Diagnosis

During the physical exam, your health care provider might ask you to bend in different directions to test the range of motion in your spine. Your provider might try to reproduce your pain by pressing on specific portions of your pelvis or by moving your legs into a particular position. You also may be asked to take a deep breath to see if you have difficulty expanding your chest.

Imaging tests

X-rays allow doctors to check for changes in joints and bones, though the visible signs of ankylosing spondylitis might not be evident early in the disease.

An MRI uses radio waves and a strong magnetic field to provide more-detailed images of bones and soft tissues. MRI scans can reveal evidence of ankylosing spondylitis earlier in the disease process, but are much more expensive.

Lab tests

There are no specific lab tests to identify ankylosing spondylitis. Certain blood tests can check for markers of inflammation, but inflammation can be caused by many different health problems.

Blood can be tested for the HLA-B27 gene. But many people who have that gene don't have ankylosing spondylitis and people can have the disease without having the gene.

More Information

Treatment

The goal of treatment is to relieve pain and stiffness and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as naproxen (Aleve, Naprosyn, others) and ibuprofen (Advil, Motrin IB, others) — are the medications doctors most commonly use to treat ankylosing spondylitis. These medications can relieve inflammation, pain and stiffness, but they also might cause gastrointestinal bleeding.

If NSAIDs aren't helpful, your doctor might suggest starting a tumor necrosis factor (TNF) blocker or an interleukin-17 (IL-17) inhibitor. These drugs are injected under the skin or through an intravenous line. These types of medications can reactivate untreated tuberculosis and make you more prone to infections.

Examples of TNF blockers include:

  • Adalimumab (Humira)
  • Certolizumab pegol (Cimzia)
  • Etanercept (Enbrel)
  • Golimumab (Simponi)
  • Infliximab (Remicade)

IL-17 inhibitors used to treat ankylosing spondylitis include secukinumab (Cosentyx) and ixekizumab (Taltz).

Therapy

Physical therapy is an important part of treatment and can provide a number of benefits, from pain relief to improved strength and flexibility. A physical therapist can design specific exercises for your needs. To help preserve good posture, you may be taught:

  • Range-of-motion and stretching exercises
  • Strengthening exercises for abdominal and back muscles
  • Proper sleeping and walking positions

Surgery

Most people with ankylosing spondylitis don't need surgery. Surgery may be recommended if you have severe pain or if a hip joint is so damaged that it needs to be replaced.

Lifestyle and home remedies

Lifestyle choices can also help manage ankylosing spondylitis.

  • Stay active. Exercise can help ease pain, maintain flexibility and improve your posture.
  • Don't smoke. If you smoke, quit. Smoking is generally bad for your health, but it creates additional problems for people with ankylosing spondylitis, including further hampering breathing.
  • Practice good posture. Practicing standing straight in front of a mirror can help you avoid some of the problems associated with ankylosing spondylitis.

Coping and support

The course of your condition can change over time, and you might have painful episodes and periods of less pain throughout your life. But most people are able to live productive lives despite a diagnosis of ankylosing spondylitis.

You might want to join an online or in-person support group of people with this condition, to share experiences and support.

Preparing for your appointment

You might first bring your symptoms to the attention of your family doctor. He or she may refer you to a doctor who specializes in inflammatory disorders (rheumatologist).

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

  • Your symptoms, including any that may seem unrelated to the reason you made the appointment, and when they began
  • Key personal information, including major stresses, recent life changes and family medical history
  • All medications, vitamins and other supplements you take and their doses
  • Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you're given.

For ankylosing spondylitis, basic questions to ask your doctor include:

  • What's likely causing my symptoms?
  • Other than the most likely cause, what are other possible causes for my symptoms?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What's the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Should I see a specialist?
  • Are there brochures or other printed material I can have? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

  • Where is your pain?
  • How severe is your pain?
  • Have your symptoms been continuous or occasional?
  • What, if anything, seems to worsen or improve your symptoms?
  • Have you taken medications to relieve the pain? What helped most?
Nov. 25, 2021
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  3. Kellerman RD, et al. Rheumatology and the musculoskeletal system. In: Conn's Current Therapy 2021. Elsevier; 2021. https://www.clinicalkey.com. Accessed Aug. 5, 2021.
  4. AskMayoExpert. Ankylosing spondylitis. Mayo Clinic; 2021.
  5. Yu DT, et al. Clinical manifestations of axial spondyloarthritis in adults. https://www.uptodate.com/contents/search. Accessed Aug. 5, 2021.
  6. Yu DT, et al. Treatment of axial spondyloarthritis in adults. https://www.uptodate.com/contents/search. Accessed Aug. 5, 2021.