Ankylosing Spondylitis: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Ankylosing Spondylitis?
A rheumatologist (a doctor who treats arthritis and joint disease) usually treats ankylosing spondylitis. A physical therapist (a movement expert) helps with exercise and posture. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is ankylosing spondylitis?
Ankylosing spondylitis (AS) is a type of arthritis. It causes inflammation in the joints and ligaments of the spine. Ligaments are the strong bands that hold bones together. AS may also affect joints like the knees, ankles, and hips.
Inflammation in the spine can cause stiffness. In severe cases, the vertebrae (bones in the spine) fuse, which means they grow together. When the vertebrae fuse, the spine becomes rigid and hard to bend.
AS is a chronic (long-term) form of arthritis. It mostly affects the joints at the base of the spine, where it connects with the pelvis (the hip bones). Many people have mild episodes of back pain and stiffness that come and go.
Symptoms
The most common symptom is lower back and hip pain and stiffness. The pain typically worsens during rest or inactivity. It may be worse at night or in the morning. It often feels better with movement.
AS often starts in the sacroiliac joints (the joints between the pelvis and spine). Over time, it may involve the spine.
Other symptoms may include:
- Pain, stiffness, and swelling in other joints, such as the ribs, shoulders, knees, or feet.
- Trouble taking deep breaths if the joints connecting the ribs are affected.
- Eye pain and vision changes from uveitis (inflammation of the eye).
- Fatigue (feeling very tired).
- Skin rashes, in particular psoriasis (a skin condition with scaly patches).
- Belly pain and loose bowel movements.
Symptoms may worsen in flares and improve during remission. A flare is a period when symptoms get worse. Remission is a period when they ease up.
Causes and who gets it
Researchers do not know the cause of AS. Studies show that both genes and environment may lead to the disease. The HLA-B27 gene raises the risk. But having this gene does not mean you will get the disease. Many people have the gene and never develop AS.
These factors may raise your risk:
- Family history of ankylosing spondylitis.
- Age. Most people develop symptoms before age 45. Some develop it as children or teens.
- Other conditions, such as Crohn's disease, ulcerative colitis, or psoriasis.
The disease often begins between ages 20 and 40. It affects more males than females. AS belongs to a family of arthritis called spondyloarthritis.
How doctors diagnose it
Your doctor will ask about your medical and family history and do a physical exam. The exam checks your spine, pelvis, heels, and chest. The doctor watches how you move and bend and asks you to breathe deeply to check for rib stiffness.
No single test diagnoses AS. Your doctor may order imaging studies and lab tests. X-rays show joint changes, but changes may take years to show. MRI (magnetic resonance imaging) can show them earlier.
Blood tests may check for the HLA-B27 gene and for markers of inflammation.
Treatment
There is no cure for AS, but there are many treatment options to control symptoms. The goals are to relieve symptoms, help you keep proper posture, flexibility, and strength, and halt or slow the progression of the disease. In most cases, treatment includes medicine and physical therapy.
Over-the-counter anti-inflammatory medicines (NSAIDs), such as ibuprofen and naproxen, can relieve pain and swelling. Talk to your provider or pharmacist before daily long-term use of an over-the-counter NSAID. If these do not help, your doctor may prescribe stronger NSAIDs or biologic medicines that target parts of the immune system.
Physical therapy can relieve pain, strengthen muscles, improve posture, and keep joints flexible. A physical therapist can suggest sleeping positions and a home exercise plan.
If you smoke, quit. AS is more severe in people who smoke, and smoking blunts the effect of treatment.
When to see a doctor
Call 911 or go to the emergency room if you have trouble breathing, chest pain or discomfort lasting two minutes or more, a head or spine injury, or sudden weakness. Contact your provider if you have symptoms of ankylosing spondylitis or new symptoms during treatment. Get medical help right away for eye pain or vision changes. These can be signs of uveitis.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. This doctor can track your symptoms over time and review your medicines. The doctor can also coordinate your care with a rheumatologist and physical therapist.
Common questions
Is there a cure for ankylosing spondylitis?
No. There is no cure for ankylosing spondylitis, but there are many treatment options to help control symptoms. With treatment, most people with ankylosing spondylitis can have productive lives.
What does ankylosing spondylitis feel like?
It causes lower back and hip pain and stiffness. The pain is worse at night, in the morning, or when you rest. It often feels better with moving and exercise. The discomfort may wake you from sleep.
Does ankylosing spondylitis always lead to a fused spine?
Not always. In severe cases, the vertebrae may fuse and the spine becomes rigid. Many people have mild episodes of back pain and stiffness that come and go.
What can I do to stay well with ankylosing spondylitis?
Stay active and exercise regularly. Practice good posture. If you smoke, quit.
Sources
- MedlinePlus Medical Encyclopedia - Ankylosing spondylitis
- NIAMS - Ankylosing Spondylitis Symptoms & Risk Factors
- NIAMS - Ankylosing Spondylitis: Diagnosis, Treatment, and Steps to Take
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
