Ankylosing Spondylitis CMA Clinical Spotlight by Dr. Amrita Singh. This article is valued at one hour of CMA CPD.
Ankylosing spondylitis (AS) is a long-term inflammatory condition that mainly affects the spine and sacroiliac joints, which are the joints connecting the lower spine to the pelvis. It belongs to a group of inflammatory rheumatic conditions known as axial spondyloarthritis (NHS, 2019; Johns Hopkins Medicine, n.d.).
The condition causes inflammation in the joints and ligaments of the spine, leading to back pain, stiffness, and reduced mobility. Symptoms often begin gradually, commonly in early adulthood, and are usually worse after rest or in the morning, improving with movement or exercise (NHS, 2019; Mayo Clinic, 2023).
Over time, ongoing inflammation may cause new bone formation, which can lead to parts of the spine becoming less flexible. In more advanced cases, some spinal bones may fuse together, resulting in a more rigid posture. However, the severity and progression of ankylosing spondylitis vary widely between individuals (Cleveland Clinic, 2023).
Although ankylosing spondylitis primarily affects the spine, it can also involve other areas of the body, including the hips, shoulders, ribs, eyes, skin, and bowel. Early recognition, appropriate medical management, physical activity, and supportive care can help reduce symptoms, preserve mobility, and improve quality of life (Johns Hopkins Medicine, n.d.; NHS, 2019).
Causes
The exact cause of AS is not fully understood, but it is believed to develop due to a combination of genetic, immune, and environmental factors. The condition occurs when the immune system becomes overactive and causes inflammation in the spine, sacroiliac joints, and sometimes other parts of the body (NHS, 2019; Johns Hopkins Medicine, n.d.).
One of the strongest genetic associations is with the HLA-B27 gene. Many people with ankylosing spondylitis carry this gene, although having HLA-B27 does not necessarily mean that a person will develop the condition. This suggests that genetics increase susceptibility, but other triggers are also likely involved (Mayo Clinic, 2023; Cleveland Clinic, 2023).
The inflammation in ankylosing spondylitis mainly affects the places where ligaments and tendons attach to bone, especially around the spine and pelvis. Over time, repeated inflammation may lead to pain, stiffness, and, in some cases, new bone formation that reduces spinal flexibility (NHS, 2019).
Family history may also play a role, as ankylosing spondylitis is more common in people who have close relatives with the condition or related forms of spondyloarthritis (Johns Hopkins Medicine, n.d.).
Signs and symptoms
The signs and symptoms of AS usually develop gradually and may vary in severity from person to person. The most common early symptom is persistent lower back pain and stiffness, often starting in early adulthood and lasting for more than three months (NHS, 2019; Johns Hopkins Medicine, n.d.).
Back pain associated with ankylosing spondylitis is typically worse after rest, especially in the morning or during the night, and often improves with movement or exercise. Morning stiffness may last for a prolonged period and can affect daily mobility (Mayo Clinic, 2023; NHS, 2019).
Pain and stiffness may also affect the buttocks, hips, shoulders, neck, ribs, and heels, depending on which joints or tendon attachment sites are inflamed. Some individuals may experience alternating buttock pain due to inflammation of the sacroiliac joints (Cleveland Clinic, 2023).
Ankylosing spondylitis can also cause fatigue, which may result from ongoing inflammation, disturbed sleep, pain, or reduced physical activity. In some cases, inflammation of the ribs and chest wall may make deep breathing uncomfortable (NHS, 2019).
The condition may also involve areas outside the spine. Some individuals develop eye inflammation (uveitis), which can cause eye pain, redness, light sensitivity, and blurred vision. Others may have associated inflammatory conditions affecting the skin or bowel (Johns Hopkins Medicine, n.d.; Cleveland Clinic, 2023).
As the condition progresses, reduced spinal flexibility, postural changes, and difficulty bending or twisting may occur. However, early recognition, treatment, and regular movement can help reduce symptoms and support long-term function.
Types / stages
Ankylosing spondylitis is now commonly understood within the broader group of conditions called axial spondyloarthritis, which mainly affects the spine and sacroiliac joints. It is not usually graded in one simple universal system like some injuries, but it may be described according to disease type, stage, severity, and structural changes (Johns Hopkins Medicine, n.d.; Johns Hopkins Medicine, n.d.).
- Non-radiographic axial spondyloarthritis
This is an earlier or less structurally visible form of axial spondyloarthritis. Individuals may have inflammatory back pain and other symptoms, but clear changes may not yet be visible on standard X-rays. Inflammation may still be detected through clinical assessment, blood tests, or MRI in some cases (NICE, 2017; Johns Hopkins Medicine, n.d.). - Radiographic axial spondyloarthritis / Ankylosing spondylitis
This form is traditionally referred to as ankylosing spondylitis. In this stage, changes in the sacroiliac joints or spine may be visible on X-ray. These changes reflect ongoing inflammation and possible structural damage over time (NHS, 2019; NICE, 2017). - Early-stage ankylosing spondylitis
In the early stage, symptoms commonly include lower back pain, stiffness, buttock pain, fatigue, and reduced flexibility. Symptoms are usually worse after rest and improve with movement or exercise. At this stage, maintaining mobility and controlling inflammation are important goals (Mayo Clinic, 2023; NHS, 2019). - Progressive or established ankylosing spondylitis
As inflammation continues, individuals may experience more persistent stiffness, reduced spinal mobility, postural changes, and involvement of other joints such as the hips, shoulders, ribs, or heels. Some may also develop extra-articular symptoms such as uveitis, bowel inflammation, or skin involvement (Cleveland Clinic, 2023; Johns Hopkins Medicine, n.d.). - Advanced ankylosing spondylitis
In advanced cases, long-term inflammation may lead to new bone formation and possible fusion of parts of the spine, known as ankylosis. This can reduce flexibility and contribute to a more rigid posture. However, progression varies widely, and not everyone develops spinal fusion (NHS, 2019; Cleveland Clinic, 2023).
In terms of severity, ankylosing spondylitis may also be described as mild, moderate, or severe, depending on pain levels, stiffness, fatigue, mobility restriction, imaging findings, and impact on daily life. Regular assessment helps guide treatment and monitor progression (NICE, 2017).
Risk factors
Several factors can increase the likelihood of developing AS, although having a risk factor does not mean that the condition will definitely occur. AS is influenced by a combination of genetic, immune, and biological factors (NHS, 2019; Johns Hopkins Medicine, n.d.).
One of the strongest risk factors is the presence of the HLA-B27 gene. Many people with ankylosing spondylitis carry this gene, although not everyone with HLA-B27 develops the condition. This means the gene increases susceptibility but is not the sole cause (Mayo Clinic, 2023; Cleveland Clinic, 2023).
A family history of ankylosing spondylitis or related inflammatory conditions may also increase risk. People with close relatives affected by AS or other forms of spondyloarthritis may have a higher chance of developing the condition (Johns Hopkins Medicine, n.d.).
Age is another important factor. Symptoms often begin in late adolescence or early adulthood, commonly before the age of 40. The gradual onset of back pain and stiffness in younger adults is therefore an important clinical feature to recognise (NHS, 2019; NICE, 2017).
Sex may also influence risk and presentation. Ankylosing spondylitis has historically been diagnosed more often in men, although it is increasingly recognised that women may also be affected and may sometimes experience delayed diagnosis due to different symptom patterns (Cleveland Clinic, 2023).
Other associated factors include the presence of related inflammatory conditions, such as psoriasis, inflammatory bowel disease, or recurrent uveitis, which may occur alongside axial spondyloarthritis in some individuals (Johns Hopkins Medicine, n.d.).
Complications
Ankylosing spondylitis can lead to several complications, particularly when inflammation is persistent, severe, or not adequately controlled. These complications may affect the spine, joints, eyes, chest, and overall quality of life (NHS, 2019; Johns Hopkins Medicine, n.d.).
One of the main complications is reduced spinal mobility. Long-term inflammation may lead to stiffness, postural changes, and, in some cases, fusion of parts of the spine. This can make bending, twisting, and maintaining an upright posture more difficult (Mayo Clinic, 2023; Cleveland Clinic, 2023).
Inflammation may also affect the hips, shoulders, ribs, and other joints, causing pain, stiffness, and reduced function. When the ribs or chest wall are involved, deep breathing may become uncomfortable, and chest expansion may be reduced (NHS, 2019).
A common extra-spinal complication is uveitis, an inflammatory eye condition that can cause eye pain, redness, blurred vision, and sensitivity to light. Uveitis requires prompt medical attention to prevent further eye complications (Johns Hopkins Medicine, n.d.; Cleveland Clinic, 2023).
In some individuals, ankylosing spondylitis may be associated with other inflammatory conditions, including psoriasis and inflammatory bowel disease, which can add to the overall health burden and require coordinated care (Johns Hopkins Medicine, n.d.).
Long-term inflammation and reduced mobility may also contribute to fatigue, sleep disturbance, reduced physical fitness, and emotional distress. In more advanced cases, changes in posture and spinal rigidity may affect confidence, independence, and daily functioning.
Although these complications can be significant, early diagnosis, appropriate medical management, regular movement, posture awareness, and supportive care can help reduce their impact and preserve long-term quality of life.
Prognosis
The prognosis of AS varies between individuals, depending on the severity of inflammation, age of onset, response to treatment, and how well mobility is maintained. For many people, symptoms can be managed effectively with appropriate medical care, regular exercise, posture awareness, and long-term monitoring (NHS, 2019; Johns Hopkins Medicine, n.d.).
Ankylosing spondylitis is a chronic condition, meaning it usually requires ongoing management rather than a one-time treatment approach. Some individuals experience mild symptoms with occasional flare-ups, while others may develop more persistent pain, stiffness, fatigue, or reduced spinal flexibility over time (Mayo Clinic, 2023).
Early recognition and treatment can significantly improve long-term outcomes. Regular physical activity, stretching, strengthening exercises, and maintaining good posture are important for preserving spinal mobility and reducing stiffness (NHS, 2019).
In more advanced cases, ongoing inflammation may lead to structural changes in the spine, including reduced flexibility or partial fusion. However, not everyone develops severe spinal fusion, and the progression of the condition can vary widely (Cleveland Clinic, 2023).
With appropriate management, many individuals with ankylosing spondylitis are able to maintain independence, continue working, and lead active lives. Long-term follow-up is important to monitor symptoms, manage flare-ups, detect complications such as uveitis, and support overall quality of life (Johns Hopkins Medicine, n.d.).
Nutritional perspective
Nutrition may play a supportive role in managing inflammation, maintaining bone health, supporting energy levels, and improving overall wellbeing in ankylosing spondylitis. While diet cannot cure the condition or replace medical management, a balanced nutritional approach may help support long-term health and symptom control (NHS, 2019; Johns Hopkins Medicine, n.d.).
Because ankylosing spondylitis is an inflammatory condition, a diet rich in anti-inflammatory foods may be beneficial. This includes fruits, vegetables, whole grains, pulses, nuts, seeds, and healthy fats, particularly omega-3 fatty acids found in oily fish, flaxseeds, chia seeds, and walnuts (Mayo Clinic, 2023).
Maintaining a healthy weight is also important, as excess body weight may place additional strain on the spine, hips, knees, and other joints. A balanced diet combined with regular physical activity can help reduce mechanical stress and support mobility (Cleveland Clinic, 2023).
Bone health should also be considered, as chronic inflammation and reduced mobility may increase the risk of reduced bone density. Adequate calcium, vitamin D, magnesium, and protein intake can support bone strength and muscle function. Sources may include dairy products, fortified foods, leafy greens, nuts, seeds, legumes, and safe sunlight exposure where appropriate (NHS, 2019).
Some individuals with ankylosing spondylitis may also have associated inflammatory bowel disease, so nutritional advice should be individualised if digestive symptoms are present. In such cases, professional dietary guidance may help ensure symptom control while maintaining nutritional adequacy (Johns Hopkins Medicine, n.d.).
Psychological perspective
Ankylosing spondylitis can have a significant psychological and emotional impact, particularly because it is a chronic condition that may involve persistent pain, stiffness, fatigue, flare-ups, and changes in mobility. Living with unpredictable symptoms can affect mood, motivation, sleep, confidence, and overall quality of life (NHS, 2019; Johns Hopkins Medicine, n.d.).
Chronic back pain and morning stiffness may contribute to frustration, irritability, low mood, and emotional fatigue, especially when symptoms interfere with work, exercise, family life, or social activities. Fatigue may also reduce concentration and increase the sense of physical and mental burden (Mayo Clinic, 2023).
Some individuals may experience anxiety about disease progression, particularly concerns about spinal stiffness, posture changes, reduced independence, or future disability. Fear of flare-ups may also lead to activity avoidance, which can worsen stiffness and reduce confidence in movement (Cleveland Clinic, 2023).
Sleep disturbance is another important psychological factor. Pain and stiffness during the night or early morning can interrupt sleep, leading to daytime tiredness, reduced resilience, and increased emotional sensitivity (NHS, 2019).
Psychological support, education, and reassurance can help individuals develop confidence in managing the condition. Stress-management strategies, pacing, regular movement, supportive routines, and social support may help improve coping and emotional wellbeing. A holistic approach should therefore address not only spinal symptoms but also the person’s mental health, confidence, lifestyle, and long-term quality of life (Johns Hopkins Medicine, n.d.).
Homeopathic perspective
From a homeopathic perspective, ankylosing spondylitis is viewed as a chronic constitutional condition involving the body’s musculoskeletal, inflammatory, and regulatory systems. Rather than focusing only on spinal stiffness or back pain, homeopathy considers the individual’s overall pattern of symptoms, physical constitution, emotional state, lifestyle, and response to stress.
Homeopathic assessment is individualised, taking into account the nature of the pain and stiffness, whether symptoms are worse after rest or improved by movement, the timing of symptoms, sensitivity to cold or damp weather, fatigue levels, sleep quality, posture, and associated complaints such as eye, bowel, or skin involvement.
Because ankylosing spondylitis is a long-term inflammatory condition, the homeopathic approach may focus on supporting overall balance, resilience, mobility, and comfort, while considering the individual’s broader susceptibility and constitutional tendencies. Attention may also be given to the emotional impact of living with chronic stiffness, flare-ups, reduced mobility, and uncertainty about progression.
Supportive homeopathic care may aim to help the individual maintain comfort, adaptability, and confidence in movement, alongside lifestyle measures such as regular gentle exercise, posture awareness, breathing exercises, stress management, and appropriate rest.
Within this holistic framework, the focus remains on supporting the person as a whole, with attention to physical, emotional, and constitutional factors that may influence long-term wellbeing and quality of life.
Summary
Ankylosing spondylitis is a chronic inflammatory condition that mainly affects the spine and sacroiliac joints, causing persistent back pain, stiffness, reduced flexibility, and fatigue. It belongs to the wider group of conditions known as axial spondyloarthritis, and symptoms often begin gradually in late adolescence or early adulthood.
The condition is linked to immune system activity and genetic susceptibility, particularly the HLA-B27 gene, although not everyone with this gene develops ankylosing spondylitis. Symptoms are typically worse after rest or in the morning and often improve with movement or exercise.
Ankylosing spondylitis may progress from non-radiographic axial spondyloarthritis to radiographic disease, where changes become visible on imaging. In advanced cases, long-term inflammation may lead to reduced spinal mobility, postural changes, or partial spinal fusion, although progression varies widely between individuals.
Complications may include reduced spinal flexibility, hip or shoulder involvement, rib and chest wall stiffness, uveitis, fatigue, sleep disturbance, and emotional distress. However, early recognition, appropriate medical care, regular movement, posture awareness, and supportive lifestyle strategies can help preserve function and quality of life.
A comprehensive approach includes nutritional support for inflammation regulation and bone health, psychological support for coping with chronic symptoms, and holistic care focused on comfort, mobility, resilience, and long-term wellbeing.
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References
- Cleveland Clinic. (2023, December 19). What Is Ankylosing Spondylitis? Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/ankylosing-spondylitis
- Mayo Clinic. (2023, December 21). Ankylosing spondylitis – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808
- NHS . (2019). Overview – Ankylosing spondylitis. NHS. https://www.nhs.uk/conditions/Ankylosing-spondylitis/
- Johns Hopkins Medicine. (n.d.). Ankylosing Spondylitis. Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/ankylosing-spondylitis
- Do take a look at the Complementary Medical Association’s library of a wide range of health conditions here.
About the Author
Amrita Singh is a qualified Homoeopath, Psychologist, and Nutritionist with a strong multidisciplinary foundation in mind–body health. She holds an MSc in Psychology (UK) and an MSc in Food, Nutrition & Dietetics (India), alongside formal training in classical homoeopathy from the Central College of Homoeopathy, London. She is currently pursuing postgraduate studies with the Irish School of Homoeopathy.
A full member of the Complementary Medical Association (MCMA), Homoeopathy International (R. Hom. Int.), the British Psychological Society (Graduate Member), and Balen’s insured, Amrita integrates emotional insight, nutritional balance, and gentle homoeopathic care in her clinical approach.
Formerly the Head of Department at RMCH&RC, she now works with clients internationally & runs two physical clinics (Meerut City, Uttar Pradesh & Ambala Cantt., Haryana) in India, offering compassionate, holistic guidance that honours the interconnectedness of emotional wellbeing, physical health, and lifestyle patterns.
Contact & Credentials
Amrita Singh
Homoeopath, Psychologist & Nutritionist
Dip. CCH (England) | MSc Psychology (England) | MSc Food, Nutrition & Dietetics (India)
MCMA | R. Hom. Int. (Balen’s Insured) | GMBPsS
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