, what are other possible causes for my symptoms?
What tests do I need?
Is my condition likely temporary or lifelong?
What course of action do you recommend?
What are the alternatives to the primary approach you are suggesting?
I have other health conditions. How can I best manage them together?
Are there restrictions I need to follow?
Should I see a specialist?
Are there brochures or other printed material I can have? What websites do you recommend?
What to Expect from Your Doctor
Your healthcare professional is likely to ask you questions, such as:
Where is your pain?
How serious is your pain?
Have your symptoms been continuous or occasional?
What, if anything, seems to worsen or improve your symptoms?
Have you taken medicines to relieve the pain? What helped most?
Frequently Asked Questions
What is ankylosing spondylitis?
Ankylosing spondylitis, also called axial spondyloarthritis, is a type of inflammatory disease that mainly affects the spine. Over time, the inflammation can cause some of the vertebrae to fuse together, making the spine less flexible and leading to a hunched posture.
What is the difference between ankylosing spondylitis and nonradiographic axial spondyloarthritis?
Ankylosing spondylitis and nonradiographic axial spondyloarthritis are the two types of axial spondyloarthritis. Ankylosing spondylitis (the radiographic type) can be seen on X-ray, while nonradiographic axial spondyloarthritis cannot be seen on X-ray and is found based on symptoms, blood tests and other imaging tests such as MRI.
How do I know if my back pain is ankylosing spondylitis?
A key clue is the pattern: inflammatory back pain comes on slowly, is worse in the morning or after rest, and improves with exercise and worsens with rest — the opposite of most ordinary back pain. Pain that wakes you at night and slow-onset low back or buttock pain are also warning signs worth discussing with a doctor.
Does ankylosing spondylitis only affect the spine?
No. It most commonly affects the sacroiliac joints, lower back vertebrae, tendon and ligament attachment points, the cartilage between the ribs and breastbone, and the hip and shoulder joints. Inflammation can also affect the eyes (uveitis), and if the chest joints stiffen, deep breathing can become harder.
What is uveitis and why is it an emergency?
Uveitis is inflammation of the eye and one of the most common complications of ankylosing spondylitis. It causes sudden eye pain, redness, light sensitivity and blurry vision. Because it can damage the eye, you should see an eye specialist right away if these symptoms develop.
Is ankylosing spondylitis caused by the HLA-B27 gene?
The exact cause is unknown, but genetic factors are involved. People with the HLA-B27 gene are at greatly increased risk — yet only some people with the gene develop the condition, and not everyone with ankylosing spondylitis has the gene. The disease usually starts in late adolescence or early adulthood [1].
Can ankylosing spondylitis be cured?
There is no cure, but treatments can lessen symptoms, manage pain and possibly slow down the progression. NSAIDs are the most common first treatment; if they are not helpful, TNF blockers, IL-17 inhibitors or JAK inhibitors may be used, along with physical therapy. Treatment works best when started early before permanent damage is done.
Conclusion
The three lessons to carry away from this guide:
The pain pattern is the fingerprint: back and buttock pain that builds slowly, worsens in the morning and at rest, wakes you at night, and improves with exercise is the signature of inflammatory back pain — and it deserves a rheumatologist's attention rather than another bottle of painkillers.
The spine fuses because the body over-heals: new bone bridges inflamed vertebrae and flattens the spine's curves — which is exactly why early treatment, before permanent damage, changes the long-term outcome.
Daily choices are part of the treatment plan: staying active, not smoking, and practicing good posture sit alongside NSAIDs, biologics, and physical therapy as ways to preserve flexibility and posture for decades.
This guide has walked you through what ankylosing spondylitis is, the two types, the four-step fusion mechanism, the symptom pattern, the HLA-B27 gene link, the four complications, the diagnosis, the treatment ladder, self-care, and the questions to bring to your appointment. Remember that every answer here is a starting point, not a substitute for your provider's examination.
Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Related Reading
Spine X-Ray: What It Shows, How to Prepare, What Happens and What the Results Mean explains the imaging test often used to look at the bones of the spine.
References
Mayo Clinic. Ankylosing spondylitis — Symptoms & causes. Accessed October 12, 2026. https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808
Mayo Clinic. Ankylosing spondylitis — Diagnosis & treatment. Accessed October 12, 2026. https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/diagnosis-treatment/drc-20354813
Lee SC, Yang CH, Tsai YC, et al. The effect of uveitis and undiagnosed spondyloarthritis: a systematic review and meta-analysis. Sci Rep. 2023;13(1):14779. PMID 37679498. https://doi.org/10.1038/s41598-023-41971-z
Hansmaennel A, Fakih O, Gerazime A, et al. Effects of disease-modifying anti-rheumatic drugs on sacroiliac MRI score in axial spondyloarthritis: a systematic review and meta-analysis. Clin Rheumatol. 2024;43(3):1045-1052. PMID 38158505. https://doi.org/10.1007/s10067-023-06849-5
Wang J, Li X, Yang F, et al. Efficacy and safety of mind-body exercise for patients with axial spondyloarthritis: a systematic review and meta-analysis. J Orthop Surg Res. 2024;19(1):586. PMID 39342350. https://doi.org/10.1186/s13018-024-05072-5
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