Ankylosing
Spondylitis (AS)
MBChB (New Zealand), PGDipObstMedGyn, FRACP (New Zealand), FAMS (Rheumatology)
A strong genetic component is associated with AS. Many people with AS carry the HLA-B27 gene, although having this gene does not mean a person will definitely develop AS.
AS most commonly affects males, often beginning in the teenage years or early adulthood.
Having a close family member with AS can increase the likelihood of developing AS.
Ankylosing Spondylitis
The symptoms of ankylosing spondylitis often develop gradually and can vary in intensity over time. Early symptoms may include lower back pain and stiffness, which are often worse in the morning or after periods of inactivity.
Back pain and stiffnessPain and stiffness often affect the lower back, hips or buttocks. These symptoms may improve with movement but tend to return after long periods of sitting or lying down.- Joint pain and swellingWhile the spine is most commonly affected, AS can also involve other joints and areas where tendons attach to bone, including the knees, ankles, feet, heels, shoulders, neck and rib cage.
- FatigueOngoing inflammation can cause fatigue that doesn’t always improve with rest. The level of tiredness may vary depending on how active the AS is.
- Eye inflammationSome people with AS may develop episodes of eye redness, pain or sensitivity to light. This requires prompt medical attention.
Diagnosing ankylosing spondylitis can be challenging in the early stages, as symptoms may come and go and can resemble other causes of back pain. A thorough evaluation is important to identify the underlying cause.
Diagnosis begins with a detailed discussion of your symptoms, including when they occur and what makes them better or worse. During the physical examination, the doctor will check for areas of pain and swelling, assess your posture and evaluate spinal flexibility.
Blood tests are used to look for signs of inflammation, such as elevated ESR or CRP levels. Testing for the HLA-B27 gene can also help support the diagnosis.
X-rays, MRI scans or both may be recommended to detect inflammation or structural changes in the spine and sacroiliac joints. MRI scans provide more detailed images of bones and soft tissues and are particularly useful for identifying early changes that may not yet appear on X-ray.
AS can also affect other parts of the body, including the eyes, joints or tendons. A comprehensive assessment is essential as part of the overall evaluation.
How Do Rheumatologists Treat Ankylosing Spondylitis?
Management of ankylosing spondylitis (AS) is tailored to each individual, depending on whether symptoms affect the spine, peripheral joints, or the areas of tendon and ligament attachments to the bone. Treatment aims to reduce pain and inflammation, preserve spinal mobility, improve daily functioning, and support long-term quality of life.
NSAIDs are often used to manage AS, helping to reduce inflammation, relieve pain and ease stiffness.
DMARDs may be used to relieve symptoms and prevent joint damage depending on the pattern of joint involvement.
Biologics work by targeting specific parts of the immune system that cause inflammation. They help reduce pain, swelling and stiffness. Treatment will be tailored to the areas which are affected such as spine, tendons or eyes to help you remain active and well.
Physiotherapy is recommended for everyone with AS. A structured programme that focuses on posture, spinal extension, stretching, and strengthening can help improve flexibility and strength. Staying active is an important part of managing AS over the long-term.
Even though ankylosing spondylitis is a long-term condition, making lifestyle changes can help manage symptoms and support overall comfort, flexibility and mobility.
Regular physical activity is important for maintaining flexibility in the spine, neck, and other joints. Staying active can help reduce stiffness and support good posture. Exercises that combine stretching with strengthening exercises for abdominal and back muscles are particularly beneficial.
Smoking is strongly discouraged for people with ankylosing spondylitis. Smoking can make symptoms harder to control and may reduce how well treatments work. Because AS can also affect the rib cage and chest movement, smoking places an additional strain on breathing.
There is no special diet or specific dietary restrictions for ankylosing spondylitis. However, maintaining a balanced, nutritious diet can support overall well-being and maintain a healthy weight.
Our Rheumatologist
Dr Poh Yih Jia
Senior Consultant Rheumatologist
Dr Poh Yih Jia is a senior consultant rheumatologist with over 20 years of medical experience in New Zealand and Singapore. She has extensive expertise in managing complex autoimmune diseases and inflammatory arthritis, including ankylosing spondylitis.
Her commitment to patient-centred care has earned her multiple accolades, including the Singapore Health Quality Service Award and the Service with a Heart Award. She remains dedicated to advancing rheumatology through clinical practice, education and research, ensuring her patients receive the most current, evidence-based care for ankylosing spondylitis and other autoimmune diseases.
FAQs on Ankylosing Spondylitis
Ankylosing spondylitis is an inflammatory arthritis that mainly affects the spine and sacroiliac joints, causing back pain, morning stiffness and reduced flexibility. Symptoms often begin in the teenage years or early adulthood. Over time, inflammation can lead to new bone formation and gradual fusion of the vertebrae, which may limit spinal movement. While the exact cause is not fully understood, it is linked to genetic factors. Many individuals with AS carry the HLA-B27 gene or have a family history of the condition.
Early symptoms of AS often include persistent lower back pain and stiffness that eases with movement rather than rest. Pain in the buttocks, hips or heels may also occur. Symptoms usually develop gradually in younger adults and may come and go. Because these symptoms can be similar to other causes of back pain, a comprehensive assessment with blood tests and imaging is important for an accurate diagnosis.
There is currently no cure for ankylosing spondylitis, but many people manage their symptoms effectively with the right treatment. Medications, targeted exercises and regular monitoring can help reduce inflammation, ease stiffness and preserve spinal mobility. With early and appropriate care, most people with AS are able to stay active and enjoy a fulfilling life.
Without timely diagnosis and care, ankylosing spondylitis can lead to increasing pain, stiffness and reduced mobility that may affect daily activities. In some cases, inflammation can affect other parts of the body, including the eyes or ribs, causing pain, redness, blurry vision or breathing difficulties. Over time, parts of the spine may gradually fuse. Early and appropriate management can help reduce these risks.
Ankylosing spondylitis cannot be prevented, as genetics play a key role in its development. However, early recognition of symptoms and prompt treatment can help slow the disease and reduce long-term complications. Along with medical care, healthy lifestyle habits such as regular exercise, staying active and avoiding smoking can make a difference in managing AS and maintaining an active, fulfilling life.