The 3 Stages of Ankylosing Spondylitis

If you have ankylosing spondylitis (AS), then you understand how this condition can affect the way you move and function. The disease is chronic in nature, and once diagnosed, it can progress through different stages. The stages of ankylosing spondylitis, the rate of progression, and the prognosis of the disease are all different for each individual.

Ankylosing spondylitis is not a life-threatening disease, even though it is a progressive chronic condition with no known cure. Researchers also do not know what causes AS, but it mostly affects men who are middle-aged. It can cause certain problems that limit mobility and lead to other co-morbidities. By understanding the potential progression and stages of AS, you can do things to limit the effect that progressive AS has on your life.

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There are three stages of AS, and each stage has its own separate characteristics. People with AS progress to and through each stage at different rates. And while there is no cure for AS, there are things to do at certain times to ensure that you improve your chances at an excellent prognosis with AS.

Early Ankylosing Spondylitis

In the early stages of AS, you may experience mild back pain and stiffness. This usually starts very low in the back, near your sacroiliac joints. It may be on one or both sides, and it is typically better with movement.

It is a good idea to work closely with a rheumatologist in the early stages of ankylosing spondylitis. They can assess your condition and make treatment recommendations. Most people in the early stages of AS benefit from controlling the inflammation with over-the-counter (OTC) anti-inflammatory medications such as naproxen or ibuprofen.

Exercise Can Help With Symptoms

Exercise is important in all stages of ankylosing spondylitis, and starting an exercise program for your condition is key in the early stages. Working with a physical therapist may be beneficial, as they can set up an exercise program tailored specifically to your needs.

Progressing Ankylosing Spondylitis

As ankylosing spondylitis progresses, you may experience more pain and stiffness on both sides of your spine that extends up toward your mid back and neck. Stiffness and achy pain may limit your movement, and you may find it difficult to keep an upright posture due to pain and stiffness.

During this stage, the inflammation from AS may affect other body systems. Your eyes may suffer from inflammation or uveitis. Symptoms may include:

  • Eye redness
  • Sensitivity to light
  • Blurred vision
  • Pain in the eye or eyes

Your digestive tract may become irritated as a result of chronic inflammation due to AS. Your kidneys or liver may also be irritated from taking anti-inflammatory medication. If this happens, or if the medication becomes less effective at managing your symptoms, your rheumatologist may switch medicines and prescribe a biologic medicine.

Biologics for AS

Biologics are often used to manage your ankylosing spondylitis condition, and they may help offer protection from damage to your joints. Joint damage cannot be undone in AS, so protecting the joints should be a priority.

Common biologic medicines include tumor necrosis factor inhibitors (TNFi) like Enbrel (etanercept) and Humira (adalimumab). If those are not effective, a biologic called IL-17 inhibitors may be prescribed. The most important component of successful management is finding the best medication for your condition and remaining active as the disease progresses.

Advanced Ankylosing Spondylitis

If your ankylosing spondylitis progresses, it may become an advanced form of the disease process. During advanced AS, your spinal motion becomes severely limited by fusing of the joints of your spine. Bony growth appears between the joints, limiting mobility and causing spinal pain.

Complications of advanced AS include:

  • Issues with posture: As your spine slowly fuses during advanced AS, you may notice your posture becoming more rounded forward. Physical therapy may help you attain and maintain proper posture as this occurs.
  • Osteoporosis and spinal fractures: People with advanced AS may be more likely to suffer from osteoporosis. This may lead to spinal fractures, so having a yearly DEXA scan may be a good idea to assess your bone health.
  • Rib pain and breathing and cardiac issues: Advanced AS may also cause scarring and changes to your ribs, affecting the way they move during respiration. Some people with advanced AS experience breathing problems and work with a respiratory therapist to maintain appropriate respiration. Cardiac function may also be compromised.

Working closely with your rheumatologist is important during advanced AS. Medication may need to be adjusted, and you may need to find ways to appropriately manage the pain that may come with disease progression. The main goals of treatment are to maintain joint and spinal health, prevent serious complications of AS, and ensure you are able to continue functioning as much as possible.


Progression of ankylosing spondylitis is likely to happen over time. You can expect to feel spinal pain extending from your low back and up into your neck as the disease progresses. Continuing an exercise program for spinal and cardiorespiratory health is important, and learning to attain and maintain proper upright posture can help keep your spine in an optimum position as it fuses.

Keep in mind that everyone with AS progresses through the disease differently, so be sure to follow your doctor's advice in regard to activity modification, medication, and exercise. And progression does not necessarily happen in a linear fashion; some people have periods of worsening symptoms followed by months or years of stability and no progression.

Some factors in disease progression can be controlled; others are beyond your control to prevent the progression of AS.

Factors Affecting Progression

There are different factors that may affect the speed and amount of progression of ankylosing spondylitis. These may include:

  • Age at onset: People who are diagnosed with AS earlier tend to progress more rapidly with the disease and have a worse prognosis.
  • Sex: Men are more likely than women to have AS, and their outcomes tend to be worse overall.
  • Whether other joints are involved: Research indicates that if your hip joints become inflamed and stiff due to AS, you are likely to have a more rapid progression with the disease and, therefore, a less favorable prognosis.
  • Genetics: There is a genetic component to ankylosing spondylitis, and people with family members with an advanced progression tend to also experience an advanced progression.
  • Response to medication: If your body's response to biologic medication is positive, then the progression of AS and your overall prognosis may be more favorable.
  • Inflammation levels: People with higher blood inflammation markers at the onset of AS tend to have a worse prognosis.

Everyone is different, and everyone experiences ankylosing spondylitis differently. By working closely with your healthcare team and by staying on track with your medication and exercise program, you may be able to have a more favorable outcome with a less rapid or severe progression of the disease.


Ankylosing spondylitis is a progressive disease that causes gradual stiffening and fusing of your spinal joints. While the disease is not fatal, it can be painful and may limit your normal functional activity.

Progression of ankylosing spondylitis occurs differently for different people. Understanding its progression—and what you can do to minimize the effects of progression—can help you to reduce pain and maintain function as you age.

A Word From Verywell

If you have ankylosing spondylitis, you may feel like things are hopeless and that your spine will painfully fuse, limiting your mobility. However, favorable outcomes are very possible if you are able to exercise and manage your pain, and if you respond well to certain medications.

While there is no permanent cure for AS, there are ways to limit its effect on you and to reduce the deterioration of your spinal joints. That way, you can be sure to have a favorable outcome and enjoy years of active living.

Frequently Asked Questions

  • Is ankylosing spondylitis fatal?

    Ankylosing spondylitis is not a fatal condition. It may be progressive, and rapid progression of the disease may limit normal movement and breathing ability.

  • How can I prevent ankylosing spondylitis?

    There is no way to prevent ankylosing spondylitis, as it is an autoimmune disease. However, you can do things to minimize the effects of AS if you have it.

  • How fast does ankylosing spondylitis progress?

    Ankylosing spondylitis progresses at different rates for each person. A younger age of onset typically, but not always, means a more rapid progression of the disease.

4 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.
  1. Akassou A, Bakri Y. Does HLA-B27 status influence ankylosing spondylitis phenotype?. Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544117751627. doi:10.1177/1179544117751627

  2. Watad A, Bridgewood C, Russell T, Marzo-Ortega H, Cuthbert R, McGonagle D. The early phases of ankylosing spondylitis: emerging insights from clinical and basic scienceFront Immunol. 2018;9:2668. doi:10.3389/fimmu.2018.02668

  3. Haroon NN, Paterson JM, Li P, Inman RD, Haroon N. Patients with ankylosing spondylitis have increased cardiovascular and cerebrovascular mortality: a population-based studyAnn Intern Med. 2015;163(6):409-416. doi:10.7326/M14-2470

  4. Sari I, Lee S, Tomlinson G, Johnson SR, Inman RD, Haroon N. Factors predictive of radiographic progression in ankylosing spondylitisArthritis Care Res. 2021;73(2):275-281. doi:10.1002/acr.24104

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.