Ankylosing spondylitis, also called Bechterew’s disease, is a form of arthritis that primarily affects the spine.

It causes inflammation of the spinal joints, which can lead to chronic pain and disability if left untreated. In very severe cases, the inflammation can cause new bone to form on the spine. This may lead to immobility.

Ankylosing spondylitis can also cause pain and stiffness in other parts of the body. It may affect other large joints, such as the shoulders, hips, heels, and knees.

The symptoms of ankylosing spondylitis vary. Like other forms of arthritis, it typically features mild to moderate flare-ups of inflammation that alternate with periods of almost no symptoms.

Knowing the warning signs can help. The most common symptom is back pain in the morning and at night. You may also experience pain in the large joints, such as the hips and shoulders. Other symptoms may include:

  • early morning stiffness
  • poor posture or stooped shoulders
  • loss of appetite
  • low-grade fever
  • weight loss
  • fatigue
  • anemia or low iron
  • reduced lung function

Because ankylosing spondylitis involves inflammation, it can affect other parts of the body as well. If you have ankylosing spondylitis, you may also experience:

  • inflammation of the bowels
  • eye inflammation
  • heart valve inflammation
  • plantar fasciitis and Achilles tendinitis

You should see your doctor if you experience severe or recurring joint pain or if the pain interferes with your daily life. If a primary care doctor suspects ankylosing spondylitis, they may refer you to a rheumatologist. Rheumatologists are experts in arthritis and other muscular and skeletal disorders.

The cause of ankylosing spondylitis is currently unknown.

The disorder does tend to run in families, so genetics probably plays a role. If your parents or siblings have ankylosing spondylitis, you are more likely to develop it than someone with no family history.

Family history

A family history of ankylosing spondylitis is a risk factor, along with the presence of the HLA-B27 protein. More than 90 percent of people with this condition have the gene that expresses this protein.


Unlike other arthritic and rheumatic disorders, initial symptoms of ankylosing spondylitis often appear in younger adults. Symptoms often appear between ages 20 and 40.


Some guidance states that ankylosing spondylitis is around twice as common in males than females. However, the actual prevalence of the condition may be more even, according to a 2018 review.

Ankylosing spondylitis symptoms can differ between males and females, which may lead to a late or missed diagnosis.

If ankylosing spondylitis is left untreated, some complications may develop. These include:

  • vertebrae may fuse together because of chronic inflammation
  • inflammation can spread to nearby joints, including hips and shoulders
  • inflammation may spread to ligaments and tendons, which may make flexibility worse
  • difficulty breathing
  • eye irritation
  • heart, lung, or bowel damage
  • compression fractures of the spine

It’s important to seek treatment for lower back pain or chronic joint stiffness.

Roughly 10–30 percent of people with ankylosing spondylitis may experience heart complications, including heart valve disease. This can be the result of fibrous tissue growth near the valve and inflammation of the inner lining of arteries.

There’s no current cure for ankylosing spondylitis, but treatment can help manage pain and prevent disability. Timely treatment may also slow or even stop possible complications, such as bone deformity.


Doctors may prescribe a range of medications to treat ankylosing spondylitis. Which medications a person receives will depend on the progress and severity of their condition.

  • NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are often used to help manage pain and inflammation. They’re generally safe with few complications.
  • Corticosteroids. Corticosteroids are powerful inflammation-fighters that can ease symptoms and slow damage around the spine, but they cannot be used long term.
  • Biologics. Tumor necrosis factor (TNF) and IL-17 inhibitors are drugs that can block inflammation triggers in your body. These drugs act to prevent inflammation, and they may ease joint pain and stiffness.
  • DMARDs. Your doctor may also prescribe disease-modifying antirheumatic drugs (DMARDs). These drugs work to slow the process of the disease in the body to prevent worsening symptoms.


If you have severe damage or deformity to your knee or hip joints, joint replacement surgery may be necessary. Likewise, people with poor posture from fused bones may require an osteotomy. During this procedure, a surgeon will cut and realign the bones in the spine.

Treatment relies largely on how severe the condition is and how troublesome the symptoms are.

In addition to more traditional medical treatments, some natural remedies may help ease symptoms of ankylosing spondylitis. A person may often use these alongside prescribed treatment plans. Talk with your doctor about which ones are safe to use together and which are best for you.


Daily exercise and posture practice can help you maintain flexibility and range of motion. Each of these exercises may help reduce symptoms of ankylosing spondylitis:

These exercises may be part of a holistic treatment plan that includes medication and physical therapy.


Stretching can make your joints more flexible and improve strength. This can lead to less pain and a better range of motion in your joints.

Posture training

Stiffness in the spine may encourage bad posture. Over time, bones in the spine can fuse together in slouching or slumping positions. You can reduce the risk of this by practicing good posture.

Because this may not come naturally after years of poor posture, you may need to encourage better posture with reminders to correct it regularly. You can also use support devices, such as ergonomic support chairs or seat cushions.

Heat and cold therapy

Heating pads or a warm shower can help ease pain and stiffness in the spine and other affected joints. Ice packs can reduce inflammation in painful or swollen joints.


This alternative treatment may help reduce pain and other symptoms of ankylosing spondylitis. It does so by activating natural pain-relieving hormones.

Massage therapy

In addition to being relaxing and invigorating, massage can help you maintain flexibility and improve your range of motion. Be sure to tell your massage therapist that you have ankylosing spondylitis. They can be aware of tender points around your spine.

Many treatments for ankylosing spondylitis are also smart practices for a healthier life.

There’s no one-size-fits-all diet for ankylosing spondylitis. A nutrient-dense diet that provides plenty of vitamins and minerals through a wide variety of foods is a great place to start. Be sure to include:

Try to cut down or eliminate foods that are low in nutrients and rich in fat, sugar, and sodium, which includes highly processed foods. Many boxed, bagged, or canned foods can often contain ingredients like preservatives and trans fats, which can worsen inflammation.

It’s important to carefully read food labels to help you better understand what ingredients — and how much of them — you’re consuming, which can also help you better understand a product’s nutritional value.

Likewise, limit how much alcohol you drink or avoid it altogether. Alcohol can interfere with medications and may make symptoms worse.

The first step will be a thorough physical exam with special emphasis on joint function and range of motion of joints as well as the spine. Your doctor will ask you for details about your pain and your history of symptoms.

Your doctor will then use an X-ray to check for signs of damage to joints of your spine and any other painful joints. Erosion or damage to joints may not be detected if the disease is in its early stages. They may also recommend an MRI scan.

They may also carry out blood tests to assess signs of inflammation such as erythrocyte sedimentation rate and C-reactive protein. An HLA-B27 test will be ordered to assess the presence of this protein. The presence of this protein does not mean that you have ankylosing spondylitis, only that you have the gene that produces this protein and that you may be at risk for developing spondylitis.

Diagnosing this type of arthritis can take time.

It’s not known how you can prevent ankylosing spondylitis because no one knows what causes it in the first place. However, if you have the disease, you can focus on preventing disability by:

  • staying active
  • eating a nutrient-dense diet
  • maintaining a moderate weight

These health-promoting lifestyle approaches, coupled with traditional treatments, may help delay or slow disease progression.

Ankylosing spondylitis is a progressive condition. This means it’ll worsen over time and may lead to disability. It’s also a chronic condition, so there is no treatment that can cure it.

Medication, stretching exercises, formal physical therapy, and alternative therapies can help:

  • ease symptoms
  • improve posture
  • help prevent and delay inflammation and damage

Talk with your doctor if you’ve been experiencing chronic back pain. They can help look for a cause, such as ankylosing spondylitis, and help create a treatment plan to ease symptoms and discomfort.

The sooner you begin treatment, the more likely you may be able to prevent some long-term effects of the condition.