Ankylosing spondylitis (AS) is a type of autoimmune arthritis that typically affects your spine and hip or lower back joints. This condition causes inflammation leading to pain, swelling, stiffness, and other symptoms.

Like other kinds of arthritis, ankylosing spondylitis can sometimes flare. A flare-up happens when symptoms worsen. During a flare-up, you might need more care and treatment than you need at other times. Remission or partial remission is when you have fewer, milder, or no symptoms.

Knowing when you might have a flare-up and what to expect can help you manage your health. Talk to your doctor about the best way to help prevent and soothe symptoms. There are several ways to ease symptoms and treat ankylosing spondylitis.

Flare-ups and their symptoms can be very different for every person with ankylosing spondylitis.

Most people with this condition notice symptoms from the ages of 17 to 45 years. Symptoms can also begin during childhood or in older adults. Ankylosing spondylitis is 2.5 times more common in men than women.

There are two main kinds of ankylosing spondylitis flare-ups:

  • local: in one or two areas only
  • general: throughout the body

Signs and symptoms of ankylosing spondylitis flare-ups may change depending on how long you’ve had the condition. Long-term ankylosing spondylitis flare-ups typically cause signs and symptoms in more than one part of the body.

Pain in the lower back, hips, and buttocks

Pain may begin gradually over a few weeks to months. You may feel discomfort on only one side or alternating sides. The pain normally feels dull and spreads over the area.

It’s usually not a sharp pain. The pain is normally worse in the mornings and at night. Resting or being inactive may worsen the pain.

Treatment:

Stiffness

You may have stiffness in the lower back, hips, and buttocks area. Your back may feel stiff and it might be slightly difficult to stand up after sitting or lying down. Stiffness is typically worse in the morning and at night, and improves during the day. It may get worse during rest or inactivity.

Treatment:

  • stretching, movement, and light exercise
  • physical therapy
  • heat therapy
  • massage therapy

Neck pain and stiffness

The Spondylitis Association of America notes that women may be more likely to have symptoms that start in the neck and not the lower back.

Treatment:

  • light exercise and stretching
  • warm shower or bath
  • heat therapy
  • NSAIDs
  • physical therapy
  • massage therapy

Fatigue

Inflammation and pain can lead to fatigue and tiredness. This may be worsened by disturbed sleep at night due to pain and discomfort. Controlling inflammation helps to manage fatigue.

Treatment:

  • NSAIDs
  • physical therapy

Other early symptoms

Inflammation, pain, and discomfort can cause loss of appetite, weight loss, and a mild fever during flare-ups. Managing pain and inflammation helps to ease these symptoms.

Treatment:

  • NSAIDs
  • physical therapy
  • prescription medications

Chronic back pain

An ankylosing spondylitis flare-up may cause chronic back pain over time. You may feel dull to burning pain on both sides of the lower back, buttocks, and hips. Chronic pain can last for three months or longer.

Treatment:

  • NSAIDs
  • prescription medications
  • steroid injections
  • physical therapy, such as floor and water exercises

Pain in other areas

Pain can spread to other joints over the course of a few months to years. You may have pain and tenderness in the mid to upper back, the neck, shoulder blades, ribs, thighs, and heels.

Treatment:

  • NSAIDs
  • prescription medications
  • steroid injections
  • physical therapy, such as floor and water exercises

Stiffness

You may also have more stiffness in your body over time. Stiffness may also spread to the upper back, neck, shoulders, and ribcage. Stiffness may be worse in the mornings and get only slightly better during the day. You may also have muscles spasms or twitching.

Treatment:

  • NSAIDs
  • prescription medications
  • muscle relaxer drugs
  • physical therapy
  • floor and water exercises
  • infrared sauna
  • massage therapy

Loss of flexibility

You may lose normal flexibility in some joints. Long-term inflammation in the joints can fuse or join bones together. This makes the joints stiffer, painful, and harder to move. You may have less flexibility in your back and hips.

Treatment:

  • NSAIDs
  • prescription medication
  • muscle relaxer drugs
  • steroid injections
  • back or hip surgery
  • physical therapy

Difficulty breathing

Bones in your rib cage can also fuse or join together. The rib cage is designed to be flexible to help you breathe. If the rib joints become stiffer, it may be harder for your chest and lungs to expand. This may make your chest feel tight.

Treatment:

  • NSAIDs
  • prescription anti-inflammatory drugs
  • steroid injections
  • physical therapy

Difficulty moving

Ankylosing spondylitis can affect even more joints over time. You may have pain and swelling in the hips, knees, ankles, heels, and toes. This can make it difficult to stand, sit, and walk.

Treatment:

  • NSAIDs
  • prescription medication
  • muscle relaxer drugs
  • steroid injections
  • physical therapy
  • knee or foot brace

Stiff fingers

Ankylosing spondylitis flare-ups may also spread to the fingers over time. This can make the finger joints stiff, swollen, and painful. You may have difficulty moving your fingers, typing, and holding things.

Treatment:

  • NSAIDs
  • prescription medication
  • steroid injections
  • physical therapy
  • hand or wrist brace

Eye inflammation

More than one-fourth of people with ankylosing spondylitis have eye inflammation. This condition is called iritis or uveitis. It causes redness, pain, blurry vision, and floaters in one or both eyes. Your eyes may also be sensitive to bright light.

Treatment:

  • steroid eye drops
  • eye drops to dilate the pupils
  • prescription medication

Lung and heart inflammation

Rarely, ankylosing spondylitis flare-ups may affect the heart and lungs over time in some people.

Treatment:

  • NSAIDs
  • prescription medication
  • steroid injections

People with ankylosing spondylitis typically have one to five flares in a year. Flare-ups may last from a few days to three months or longer.

There are no known causes for ankylosing spondylitis. Flare-ups also can’t always be controlled. Some people with ankylosing spondylitis may feel that their flare-ups have certain triggers. Knowing your triggers — if you have any — may help prevent flare-ups.

A medical study found that 80 percent of people with ankylosing spondylitis felt that stress triggered their flare-ups.

Healthy lifestyle choices may also help manage flares. For example, regular exercise and physical therapy may help reduce pain and stiffness.

Quit smoking and avoid secondhand smoke. People with ankylosing spondylitis who smoke are at higher risk of spine damage. This condition also affects your heart. You may have a higher risk of heart disease and stroke if you’re a smoker.

Take all medications exactly as prescribed to help prevent and soothe flare-ups. Your doctor may prescribe one or more medications that help to control inflammation. This may help prevent or ease flare-ups. Drugs used to treat ankylosing spondylitis include:

  • adalimumab (Humira)
  • etanercept (Enbrel)
  • golimumab (Simponi)
  • infliximab (Remicade)
  • anti-TNF drugs
  • chemotherapy drugs
  • IL-17 inhibitor, such as secukinumab (Cosentyx)

Any disorder or condition can lead to emotional symptoms. In one study, about 75 percent of people with ankylosing spondylitis reported that they felt depression, anger, and isolation. Talk to your doctor about your emotions or seek the help of a mental health professional.

Joining a support group and getting more information can help you feel in control of your treatment. Join an ankylosing spondylitis organization to keep up to date with new health research. Talk to other people with this condition to find the best way to manage ankylosing spondylitis for you.

Your experience with ankylosing spondylitis flare-ups will not be the same as someone else with this condition. Pay attention to your body. Keep a daily symptom and treatment journal. Also, record possible triggers you might notice.

Tell your doctor if you think a treatment is helping to prevent flares or reduce symptoms or if you feel that treatment isn’t helping you. What worked for you before may no longer work for you over time. Your doctor may have to change your treatments as your ankylosing spondylitis changes.