Ankylosing spondylitis: Spot it early and act fast

What if that nagging low back pain isn’t ordinary muscle strain but an inflammatory spine problem? Ankylosing spondylitis (AS) usually starts in younger adults and quietly stiffens the spine over years. Catching it early changes outcomes, so knowing the signs pays off.

Common symptoms you can’t ignore

AS often feels different from mechanical back pain. It usually begins before age 45, gets worse at night, and improves with movement. Morning stiffness that lasts more than 30 minutes is a classic clue. Pain can also appear in the buttock, hips, or chest and may shift sides. Some people notice tendon or heel pain (enthesitis), eye inflammation (uveitis), or long-term fatigue. If family members have similar problems, that raises the chance it’s AS.

How doctors diagnose it — simple tests

Diagnosis combines history, exam, and a few tests. Blood checks like CRP or ESR can show inflammation but aren’t always high. A genetic marker, HLA-B27, is common in people with AS but not definitive by itself. Plain X-rays of the sacroiliac joints can show changes later in the disease. MRI is the best way to spot early inflammation before X-rays change. If you suspect AS, ask to see a rheumatologist—early referral matters.

Treatment has two main goals: reduce inflammation and keep you moving. For many people, NSAIDs (ibuprofen, naproxen) are the first step to control pain. Regular exercise and physical therapy are key — think daily stretching, back extension work, and low-impact cardio like swimming or cycling. Good posture and sleep setup (medium-firm mattress, pillow that supports neck) help too. Smoking makes AS worse, so quitting is a top priority.

When symptoms don’t respond to NSAIDs, doctors consider prescription options. Biologic drugs — most commonly TNF inhibitors and IL-17 blockers — can dramatically reduce spine inflammation and slow damage. For arthritis outside the spine, sulfasalazine is sometimes used. Short steroid courses or local steroid injections may ease flares, and medicines like prednisolone are reserved for specific situations. If a usual medicine is unavailable or causes side effects, your rheumatologist can suggest alternatives and management tips.

Practical tips for daily life: keep moving even when you don’t feel like it, use heat for tight muscles and cold for sharp flares, and learn gentle stretching routines you can do every day. Use ergonomic chairs and change positions often at work. If pain affects sleep, a short walk or warm shower before bed often helps.

See a doctor if you’re under 45 and have persistent back pain for more than three months, especially with night pain or long morning stiffness. Early diagnosis gives you more treatment choices and better long-term function. If you want practical articles on meds, side effects, or exercises, our site covers prednisolone tips, sulfasalazine nausea fixes, and what to do during Plaquenil shortages. Talk with your rheumatologist — they’ll tailor the plan to your life and goals.