Living with ankylosing spondylitis (AS) can feel like a roller coaster at times. You may have days where your symptoms are minor or nonexistent. Long periods without symptoms are known as remission.

On other days, worsening symptoms can come out of nowhere and linger for several days, weeks, or months. These are flares. Understanding the early signs of a flare can help you manage your symptoms and reduce discomfort caused by them.

You may notice swelling and tenderness in one or more areas of your body, particularly near your joints. The swollen area may also feel warm to the touch. Applying ice to these areas may help reduce swelling and pain.

You may experience stiffening of your joints when a flare starts. This might be particularly noticeable if you’ve been sitting or resting for a period of time and then try to get up and move.

Try to avoid this by having good posture, stretching, and doing some light exercise to maintain mobility.

Pain may gradually or suddenly appear with an AS flare. If the flare is minor, you may feel this in just one area of your body. Major flares could cause all of your movements to be painful.

While uncommon, some people report flu-like symptoms when experiencing an AS flare. This may include widespread joint and muscle aches. However, fever, chills, and sweating are more consistent with an infection, so see your doctor to rule one out.

Flares may cause you to feel more tired than normal. This is typically because of inflammation or chronic anemia caused by inflammation.

The inflammation caused by AS may alter your digestive tract. This may lead to abdominal pain or diarrhea. You may also find yourself without an appetite during a flare.

You may find your emotional state worsens when you sense early signs of an AS flare. It can be difficult to manage a condition like AS, especially when you have experienced uncomfortable flares in the past.

This may cause you to be more susceptible to feelings of despair, anger, or withdrawal when another flare begins. If you find yourself experiencing symptoms of anxiety or depression, it’s important to talk to your doctor, who may refer you to a mental health professional. These kinds of feelings are not uncommon with chronic disease.

AS is a chronic auto-inflammatory condition. This means your immune system triggers inflammation in one or more places in your body from time to time, causing flare-ups.

For AS, inflammation most commonly occurs in the spine and hips. Specifically, it often occurs in the sacroiliac joints on either side of the lower spine in the pelvis. It may also occur in other areas of your body, particularly near your joints and where tendons and ligaments meet bone.

There isn’t a single known cause for an AS flare. In one older study from 2002, participants cited stress and “overdoing it” as their main triggers.

There are two types of AS flares. Localized flares occur in just one area of the body and are classified as minor. Generalized flares occur throughout the body and are classified as major.

But minor flares may turn into major flares. In one study, researchers found that 92 percent of participants with AS experienced minor flares before and after a major flare. The study also reported that major flares lasted about 2.4 weeks in duration, though your flare may be shorter or longer.

AS flares can occur in many places in the body, including your:

  • neck
  • back
  • spine
  • buttocks (sacroiliac joints)
  • hips
  • ribs and chest, especially where your ribs connect with your sternum
  • eyes
  • shoulders
  • heels
  • knees

Keep in mind that flare symptoms vary from person to person. You may experience some of these early symptoms of a flare but not others. Early flare symptoms may change over time, or you may notice the same ones each time a flare begins.

You may manage your AS with lifestyle changes, over-the-counter medications, and home remedies. But flares, whether local or general, may require more aggressive treatment.

Your doctor may prescribe medications like tumor necrosis factor (TNF) blockers or interleukin-17 (IL-17) inhibitors in addition to nonsteroidal anti-inflammatory drugs (NSAIDs). These medications usually require a visit to your doctor’s office or a trip to the pharmacy. Some medications may be oral while others might be injectable or given intravenously.

You may also want to try other methods for treating flares at home. These include:

  • staying active with appropriate exercise, such as swimming and tai chi
  • taking warm, relaxing baths
  • getting extra sleep
  • meditating
  • applying heat or ice to inflamed areas
  • engaging in a low-key hobby like reading or watching a favorite television show or movie

Check in with your doctor to discuss any emotional changes that occur during flares. You may need coping techniques to help you through the psychological challenges of the condition. These can help you manage your mood and outlook when a flare arises.

AS flares can come out of nowhere, and symptoms vary from person to person. Understanding early signs of a flare may help you keep up with your daily activities and know when it’s time to rest and take care of yourself. It’s not always possible to avoid flares, but being aware of your body and early signs may help you lessen the effects of the condition.