What causes it?

The exact cause isn’t fully understood. It likely results from a combination of:

• Genetics (many people with AS carry the HLA-B27 gene, though not everyone with this gene develops the disease).
• Immune system dysfunction.
• Environmental factors.

How is it diagnosed?

There is no single test for AS. Diagnosis is based on:

• Your symptoms and medical history.
• Physical examination.
• Imaging such as X-rays or MRI of the sacroiliac joints and spine.
• Blood tests, including markers of inflammation and sometimes HLA-B27 testing.

Ankylosing spondylitis (AS) is a chronic inflammatory disease that mainly affects the spine and the joints where the spine connects to the pelvis (the sacroiliac joints). Over time, ongoing inflammation can lead to pain, stiffness, and, in some people, new bone formation that reduces spinal flexibility.

Common symptoms

Symptoms usually begin before age 45 and often develop gradually. They can include:

• Persistent low back pain and stiffness lasting more than 3 months.
• Pain that is worse after rest (such as in the morning or after sitting) and improves with movement or exercise.
• Pain in the buttocks, sometimes alternating from one side to the other.
• Reduced flexibility of the back or neck.
• Fatigue.
• Pain where tendons and ligaments attach to bone (called enthesitis), such as at the heels.

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.

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.

Ankylosing spondylitis (AS) is a form of axial spondyloarthritis that causes inflammation mainly around the spine and sacroiliac joints. Treatment aims to control inflammation and pain, maintain mobility and posture, preserve function, and reduce the risk of complications. Current recommendations emphasize combining exercise/physiotherapy with medication and tailoring treatment to the individual.

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.

• Treatment of associated conditions: AS can occur alongside uveitis (eye inflammation), psoriasis, or inflammatory bowel disease, and these may affect medication choices.

• Avoid smoking: Smoking can worsen overall health and is associated with poorer outcomes in axial spondyloarthritis.

• Healthy lifestyle: Maintaining a healthy weight, staying physically active, getting adequate sleep, and eating a balanced diet can support overall health.

• Regular rheumatology follow-up: Disease activity, mobility, medication response, and potential complications should be monitored.

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.