What is Ankylosing spondylitis (AS)?

Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine, causing pain, stiffness, and loss of mobility.

It belongs to a group of conditions known as spondyloarthritis, which are characterised by inflammation of the joints and entheses (the sites where tendons and ligaments attach to bones).

Early symptoms often include back and neck pain, which is usually worse early in the morning or after rest. The pain may improve with exercise. AS can also affect other joints or include symptoms such as bowel irritation and sore eyes.

Common early symptoms include aching across the buttocks and pain across the chest or between the shoulder blades. Symptoms may flare and go into remission or slowly worsen over time. Without early treatment AS may lead to permanent stiffening of the spine and damage to other joints.

While AS can be challenging to live with, understanding the condition and its management can greatly improve quality of life.

The symptoms of AS usually begin between the ages of 15 and 45 years.

What causes it?

While the exact cause is unknown, factors that may contribute include the following.

Unlike other back problems, AS is not caused by specific jobs, injuries, or activities.

A stylised icon of a row of people all stood in front of each other, arms out Causes

  1. Genetics: The HLA-B27 gene is strongly linked to AS, though not everyone with the gene will develop the condition.

  2. Family History: Having a relative with AS increases your risk.

What are the symptoms?

The most common symptoms of AS include:

  • Back Pain: Persistent pain and stiffness in the lower back, buttocks, and hips are common symptoms of AS. This pain is often worse in the morning or after periods of inactivity.
  • Stiffness: People with AS may experience stiffness and limited mobility, particularly in the morning or after prolonged periods of sitting or lying down.
  • Fatigue: Chronic inflammation and pain associated with AS can lead to fatigue and reduced energy levels.
  • Joint Pain: In addition to the spine, AS can affect other joints such as the shoulders, knees, and ankles, causing pain and swelling.
  • Eye Inflammation: Some people with AS may develop inflammation of the eyes (uveitis), leading to redness, pain, and sensitivity to light

Other Common Questions

Many people mistake early AS symptoms for common back pain. However, early diagnosis is essential to prevent long-term complications.

Diagnosis typically involves:

  • Symptom Assessment: Your doctor will evaluate your symptoms and medical history.
  • Physical Examination: Testing for joint and spinal flexibility.
  • Blood Tests: To detect inflammation or the presence of the HLA-B27 gene.
  • Imaging: X-rays or MRIs to check for joint damage.

If AS is suspected, your doctor should refer you to a rheumatologist, a specialist in arthritis care.

With the right treatment, most people with AS can lead full and active lives. Many people find there are times when their symptoms worsen (known as a ‘flare’), and times when their symptoms get better.

In most cases AS can be well controlled with treatment and the pain improves over time. However some people may have severe, long lasting pain.

As a result of the inflammation in the spine, new bone may grow around the joints. This leads to permanent stiffness in the back or neck of some people with AS.

In severe cases this extra bone can fuse the bones in the spine together, stopping the spine from moving. Fusion of the spine can lead to a bent or forward stooped posture.

This used to be common but can now usually be prevented by starting proper treatment as early as possible.

Currently there is no cure for AS. However treatment for AS has improved dramatically, with new medicines that are extremely helpful in controlling the condition. Be wary of any products or therapies that claim to cure AS.

Your rheumatologist will tailor your treatment to your symptoms and the severity of your condition. There is no way of predicting exactly which treatment will work best for you. Each treatment has its own benefits and risks. Your doctor may need to trial several different treatments before finding the one that is right for you.

Treatment for AS usually involves:

  • physiotherapy exercises (such as hydrotherapy or exercises in water), to keep the spine flexible and improve posture
  • medicines, such as:
    • analgesics (pain relievers, such as paracetamol)
    • non-steroidal anti-inflammatory drugs (NSAIDs)
    • corticosteroid medicines or injections
    • disease-modifying anti-rheumatic drugs (DMARDs)
    • biological DMARDs.

For more information about medicines see the Australian Rheumatology Association’s Patient Medicine Information or the Medicines & Arthritis information sheet.

You play a vital role in managing AS. Here’s how you can take charge:

  1. See a Rheumatologist Early: A specialist can provide an accurate diagnosis and guide your treatment. If you haven’t seen a rheumatologist, ask your doctor for a referral.
  2. Learn About AS: Knowledge is empowering. Use trustworthy resources and involve yourself in your treatment decisions. Consider joining a self-management course through Arthritis WA.
  3. Stay Active: Regular physical activity helps reduce pain, maintain flexibility, and boost overall well-being. Work with a physiotherapist to find exercises that suit you, such as swimming, walking, or yoga.
  4. Eat Well: A balanced diet rich in fruits, vegetables, and omega-3 fatty acids supports overall health and reduces inflammation.
  5. Address Emotional Wellbeing: Living with a chronic condition can be emotionally taxing. Acknowledge your feelings and seek support when needed. Counselling or peer support groups can make a big difference.
  6. Maintain Good Posture: Strengthen your back muscles and practice good posture to prevent complications.

By understanding ankylosing spondylitis and actively managing its symptoms, people with AS can lead fulfilling and productive lives despite the challenges posed by the condition.

With the right combination of treatment, lifestyle modifications, and support, it is possible to minimise the impact of AS and maintain a good quality of life.

Downloads

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Ankylosing spondylitis

This sheet has been written for people affected by ankylosing spondylitis. It provides general information to help you understand how you may be affected and what you can do to manage it. It also tells you where to find further information and advice

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Taking Control of your Ankylosing Spondylitis

This booklet is designed for people who have ankylosing spondylitis. It will help you understand your condition so that you can better manage your symptoms and continue to lead an active and healthy life.