Understanding Ankylosing Spondylitis: Key Facts for Patients

Understanding Ankylosing Spondylitis: A Patient‑Friendly Guide

Ankylosing spondylitis (AS) is a type of arthritis that mainly affects the spine and the joints at the base of the spine, called the sacroiliac joints. It causes inflammation that leads to pain and stiffness, especially in the lower back and hips. Over time, this inflammation can cause the bones of the spine to fuse together, reducing flexibility and sometimes leading to a stooped posture. Although AS is a lifelong condition, with the right treatment and lifestyle changes, most people can manage their symptoms and stay active.

AS often begins in young adults, more commonly in men, and is strongly linked to a genetic marker called HLA‑B27. This marker is part of the immune system. People who carry HLA‑B27 are more likely to develop AS, though not everyone with the gene will get the disease. Because it is inherited, related conditions can sometimes be seen in families. These include psoriatic arthritis, reactive arthritis, and arthritis linked to inflammatory bowel disease such as Crohn’s disease or ulcerative colitis.

Symptoms Beyond the Spine

AS does not only affect the back. It can cause inflammation in other parts of the body, known as extra‑articular symptoms. These include:

• Eye inflammation (uveitis): causing pain, redness, sensitivity to light, and blurred vision.
• Gut problems: such as Crohn’s disease or ulcerative colitis, leading to abdominal pain and diarrhea.
• Skin conditions: like psoriasis, which may appear in patients or family members.
• Heart involvement: in rare cases, AS can affect the heart valves or rhythm.
• Lung involvement: reduced chest expansion can affect breathing in advanced cases.

Who to Consult

If you suspect AS, the first step is to see your general practitioner (GP). They may refer you to a rheumatologist, who specializes in inflammatory joint diseases and is the main doctor for diagnosing and managing AS. Depending on your symptoms, you may also see a physiotherapist for exercise guidance, an ophthalmologist if your eyes are affected, or a gastroenterologist if bowel symptoms occur.

Management Strategies

Treatment focuses on controlling inflammation, relieving pain, and keeping the spine flexible.

Education and Self‑Management Understanding the condition helps patients take an active role in their care. Knowing that exercise improves symptoms and that early treatment can prevent complications is empowering.

Physical Activity Exercise is central to managing AS. Stretching and strengthening exercises help maintain posture and flexibility. Swimming and yoga are particularly beneficial. Check out some exercises for Ankylosing Spondylitis by clicking this link. Physiotherapists can design tailored programs to keep the spine mobile and prevent stiffness. Unlike mechanical back pain, AS pain improves with activity, so regular movement is encouraged.

Medications

• NSAIDs (Non‑steroidal anti‑inflammatory drugs): First‑line treatment to reduce pain and stiffness. They work by blocking enzymes that produce inflammatory chemicals. Side effects can include stomach irritation, ulcers, and increased cardiovascular risk.
• Biologic therapies: These are advanced medicines used when NSAIDs are not enough. They target specific proteins in the immune system that drive inflammation.
  • TNF inhibitors (adalimumab, etanercept, infliximab, golimumab, certolizumab pegol) block a protein called TNF, which fuels inflammation. By reducing TNF activity, they ease pain and stiffness and help prevent long‑term damage.
  • IL‑17 inhibitors (secukinumab, ixekizumab) block another protein, IL‑17, which also plays a key role in inflammation. These medicines are often used if TNF inhibitors are not effective or suitable.
  • Possible side effects: Because biologics affect the immune system, they can increase the risk of infections. Doctors usually check for tuberculosis and hepatitis before starting treatment, and regular monitoring is needed.
• DMARDs (Disease‑modifying antirheumatic drugs): Sometimes used if peripheral joints are involved, though they are less effective for spinal symptoms.
• To know more about the drugs, click this link.

Lifestyle Adjustments Maintaining good posture, practicing breathing exercises, and avoiding smoking are important. Smoking worsens AS and increases the risk of severe spinal damage. Psychological support, such as counseling or joining support groups, can also help patients cope emotionally and stay motivated with long‑term treatment.

If you need more info, you can click this link to gather information from the patient.co.uk website regarding the same condition.

Case Example

Raj, a 29‑year‑old software engineer, noticed persistent back pain that was worse in the mornings and improved when he went jogging. His GP referred him to a rheumatologist, who diagnosed ankylosing spondylitis after blood tests and imaging. Raj started on NSAIDs, which eased his pain, and was guided by a physiotherapist to do daily stretching exercises. When his symptoms flared despite medication, he was prescribed a biologic therapy. With regular exercise, medical treatment, and lifestyle changes, Raj has maintained good posture and continues to work actively, managing his condition successfully.

Key Message: Ankylosing spondylitis is strongly linked to the HLA‑B27 antigen, which increases the risk of inflammation in the spine and other areas. Family members may develop related conditions such as psoriatic arthritis or inflammatory bowel disease. Extra‑articular symptoms like eye inflammation, gut problems, or skin disease are common and require specialist care. With early diagnosis, regular exercise, appropriate medication—including biologics such as TNF inhibitors and IL‑17 inhibitors—and support from specialists, most people can lead active and fulfilling lives.