About-Ankylosing spondylitis (AS), also called Bechterew’s disease, is a chronic inflammatory disease that mainly affects the spine and the joints between the lower spine and pelvis (sacroiliac joints). It belongs to a group of conditions called spondyloarthritis. The inflammation can cause pain, stiffness and reduced movement in the back. Over many years, some people develop new bone formation between the vertebrae, which can cause parts of the spine to become stiff or fuse together. However, the course and severity of ankylosing spondylitis vary considerably from person to person. AS often begins in adolescence or early adulthood, although it can occur at any age. Early diagnosis and appropriate treatment can help control inflammation, maintain mobility and reduce the risk of long-term complications.
AS is a systemic inflammatory condition and may be associated with problems outside the spine. Some people may develop inflammatory bowel disease, including Crohn’s disease or ulcerative colitis. Psoriasis can also occur in people with spondyloarthritis.
The specific cause of ankylosing spondylitis is not known. Researchers believe that a combination of genetic and environmental factors contributes to the development of the disease. A strong association exists between AS and a gene called HLA-B27. However, having HLA-B27 does not mean that a person will definitely develop ankylosing spondylitis. Many people who carry this gene never develop the disease. Other genetic factors and changes in the immune system are also believed to contribute. Environmental factors, infections and changes in the gut microbiome are being studied as possible contributors, although the exact mechanism is not completely understood. Ankylosing spondylitis is an inflammatory disease and is not simply caused by poor posture or normal aging.
There is no single test that can definitively diagnose ankylosing spondylitis. A doctor usually combines the person’s symptoms, medical history, physical examination, blood tests and imaging studies.
There is currently no cure for ankylosing spondylitis, but treatment can control inflammation, relieve pain and stiffness, preserve mobility and help prevent or slow long-term complications. Treatment is individualized according to symptoms, disease activity and other health factors.
Doctors may use medicines to control pain and inflammation. These may include:
Nonsteroidal anti-inflammatory drugs (NSAIDs)- Medicines such as ibuprofen, naproxen or other NSAIDs may help reduce pain and stiffness. They should be used according to medical advice because they can cause side effects in some people.
Biologic medicines- When inflammation remains active despite conventional treatment, a rheumatologist may consider biologic medicines. These can include medicines that target inflammatory pathways such as TNF or interleukin-17 (IL-17).
Targeted synthetic medicines- In selected patients, other targeted medicines may be considered by a specialist.
The choice of treatment depends on disease activity, other medical conditions, previous treatments and individual response.
Surgery is not required for most people with ankylosing spondylitis. However, joint replacement surgery may sometimes be considered when severe damage affects a joint such as the hip. In severe cases with major spinal deformity, specialized spinal surgery may be considered.
See a doctor if you have persistent back pain and stiffness, particularly if:
Symptoms began at a relatively young age.
Pain and stiffness are worse in the morning.
Symptoms improve with exercise but do not improve with rest.
Pain repeatedly occurs in the buttocks or hips.
You have a family history of ankylosing spondylitis.
You have unexplained joint swelling or persistent fatigue.
Early assessment by a healthcare professional is important because treatment can help control inflammation and maintain physical function. Seek urgent medical attention for sudden severe eye pain, a very red eye, marked sensitivity to light or sudden vision changes, as these can be symptoms of uveitis.
The course of ankylosing spondylitis varies widely. Some people have relatively mild symptoms, while others develop significant spinal stiffness or joint problems. Modern treatments and regular exercise have improved the ability to control inflammation and maintain function. Early diagnosis, appropriate treatment, physical activity and regular medical follow-up can help many people remain active and maintain a good quality of life.
A rheumatologist is generally the main specialist involved in diagnosing and treating ankylosing spondylitis. An orthopedic surgeon may become involved when there is significant structural or joint damage, while a physiotherapist can help with mobility, posture and exercise. If eye symptoms occur, an ophthalmologist may also be required. Patients with persistent bowel symptoms may need assessment by a gastroenterologist.
Yes. Ankylosing spondylitis is a chronic inflammatory form of arthritis that primarily affects the spine and sacroiliac joints. It belongs to the spondyloarthritis family of diseases.
Genetic factors play an important role. The HLA-B27 gene is strongly associated with AS, but carrying HLA-B27 does not mean that a person will necessarily develop the disease.
Yes. Regular, appropriate exercise is an important part of treatment. Stretching, strengthening, posture exercises and activities that maintain mobility can be beneficial. A physiotherapist can help develop an appropriate program.
No. Although the spine and sacroiliac joints are commonly affected, AS can also affect the hips and other joints, as well as areas where tendons and ligaments attach to bones. It can also be associated with eye, bowel and skin conditions.
Yes. Some people with AS develop uveitis, an inflammation inside the eye. A painful or red eye accompanied by light sensitivity or blurred vision requires prompt medical evaluation.
Long-standing inflammation and spinal changes can reduce flexibility and, in some people, contribute to changes in posture. Early treatment, regular exercise and posture-focused physiotherapy can help maintain spinal mobility.
Mechanical back pain often becomes worse with activity and improves with rest. Inflammatory back pain associated with AS tends to be worse after rest or during the night, causes morning stiffness and may improve with movement. However, only a healthcare professional can determine the cause of back pain.
This information is provided for general educational purposes and should not be considered a substitute for professional medical advice, diagnosis or treatment. Ankylosing spondylitis can affect people differently. If you have persistent back pain, stiffness, joint symptoms or other concerning symptoms, consult a qualified healthcare professional.
