Ankylosing spondylitis: what to watch for and what helps

Waking up stiff in your lower back and feeling better after moving around? That’s a common early hint of ankylosing spondylitis (AS). AS is a form of inflammatory arthritis that mostly hits the spine and sacroiliac joints. It usually starts in people in their 20s or 30s and often affects men more than women, but anyone can get it.

Symptoms can be clear once you know what to look for. Pain and stiffness in the lower back or buttock that lasts for weeks, worse in the morning or after resting, and improving with exercise are classic signs. You might also notice pain where tendons attach to bone (heel or rib pain), swollen peripheral joints, or eye inflammation (red, painful eyes and light sensitivity). Fatigue is common, too.

How AS is diagnosed

Doctors use a mix of your story, a physical exam, blood tests, and imaging. The HLA-B27 genetic marker appears in many people with AS, but it’s not a full diagnosis on its own. Blood tests check for inflammation. X-rays can show changes in the sacroiliac joints and spine, but early disease often needs MRI to spot inflammation before permanent changes occur. If AS is suspected, seeing a rheumatologist speeds up accurate diagnosis and treatment.

Treatment that helps day to day

Treatment focuses on reducing pain, lowering inflammation, and keeping your spine flexible. Over-the-counter or prescription NSAIDs (like naproxen or ibuprofen) are usually first-line. If pain and inflammation don’t respond, doctors may recommend biologic drugs — commonly TNF inhibitors (adalimumab, etanercept) or IL-17 blockers (secukinumab). These can dramatically reduce symptoms and slow damage for many people.

Physiotherapy and regular exercise are as important as medication. Stretches that open the chest and strengthen the back help posture and breathing. Aim for daily movement: walking, swimming, yoga, or targeted back exercises. Heat packs, good sleep posture and an ergonomic workspace lower daily stiffness. Quit smoking — smokers with AS tend to have worse symptoms and faster progression.

Surgery is rare but sometimes needed for severe spinal deformity or hip replacement. For peripheral joint swelling, drugs like sulfasalazine can help. Short steroid injections into a painful joint or eye drops for uveitis provide quick relief when flares occur.

Living with AS means learning what triggers flares and building routines that reduce them. Track which activities help or hurt, keep appointments with your rheumatologist, and ask about vaccine updates before starting strong immune-suppressing meds. With the right treatment plan and regular exercise, many people keep active and productive lives despite AS.