Can Morning Stiffness Be a Symptom of Ankylosing Spondylitis?

Ankylosing spondylitis (AS) is an autoimmune form of arthritis that causes joint inflammation, pain, and stiffness, most often affecting the lumbar spine of the lower back and sacroiliac joints. Joint stiffness with ankylosing spondylitis typically worsens with lack of movement, especially upon waking in the morning. 

This article will discuss how ankylosing spondylitis causes morning stiffness and ways to treat your symptoms.

Man with morning stiffness sitting up in bed

Moyo Studio / Getty Images

What Is Morning Stiffness?

Morning stiffness is the joint stiffness that occurs when you wake up in the morning. Joint stiffness is when your joints lack the mobility to move smoothly through their full range of motion. When you have stiff joints, it can be difficult and sometimes painful to move parts of your body.

Joints, especially ones that are arthritic, can naturally stiffen up from a lack of movement. This stiffness is usually most common in the morning after sleeping for several hours throughout the night without moving your joints. 

If you are also experiencing severe joint pain, swelling, redness, fever, fatigue, dizziness, or nausea, seek emergency medical help or call 911 immediately.

Is Morning Stiffness a Symptom of Ankylosing Spondylitis?

As an inflammatory autoimmune condition, ankylosing spondylitis causes inflammation throughout the body when the body produces antibodies that attack its own joints by mistake. While the exact cause is not fully understood, genetics and environmental triggers influence the development of ankylosing spondylitis.

Ankylosing Spondylitis vs. Axial Spondylitis: What's the Difference?

You may hear ankylosing spondylitis also being referred to as axial spondylitis. "Axial spondylitis" is a general term that refers to inflammatory types of arthritis that affect the spine and pelvis, and ankylosing spondylitis is one type of axial spondylitis. 

This autoimmune-triggered inflammation causes joint pain and stiffness that worsens after periods of inactivity or lack of movement. Morning stiffness that lasts longer than 30 minutes and that improves with physical activity is a hallmark symptom of ankylosing spondylitis.

Treatments and Management of Morning Stiffness

Medication is one of the most important treatment options for managing joint pain and morning stiffness with ankylosing spondylitis. Disease-modifying antirheumatic drugs (DMARDs) and tumor necrosis factor (TNF) inhibitors are medications often prescribed for patients with ankylosing spondylitis and other autoimmune conditions to reduce joint pain and inflammation throughout the body.

These medications work by reducing the activity of your immune system, which helps to prevent your body from attacking its own joints.

Additional treatment options can be performed at home and can help manage your symptoms. These include:

  • Heat to loosen and relax tight muscles and stiff joints through the use of a heating pad or warm bath or shower
  • Gentle stretching to improve your flexibility, decrease joint stiffness, and improve your ability to move your joints
  • Regular exercise to keep your joints moving
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and corticosteroids to reduce pain and inflammation

When to See Your Healthcare Provider

If you have been experiencing ongoing morning stiffness, joint pain, and decreased range of motion that has been getting worse over time or has not gone away, contact your healthcare provider. Inflammatory autoimmune conditions like ankylosing spondylitis affect your joints and cause stiffness, especially morning stiffness, that gradually develops and worsens over time.

If you have stiff joints that become red, hot, swollen, and very painful, seek immediate medical attention. These are signs that you may have an infection or are experiencing a flare-up of ankylosing spondylitis. 

If you experience any of the following symptoms, call 911; these symptoms require emergency care:

  • Severe pain
  • Dizziness
  • Nausea
  • Fever
  • Radiating pain into the arms or legs
  • Numbness or tingling
  • Paralysis


Joint pain, inflammation, and stiffness most commonly affect the lower back and sacroiliac joints in people with ankylosing spondylitis. Symptoms, especially stiffness, often occur in the morning or after long periods of little movement.

Treatment for morning stiffness from ankylosing spondylitis involves taking disease-modifying antirheumatic drugs (DMARDs) and tumor necrosis factor (TNF) inhibitors to decrease joint inflammation. At-home methods like heat and regular stretching and exercise can also help.

A Word From Verywell

Joint stiffness from ankylosing spondylitis often worsens with inactivity, so regular movement and exercise can help alleviate some of your pain by reducing stiffness and muscle tightness. Consider consulting with a healthcare provider or physical therapist to provide you with exercises to reduce your joint stiffness and strengthen your muscles to support your joints. 

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Magrey MN, Danve AS, Ermann J, Walsh JA. Recognizing Axial Spondyloarthritis: A Guide for Primary Care. Mayo Clin Proc. 2020 Nov;95(11):2499-2508. doi: 10.1016/j.mayocp.2020.02.007

  3. Ward MM, Deodhar A, Gensler LS, Dubreuil M, Yu D, Khan MA, Haroon N, Borenstein D, Wang R, Biehl A, Fang MA, Louie G, Majithia V, Ng B, Bigham R, Pianin M, Shah AA, Sullivan N, Turgunbaev M, Oristaglio J, Turner A, Maksymowych WP, Caplan L. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Care Res (Hoboken). 2019 Oct;71(10):1285-1299. doi: 10.1002/acr.24025

By Kristen Gasnick, PT, DPT
Kristen Gasnick, PT, DPT, is a medical writer and a physical therapist at Holy Name Medical Center in New Jersey.