Arthritis Ankylosing Spondylitis Ankylosing Spondylitis Guide Ankylosing Spondylitis Guide Overview Symptoms Causes Diagnosis Treatment Coping Living Well With Ankylosing Spondylitis A multi-faceted approach to living with AS By Colleen Doherty, MD Colleen Doherty, MD Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis. Learn about our editorial process Updated on July 15, 2021 Medically reviewed by David Ozeri, MD Medically reviewed by David Ozeri, MD LinkedIn David Ozeri, MD, is a board-certified rheumatologist. He is based in Tel Aviv, Israel, where he does research at Sheba Medical Center. Previously, he practiced at New York-Presbyterian Hospital. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Emotional Physical Social Practical Frequently Asked Questions Next in Ankylosing Spondylitis Guide What Is Ankylosing Spondylitis? Ankylosing spondylitis (AS) is more than just arthritis. It is a chronic, inflammatory disease of the spinal joints and other joints, like the shoulders, hips, and knees. Ankylosing spondylitis may create further havoc in the body by causing fatigue, eye pain, and even heart or lung problems. Despite the complexity and whole-body involvement of AS, you can live well with this disease—it may require some preparation and resiliency, but it can be done by taking it one step and one day at a time. Sofie Delauw / Getty Images Emotional The pain experienced by those with ankylosing spondylitis has psychological consequences, commonly causing feelings of helplessness, fear, anxiety, and sadness. These are normal human responses to a difficult situation, and it's OK to feel however you feel. However, if you think your feelings are negatively affecting you, you may want to find additional ways to cope. Watch for signs of clinical depression. Depression is more common in people with AS than it is among the general public. If you have stopped enjoying activities you once found pleasurable or are feeling sad every day, it's best to contact a healthcare professional. Depression is a very real disease and can be treated with an antidepressant and/or talk therapy. Even if you are feeling a little down, it never hurts to reach out to others to connect. Remember to keep doing the activities that give you pleasure and enjoyment. Physical Exercise Exercise is a critical part of the treatment of ankylosing spondylitis. Your healthcare provider or your physical therapist can show you safe exercises that will increase your strength, flexibility, and mobility. Exercises to help improve your posture can also lessen the possible long-term complications of the disease. Gentle exercises like walking and swimming can be particularly beneficial for those with AS. In general, exercise will help lessen the disease's impact on your life, and it may improve your mood as well. Alcohol Use Some evidence suggests that excessive alcohol use may worsen disease symptoms in AS. For optimum functionality (and for your overall health), don't drink to excess. Smoking Cessation Research shows that smoking is linked to a worse disease state, meaning more AS-related pain and inflammation. It is critical for people with AS to quit smoking. In people with AS, smoking is also linked to reduced functioning in everyday life, as well as a poorer quality of life—and this is regardless of how long a person has had AS, their age, or their gender. In addition, ankylosing spondylitis is linked to disease complications like heart and lung problems. Of course, smoking too can negatively affect the heart and lung (regardless of whether a person has AS). This is a double-risk, so stopping smoking is really in your best interest. When you are ready, speak with your healthcare provider about the best strategy for you to stop smoking. The good news is that there are a number of ways to quit (such as medications or counseling), and often a combination of them works the best. Diet and Weight Maintaining a healthy weight is also important if you have AS. Extra pounds can put additional strain on your joints. You can attain a normal weight through calorie control, daily exercise (which will also help maintain spine mobility), and a nutritious diet. Try to make losing or maintaining your weight a family or partner affair, so the focus is on living healthily and feeling well overall. Social It can be very helpful to reach out to others when dealing with AS. It’s important not to let the stress of the disease make you feel isolated and alone. Non-profit groups like the Spondylitis Association of America can be a powerful way to connect with others who are successfully dealing with the condition. Both online and in-person AS support groups are available. Sharing your experience with others can be a great source of both practical information and emotional strength. Try to communicate directly and clearly with your friends and family members about your condition. Especially when you are having a disease flare, you may need more support. Let people know your limitations, and don’t be afraid to ask for help. Practical You can take practical steps in coping with ankylosing spondylitis. While most people with the condition continue to work, some may qualify for Social Security disability benefits. Finding the Right Health Team If you have ankylosing spondylitis, it is important to work with a healthcare team that has experience with your form of arthritis. The first step is finding a rheumatologist—a medical professional who specializes in diseases of the joints and muscles. Even among rheumatologists, some tend to focus on specific diseases. Be sure to find a rheumatologist who has experience seeing patients with ankylosing spondylitis. Be assured that it is okay to seek out second opinions or change therapists (or healthcare providers). The doctor-patient relationship and the therapist-patient relationship is a two-way street, meaning that both parties have to feel comfortable and at ease. A healing, trusting partnership is vital to your AS and overall health. Ankylosing Spondylitis Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. Preparing for Flares Like many other chronic illnesses, people with AS experience flares or worsening of their symptoms, notably back pain or other joint pain that can limit functioning. Having a plan in place on what to do when you or your loved one's pain flares can reduce any unnecessary panic. This plan may include an ordered list of medications you should take to alleviate the pain—including dosages, how long you should wait between dosing, the maximum dosage allowed for that medication, and side effects to watch out for. The plan may also include reminders about when to use a hot versus cold pack on your area of pain, as well as exercises or stretches you should engage in or avoid during a flare. A list of warning signs that warrant a phone call to your healthcare provider is also good to include. It's also best to plan ahead of time how to manage daily activities like work tasks, driving, or chores. Consider asking a friend or family member to assist you when you are experiencing a flare. This way you can focus on healing and easing your discomfort, without worrying about life's everyday stresses. Frequently Asked Questions What type of exercise is helpful for ankylosing spondylitis? According to the Spondylitis Association of America, four types of exercises are beneficial for AS: stretching and range of motion; cardiovascular; strengthening; and balance. Breathing exercises are also often recommended to help keep rib joints flexible. What should I do during an ankylosing spondylitis flare-up? First, be gentle with yourself: Being uncomfortable or in pain can be emotionally taxing. Alternating between periods of rest and gentle physical activity, such as stretching, is a good next step. Taking an NSAID recommended by your healthcare provider and using heat or ice packs can help reduce pain and provide comfort. In severe flares, steroid medications may also be an option. What kinds of changes make daily living with ankylosing spondylitis easier? Consider starting your day slowly and incorporating a few minutes of gentle stretching into your wake-up routine. Throughout the day, modify activities where you can—for example, use assistive devices for reaching out-of-the-way spots or for cleaning. Most importantly, remember to slow down, because stress has been linked to flares. How Is AS Treated? 7 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. Millner JR, Barron JS, Beinke KM, et al. Exercise for ankylosing spondylitis: An evidence-based consensus statement. Semin Arthritis Rheum. 2016;45(4):411-27. doi:10.1016/j.semarthrit.2015.08.003 Zhang S, Li Y, Xu X, Feng X, Yang D, Lin G. Effect of cigarette smoking and alcohol consumption on disease activity and physical functioning in ankylosing spondylitis: a cross-sectional study. Int J Clin Exp Med. 2015;8(8):13919-27. Willock S. An Evidence Based Smoking Cessation Project in Patients Admitted to an In-patient Alcohol and Drug Treatment Rehabilitation Program. Journal of Healthcare Communications. 2017;02(04). doi:10.4172/2472-1654.100087 Maas F, Arends S, Van der veer E, et al. Obesity Is Common in Axial Spondyloarthritis and Is Associated with Poor Clinical Outcome. J Rheumatol. 2016;43(2):383-7. doi:10.3899/jrheum.150648 Spondylitis Association of America. Exercise. CreakyJoints, Global Healthy Living Foundation. Ankylosing spondylitis flares: Exactly what to do when you have one. Luo G, et al. Abrupt and Unexpected Stressful Life Events Are Followed with Increased Disease Activity in Spondyloarthritis: A Two Years Web-Based Cohort Study. Joint Bone Spine. 2019 Mar;86(2):203-209. doi:10.1016/j.jbspin.2018.05.009 Additional Reading Bagcivan G, Cinar F, Cinar M, et al. Living with pain in ankylosing spondylitis: a qualitative study. Contemp Nurse. 2015;51(2-3):135-47. DOI: 10.1080/10376178.2016.1157028 Chatfield SM et al. Complementary and alternative medicines in ankylosing spondylitis: a cross-sectional study. Clin Rheumatol. 2009;(2):213-7. DOI: 10.1007/s10067-008-1029-3 Mattey DL, Dawson SR, Healey EL, Packham JC. Relationship between smoking and patient-reported measures of disease outcome in ankylosing spondylitis. J Rheumatol. 2011;38(12):2608-15. DOI: 10.3899/jrheum.110641 By Colleen Doherty, MD Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit