Ankylosing Spondylitis

What is Ankylosing Spondylitis?

Ankylosing Spondylitis (AS) is a chronic autoimmune condition where the body’s immune system, which normally protects against infections, mistakenly attacks the spine, joints, and surrounding tissues. This causes inflammation, pain, stiffness, and may eventually lead to joint fusion if not treated early.

In some patients, AS can also affect joints outside the spine, such as knees, ankles, or wrists. This is called peripheral spondyloarthritis.

What Does It Affect?

AS primarily affects the spine and sacroiliac joints, but may also involve:

Lower back and buttocks (early signs)
Neck and upper back (progressive stiffness)
Rib cage (restricted chest expansion)
Hips, shoulders, or knees (in some cases)
Eyes (uveitis – redness, pain, blurred vision)

How is AS Diagnosed?

Diagnosis is based on clinical examination, history of inflammatory back pain, and imaging tests. Blood tests may also be done to check for inflammation and the HLA-B27 gene.

Imaging: MRI of sacroiliac joints or spine can show early changes.

Why Early Treatment is Critical

AS can cause irreversible spinal fusion if not treated. Early treatment:

Reduces pain and stiffness
Prevents spinal damage
Maintains posture and flexibility
Reduces complications such as reduced chest expansion

Treatment Overview

1. NSAIDs

First-line treatment to reduce inflammation and stiffness
Examples: Naproxen, Etoricoxib

2. Physiotherapy

Most important long-term treatment
Daily posture and flexibility exercises
Swimming, stretching, deep breathing exercises help

3. DMARDs

For peripheral arthritis, sulfasalazine or methotrexate may be used

4. Biologic & Targeted Therapies

If NSAIDs and physiotherapy do not control symptoms
Anti-TNF injections (e.g. Adalimumab, Etanercept)
JAK inhibitors (e.g. Tofacitinib) – newer oral options
Patients must be screened for TB and hepatitis before starting biologics

Lifestyle & Joint Protection

Maintain good posture during sitting, standing, and walking
Avoid prolonged inactivity or poor posture
Daily exercises are essential to prevent stiffness
Avoid smoking – worsens spinal damage
Weight control and healthy diet improve outcomes

Spondylitis Association of America- Exercise Guidance for Spondyloarthritis

Daily exercise routines tailored for spondyloarthritis, including ankylosing spondylitis:

Key components:

Stretching (range of motion) — vital for stiffness control and preventing joint fusion.
Aerobic exercises — 75–150 minutes per week (e.g., walking, swimming) for heart-lung health and reduced fatigue.
Strength training — especially core strengthening 2–4 times weekly to support the spine and posture.
Balance exercises — performed 3–5 times weekly to aid stability and reduce fall risk.

Samples available:
A downloadable exercise flyer and brochure

Team Care: Rheumatologist + Physiotherapist

Rheumatologist: medication and disease monitoring
Physiotherapist: exercise guidance and rehabilitation

When to Contact Your Doctor

New or worsening back or joint pain
Eye redness, pain, or vision changes
Fever, cough, or chest symptoms while on treatment

Final Message

Ankylosing Spondylitis is a manageable condition. With early diagnosis, regular exercise, and proper treatment, you can maintain mobility and prevent long-term complications. Work closely with your rheumatologist.

Rheumatology