Ankylosing spondylitis (AS) is a chronic inflammatory condition that primarily affects the spine. It causes pain, stiffness, and inflammation in the joints and ligaments of the spine, particularly in the lower back and pelvis. Over time, the inflammation can cause the vertebrae to fuse together, leading to reduced flexibility and, in severe cases, a forward-curved posture.
AS is part of a broader group of conditions called spondyloarthritis. While it mainly affects the spine, it can also affect other joints such as the hips and shoulders, as well as other parts of the body including the eyes, skin, and bowel.
There is no cure for ankylosing spondylitis, but with the right treatment many people are able to manage their symptoms and maintain a good quality of life.
How Common is AS?
Ankylosing spondylitis affects approximately 1 in 200 Australians. Symptoms typically begin between the ages of 15 and 45, with most people first experiencing symptoms in their late teens or 20s. It is about three times more common in males than females, though it can affect anyone.
AS is often underdiagnosed – because lower back pain is common, it can take several years from the onset of symptoms to receive a confirmed diagnosis.
Symptoms of AS tend to come and go and can vary in severity. A key feature that distinguishes AS from mechanical back pain is that symptoms typically worsen with rest and improve with physical activity.
Common symptoms include:
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- Persistent pain and stiffness in the lower back, buttocks, or neck, often worse at night or in the morning
- Morning stiffness that typically lasts longer than 30 minutes and improves with movement and exercise
- Enthesitis – pain and tenderness where tendons or ligaments attach to bone, such as the back of the heel, the sole of the foot, or the chest wall
- Dactylitis – swelling of an entire finger or toe, sometimes called "sausage digits"
- Reduced spinal flexibility and range of motion over time
- Eye inflammation (uveitis) – affecting up to 3 in 10 people with AS, causing redness, pain, and sensitivity to light
- Fatigue – persistent tiredness that is not relieved by rest
- Pain or swelling in larger joints such as the hips, knees, or shoulders
Symptoms that have lasted more than three months and are accompanied by morning stiffness and night pain should be assessed by a doctor.
The exact cause of ankylosing spondylitis is not fully understood. It is believed to involve a combination of genetic and environmental factors:
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- Genetics – AS runs in families. Around 9 in 10 people with AS carry a gene called HLA-B27, which is strongly associated with the condition. However, not everyone with this gene develops AS, so other factors must also be involved
- Immune system – AS is an autoimmune condition in which the immune system mistakenly attacks the body's own joint tissue, causing chronic inflammation
- Environmental triggers – bacterial gut infections may trigger the onset of AS in genetically predisposed individual
AS is not contagious and cannot be passed from person to person.
There is no single test for ankylosing spondylitis. Diagnosis is based on a combination of:
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- A detailed review of your symptoms and family medical history
- A physical examination to assess spinal mobility, posture, and areas of tenderness
- Blood tests to check for the HLA-B27 gene and markers of inflammation such as CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate)
- Imaging – X-rays may show changes to the sacroiliac joints in established disease, while MRI is more sensitive for detecting early inflammation before structural changes appear
If AS is suspected, your GP should refer you to a rheumatologist for specialist assessment. Early diagnosis matters – treatment started before significant joint damage occurs leads to better long-term outcomes.
Treatment aims to reduce inflammation, manage pain and stiffness, maintain spinal mobility, and prevent or slow joint damage.
Exercise and physiotherapy Regular exercise is one of the most important parts of managing AS. Physiotherapy-guided exercises that focus on posture, flexibility, and spinal mobility are recommended for all people with AS. Hydrotherapy and swimming are particularly beneficial.
Self-care Quitting smoking is strongly advised – smoking accelerates spinal damage in AS. Maintaining a healthy weight and managing stress also help with symptom control.
Medications
NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen or naproxen are the first-line treatment for AS, reducing inflammation and pain. Regular use is often recommended in active disease rather than as-needed dosing.
Corticosteroid injections may be used for targeted short-term relief in specific inflamed joints.
Conventional DMARDs (disease-modifying anti-rheumatic drugs) such as methotrexate or sulfasalazine are less effective for spinal AS but may be used when peripheral joints are affected.
When NSAIDs or cDMARDs don't provide adequate control, biologic DMARDs are used. These target specific immune pathways driving inflammation and must be prescribed by a rheumatologist. Types include TNF-alpha inhibitors and IL-17 inhibitors.
JAK inhibitors (Janus kinase inhibitors) are oral medications targeting specific immune pathways, used when other treatments have been insufficient.
The following specialty medications are available at Ace, a specialty pharmacy for Ankylosing Spondylitis.
Biosimilars of adalimumab, etanercept, and infliximab are also available on the PBS. Speak with your Ace pharmacist about your options.
With Ace, you’ll benefit from:
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- Expert Support: Our dedicated team of health concierges is always available to answer your questions, provide guidance, and help you navigate your condition with confidence.
- Specialty Medication: We offer a wide range of specialty medications and support services, designed specifically for those living with chronic illnesses. Whether you’re looking for help managing a specific condition, or simply need access to the medications you need, we’ve got you covered.
- A Wide Range of Conditions: From diabetes to heart disease, and everything in between, we help manage a variety of special condition
Take control of your health and well-being, and start your journey to better health with Ace today.
There are many organisations that support Australians living with ankylosing spondylitis. See below for a selection.
Support Organisations
Clinical & Research Resources
