Ankylosing spondylitis (AS) is a painful type of arthritis affecting the spine and pelvis. There are many common things that may worsen symptoms of AS for many people. Here are 8 and what you can do about them.

Ankylosing spondylitis (AS) is a type of arthritis characterized by pain and inflammation of the spine and pelvic region. This condition can also cause sections of the spine to grow and fuse together, resulting in stiffness and immobility.

There’s no cure for AS, but medications can help you manage your symptoms. Certain lifestyle choices may worsen your symptoms, though, even if you take prescription medication to improve your quality of life.

When you’re living with chronic back pain, exercise may seem impossible. However, leading a sedentary lifestyle can aggravate symptoms. Physical activity can help improve joint flexibility and reduce the pain and stiffness caused by AS.

You do not have to engage in high impact activity to feel better but consider adding some form of physical activity to your daily or weekly schedule.

Aim for about 30 minutes of activity at least 5 days a week. Activities you can try include:

  • swimming
  • biking
  • walking
  • strength training, such as Pilates, tai chi, or yoga

Ask your doctor for recommendations before beginning an exercise regimen.

Poor posture can also worsen AS.

On the other hand, keeping your body properly aligned can:

  • alleviate pain
  • strengthen your back muscles
  • help prevent anterior flexion deformity, where your spine is fixed in a stooped position

Resolve to practice good posture, whether you’re sitting or standing.

When sitting in a chair, your back should be straight, your shoulders should be back, and your buttocks should be touching the back of your chair. Keep your knees bent at a 90-degree angle and your feet flat on the floor.

Practice good posture while standing the old-fashioned way: Walk around with a book on your head. This teaches you how to stand tall with your body aligned.

Researchers have found a link between smoking and disease activity in people with AS.

For instance, a small 2015 study followed a total of 30 people living with AS, both nonsmokers and smokers. According to the researchers, when compared with their nonsmoking counterparts, smokers with AS reported:

  • longer bouts of morning stiffness
  • less spinal mobility
  • less chest expansion
  • higher disease activity, as measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)
  • a poorer quality of life

This could be due to the inflammatory effect smoking has on the body.

Similarly, a 2021 study of smokers and nonsmokers found that smoking was associated with signs and symptoms such as:

  • a statistically significant reduction in chest expansion
  • higher disease activity, as measured by the BASDAI and Ankylosing Spondylitis Disease Activity Score
  • a higher score on the Bath Ankylosing Spondylitis Functional Index (BASFI), which looks at your ability to perform everyday activities
  • a higher number of inflammatory markers

Both sets of researchers believe that smoking cessation should be included in treatment plans for AS.

Because AS can cause inflammation, stiffness, and joint pain, it’s important that you do not overdo it and learn how to recognize your limitations.

Failure to pace yourself could result in burnout, or you might engage in activities that put too much strain on your joints. This can make it harder for your body to recover and even trigger long-term stiffness and joint immobility.

So while activity is recommended, pace yourself. Listen to your body and rest when you feel tired or burnt out.

There’s no cure for AS, so you may need ongoing medication therapy to help manage your symptoms. Your doctor will recommend medication and dosages based on your individual condition. It’s important to take your medication as directed to slow disease progression, so try not to skip doses.

If you feel that your medication is not improving your condition, speak with your doctor. They may need to adjust your dosage or recommend a different type of medication.

Medications for ankylosing spondylitis (AS)

Treatments for this condition include:

  • anti-inflammatory medications
  • over-the-counter pain relievers
  • immunosuppressants
  • biologics, which target specific proteins causing inflammation
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Having overweight may also worsen symptoms of AS.

Carrying more weight can put too much pressure on your joints and increase your pain levels. In addition, obesity is associated with increased inflammation.

Adding physical activity to your schedule can help you achieve or maintain a moderate weight.

Consider modifying your diet as well.

Reduce your intake of processed foods, sugary foods, and fatty foods, which can inflame your body. Increase your consumption of the following foods:

  • fruits
  • vegetables
  • whole grains
  • lean meats
  • healthy fats like nuts and avocados

Sleeping is hard when you’re in pain. You may have trouble falling asleep, or you may wake up frequently throughout the night. Sleep is how your body repairs itself, so lack of sleep may worsen AS symptoms.

To reduce nighttime pain and boost sleep, you may need to get a mattress that provides more comfort and support, such as a medium-firm mattress. To lessen neck pain during the night, limit the number of pillows you use.

Other tips for creating a comfortable sleep environment:

  • Keep your room cool.
  • Turn off all lights.
  • Create a quiet environment as best you can. A white noise machine can help block out noises.

The aim is to develop a bedtime routine that encourages sleep and to practice measures that will help to prevent overstimulation. Other steps you can take:

  • Have a hot bath or shower before bed.
  • Turn off the TV and other electronic devices about 1 hour before going to bed, as recommended by the National Sleep Foundation.
  • Avoid alcohol or caffeine before bed.
  • Do not eat large meals 2 to 3 hours before you hit the hay.

Stressful situations may unknowingly worsen symptoms of AS.

Stress triggers the release of stress hormones such as cortisol and adrenaline, which send your body into fight-or-flight mode. This increases your blood pressure and heart rate.

Stress hormones also stimulate your immune system to release cytokines, which are proteins that cause inflammation. Chronic stress can keep your body in an inflammatory state and worsen AS.

To manage stress and reduce inflammation:

  • Practice deep breathing exercises and meditation to relax your mind and body.
  • Learn how to say “no.”
  • Reduce your personal obligations.
  • Set reasonable goals for yourself, physically and otherwise.
  • Get more rest.
  • Talk about your problems with a friend.
  • Distract yourself with a fun activity whenever you’re feeling stressed out.
  • Spend time in nature.
  • Adopt a pet.

Symptoms of AS can range from mild to severe. Depending on the severity of your condition, symptom flare-ups can make everyday activities challenging. Medication can help you feel better, but certain lifestyle changes are also essential to helping you improve your outlook and enjoy life to the fullest.