Ankylosing spondylitis (AS) is a chronic inflammatory form of arthritis that primarily affects the spine, causing pain, stiffness, and reduced flexibility.

The term ankylosing refers to the fusion of bones, while spondylitis means inflammation of the spine. Over time, chronic inflammation can lead to new bone formation, causing sections of the spine to fuse and become less flexible.

Ankylosing spondylitis belongs to a group of inflammatory conditions known as seronegative spondyloarthropathies, which also includes psoriatic arthritis, enteropathic arthritis (associated with inflammatory bowel disease), and reactive arthritis.

Ankylosing Spondylitis has a number of possible symptoms but the most common is back pain and stiffness.

It’s common for different people to show different symptoms, and experience different levels of discomfort and reduced mobility.

Most people with Ankylosing Spondylitis notice the first signs and symptoms of the disease in their late teens to early 30s, but it can strike at any time.

Back pain and stiffness is the most common symptom of Ankylosing Spondylitis .

Some people with Ankylosing Spondylitis live for years thinking they only have a stiff back without realizing they might have a serious autoimmune disease.

When the body’s immune system is “activated” and busy attacking the spine and joints, it can make a person feel very tired, similar to when they have the flu.

Over time, the inflammation associated with ankylosing spondylitis (AS) can spread from its initial site to other parts of the spine, potentially causing increased pain, stiffness, and reduced mobility.

The condition can also affect other joints in the body, particularly the hips and shoulders, and sometimes the knees, leading to pain, inflammation, and difficulty with movement.

In some individuals with ankylosing spondylitis (AS), inflammation can develop where tendons and ligaments attach to the bone. This commonly affects the Achilles tendon at the back of the heel and the plantar fascia along the bottom of the foot. This type of inflammation, known as enthesitis, can cause pain, tenderness, and discomfort when walking or standing.

People with ankylosing spondylitis (AS) may develop inflammation in one or both eyes, a condition known as iritis or anterior uveitis. This can cause eye pain, redness, sensitivity to light, and blurred vision. Prompt medical assessment is important, as untreated eye inflammation can lead to complications.

Some people with ankylosing spondylitis (AS) may also develop inflammation in the bowel, known as colitis. In some cases, this inflammation is associated with inflammatory bowel diseases, such as Crohn’s disease or ulcerative colitis, and may cause symptoms including abdominal pain, diarrhoea, and changes in bowel habits.

Ankylosing spondylitis (AS) is typically diagnosed by a rheumatologist, a specialist in arthritis and inflammatory diseases.

To make a diagnosis, the rheumatologist will take a detailed medical history and perform a thorough physical examination to assess symptoms, joint movement, and signs of inflammation.

Additional investigations may include blood tests to check for markers of inflammation and genetic factors, as well as imaging tests such as X-rays or magnetic resonance imaging (MRI) to identify inflammation or structural changes in the spine and sacroiliac joints. The diagnosis is based on a combination of clinical findings, medical history, and test results, as no single test can confirm AS on its ow

Ankylosing spondylitis (AS) develops when the immune system triggers an abnormal inflammatory response that affects the body’s joints and surrounding tissues. The exact cause of this immune response is not yet fully understood.

The inflammation most commonly begins in the joints between the spine and pelvis, known as the sacroiliac (SI) joints, and may also affect the small joints between the vertebrae in the spine. Over time, persistent inflammation can lead to pain, stiffness, and reduced flexibility.

In ankylosing spondylitis (AS), inflammation in the spine triggers the body’s natural healing response, which can lead to the formation of new bone.

Although this repair process is beneficial when healing minor injuries, such as a sprained ankle, it can become abnormal in people with AS. Over time, new bone may form across the joints of the spine, causing adjacent bones to gradually fuse together.

In some individuals, advanced AS can result in significant fusion of the spinal and sacroiliac joints, leading to severe stiffness, pain, and reduced mobility. Changes in spinal alignment may also cause a forward-curved or hunched posture and affect a person’s gait, or walking pattern. Early diagnosis and appropriate treatment can help control inflammation and reduce the risk of long-term complications, although they cannot always prevent the progression of the disease.

Genetics is believed to play an important role in the development of ankylosing spondylitis (AS).

Approximately 90% of people with AS carry a gene known as HLA-B27, which is associated with an increased risk of developing the condition. However, having this gene does not mean that a person will inevitably develop AS, as many people who carry HLA-B27 never develop the disease.

Although HLA-B27 is an important genetic risk factor, other genetic and environmental factors are also thought to contribute to the development of AS.

Ankylosing spondylitis (AS) should be diagnosed early and managed effectively to control inflammation, maintain spinal flexibility, and preserve joint mobility. Early treatment can help slow disease progression and reduce the risk of long-term complications, including the fusion of bones in the spine.

Although existing structural damage caused by AS cannot usually be reversed with medication, appropriate treatment can help relieve pain, reduce inflammation, improve mobility, and preserve physical function. Regular follow-up appointments with a rheumatologist are essential, along with completing any recommended blood tests and imaging scans to monitor disease activity and assess treatment effectiveness.

The management of ankylosing spondylitis generally involves two key approaches:

• Physical therapy and exercise: Regular physical activity, physiotherapy, and daily stretching can help reduce stiffness, maintain flexibility, improve posture, and support overall mobility.
• Medication: Medications can help control inflammation, relieve pain, and improve physical function and quality of life.

A summary of the main treatment options available to help manage ankylosing spondylitis and improve patients’ quality of life is provided below.

Physical therapy and regular exercise are essential components of managing ankylosing spondylitis (AS). They help reduce stiffness and pain, maintain spinal flexibility, improve posture, and preserve joint mobility.

A physiotherapist can develop an individualized exercise program that includes stretching, strengthening, posture training, and mobility exercises tailored to the patient’s needs and abilities. Daily stretching and low-impact activities, such as swimming and walking, can help maintain flexibility and improve overall physical function.

Consistency is important, as regular exercise can help manage symptoms and maintain mobility over time. Although physical therapy cannot reverse existing bone fusion, it can help preserve function, reduce discomfort, and support a better quality of life.

Ankylosing spondylitis (AS) is associated with an increased risk of cardiovascular disease. Therefore, it is important for people with AS to monitor and maintain healthy blood pressure and cholesterol levels to support heart health.

For individuals with diabetes, keeping blood glucose levels within the recommended range is essential to reduce the risk of complications and maintain overall health.

Smoking cessation is also strongly encouraged for people with AS. Smoking is associated with poorer disease outcomes, increased spinal damage, and reduced lung function. Quitting smoking can help improve overall health and may reduce the risk of complications associated with the condition.

In severe cases of ankylosing spondylitis (AS), advanced joint damage and spinal fusion can lead to significant pain, stiffness, reduced mobility, and physical deformity. When these complications severely affect a person’s quality of life, surgery may be considered.

One of the most common surgical procedures is total hip replacement, in which a damaged hip joint is replaced with an artificial joint. This procedure can help relieve pain, improve mobility, and restore physical function in people with severe hip involvement.

Spinal surgery is more complex and is generally reserved for carefully selected patients with severe spinal deformities or other serious complications. Depending on the individual’s condition, surgery may help correct deformity, improve posture, and enhance function. The decision to proceed with surgery depends on the extent of the damage, the severity of symptoms, and the potential benefits and risks of the procedure.

Medications used to treat ankylosing spondylitis (AS) can be divided into two main categories:

• Medications that relieve symptoms: These include nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics (pain relievers), and corticosteroids, such as prednisone. They may help reduce pain and inflammation, although their effectiveness varies depending on the medication and how it is administered.
• Medications that control disease activity: These include biologic therapies and targeted synthetic disease-modifying antirheumatic drugs (DMARDs), which help control inflammation and reduce disease activity. Conventional DMARDs may be useful for certain symptoms affecting peripheral joints, but they generally have limited effectiveness for inflammation confined to the spine.

Before starting any new medication, patients should consult their healthcare provider or pharmacist about potential interactions with alcohol, prescription medications, over-the-counter products, supplements, and complementary therapies.

Although some complementary approaches, such as exercise and physiotherapy, can support symptom management, there is limited scientific evidence that natural remedies or alternative therapies alone can effectively control AS-related inflammation or prevent long-term joint damage. These approaches should not replace prescribed medical treatment.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat ankylosing spondylitis (AS). They help reduce inflammation, relieve joint pain, and improve stiffness and mobility.

Several NSAIDs are available, including ibuprofen, naproxen, and celecoxib. If one medication does not provide sufficient relief or causes troublesome side effects, a doctor may recommend trying a different NSAID, depending on the patient’s medical history and individual needs.

Although NSAIDs can effectively manage symptoms, current evidence does not establish that they consistently prevent the long-term structural progression of AS. Their primary role is to control pain and inflammation and improve daily functioning.

Because NSAIDs can cause side effects, including stomach irritation, ulcers, kidney problems, and an increased risk of cardiovascular complications, patients should work with their healthcare provider to determine the most appropriate medication and dose.

Analgesics are medications used to relieve pain associated with ankylosing spondylitis (AS). However, they do not directly reduce the underlying inflammation or prevent further joint damage caused by the disease.

Analgesics range from commonly used pain relievers, such as acetaminophen (Tylenol), to stronger opioid medications, such as morphine, which may be prescribed in specific circumstances.

The choice of analgesic depends on the severity of the pain, the patient’s overall health, and their response to other treatments. Stronger pain medications, particularly opioids, require careful medical supervision because of the risk of side effects, dependence, and other complications.

Corticosteroids, such as prednisone, are medications that reduce inflammation and may help relieve symptoms in certain people with ankylosing spondylitis (AS).

However, oral corticosteroids are generally not recommended for the routine treatment of inflammation affecting the spine, as they have limited evidence of benefit for this type of disease. In selected cases, short courses of corticosteroids may be considered to manage specific inflammatory symptoms or complications.

Long-term use of prednisone can cause significant side effects, including weight gain, osteoporosis, high blood pressure, elevated blood sugar, and an increased risk of infection. Therefore, treatment decisions should be made in consultation with a rheumatologist, who can help patients weigh the potential benefits against the risks and identify the most appropriate treatment approach.

Biologic medications are used to treat ankylosing spondylitis (AS) when symptoms and inflammation are not adequately controlled with nonsteroidal anti-inflammatory drugs (NSAIDs), or when these medications are unsuitable. Biologics target specific components of the immune system involved in the inflammatory process and can help reduce pain, stiffness, and disease activity while improving mobility and quality of life.

The first biologic medications used to treat AS were tumour necrosis factor (TNF) inhibitors, introduced in the late 1990s. These medications represented a major advance in treatment for people whose symptoms did not respond sufficiently to conventional therapies.

Disease-modifying antirheumatic drugs (DMARDs) are commonly used to treat rheumatoid arthritis (RA) and other inflammatory conditions. However, their role in treating ankylosing spondylitis (AS) is more limited because many conventional DMARDs are not effective against inflammation primarily affecting the spine.

Medications such as methotrexate and sulfasalazine generally do not provide significant relief for spinal pain or stiffness associated with AS.

However, conventional DMARDs may be beneficial when AS affects peripheral joints, such as the knees, ankles, or wrists, particularly when these joints are persistently swollen and inflamed. Sulfasalazine may be considered in these cases, while methotrexate has more limited evidence of benefit for AS-related peripheral arthritis.

A rheumatologist can determine whether a DMARD is appropriate based on the joints involved, the severity of symptoms, and the patient’s response to other treatments.

Ankylosing spondylitis (AS) is a chronic inflammatory disease involving an abnormal immune response that causes the body to attack its own healthy tissues. The exact cause of this immune response is not fully understood, although genetic and environmental factors are believed to play a role.

AS is considered a systemic rheumatic disease because it can affect not only the spine and joints but also other parts of the body, including the eyes, lungs, and intestines.

Early diagnosis and treatment of ankylosing spondylitis (AS) are essential to help manage the condition and slow its progression.

Appropriate treatment can reduce inflammation, relieve pain and stiffness, maintain mobility, and help prevent long-term complications, including damage to the spine. Effective management may also help reduce the risk of complications associated with chronic inflammation, such as cardiovascular disease, and support overall health and well-being.

There is no specific diet proven to stop AS or reverse spinal changes. A Mediterranean-style pattern—vegetables and fruit, whole grains, legumes, nuts, fish, and unsaturated fats—is a reasonable approach for overall health. Foods such as tomatoes and bell peppers can be included, but they shouldn’t be considered treatments for AS.

Tomatoes and arthritis

Tomatoes can be a nutritious addition to an arthritis-friendly diet, although they do not cure arthritis or directly reverse joint damage.

• Lycopene: Tomatoes are particularly rich in lycopene, an antioxidant that helps protect cells from oxidative stress. Cooked tomatoes and tomato products can provide especially well-absorbed lycopene.

• Vitamin C: Supports collagen formation and normal connective-tissue function.

• Antioxidants: Tomatoes contain vitamin C, carotenoids, and other plant compounds that contribute to overall antioxidant intake.

• Potential anti-inflammatory effects: Laboratory and observational research suggests that compounds in tomatoes may influence inflammatory pathways, but evidence that eating tomatoes significantly reduces arthritis pain or inflammation in people is still limited.

• Heart health: Tomatoes can contribute to a heart-healthy diet, which is particularly relevant for people with rheumatoid arthritis, because RA is associated with increased cardiovascular risk.

Some people with arthritis report that tomatoes or other nightshade vegetables worsen their symptoms. There isn’t strong scientific evidence that tomatoes generally cause arthritis inflammation or should routinely be avoided. If you consistently notice symptoms after eating a particular food, discussing this pattern with a healthcare professional or dietitian can be more useful than eliminating foods unnecessarily.

For osteoarthritis, tomatoes are best viewed as part of an overall nutritious eating pattern. For rheumatoid arthritis, diet can complement medical treatment but shouldn’t replace disease-modifying medication when it is prescribed.

Ankylosing spondylitis management

Management of ankylosing spondylitis (AS) is usually long-term and focuses on controlling inflammation, maintaining spinal mobility, reducing pain and stiffness, and preventing loss of function.

Main approaches

• Regular exercise and physiotherapy: This is a cornerstone of management. Programs commonly include spinal mobility, stretching, posture, strengthening, aerobic exercise, and breathing/chest-expansion exercises.

• NSAIDs: Medicines such as naproxen or ibuprofen are commonly used for pain and stiffness when appropriate. A clinician should consider stomach, kidney, heart, and other risks before long-term use.

• Biologic medicines: If inflammation remains active despite appropriate treatment, a rheumatologist may use TNF inhibitors or IL-17 inhibitors.

• JAK inhibitors: These are another targeted option for some people with active disease.

Living with Ankylosing spondylitis can affect mental health in several ways. Research consistently shows that people with AS have higher rates of anxiety and depression than the general population, although not everyone with AS experiences these challenges.

Some of the reasons include:

• Chronic pain: Ongoing pain can increase stress, irritability, and emotional exhaustion.
• Fatigue: Persistent fatigue can make it harder to work, socialize, or enjoy activities, contributing to low mood.
• Sleep disruption: Pain and stiffness often interfere with sleep, which can worsen anxiety and depression.
• Reduced mobility: Difficulty with movement or physical limitations may lead to frustration or loss of independence.
• Uncertainty about the future: Concerns about disease progression, work, or relationships can increase emotional distress.
• Inflammation: Some evidence suggests that inflammation itself may contribute to changes in mood, although this relationship is still being studied.