Ankylosing spondylitis is a long-term inflammatory arthritis that mainly affects the sacroiliac joints at the base of the spine and the spine itself. Doctors now use the broader term axial spondyloarthritis, which includes people whose X-rays are still normal.
It usually starts before the age of 40 and is often mistaken for ordinary back strain for years. Untreated inflammation can lead to new bone forming between vertebrae and a stiff, stooped spine, which modern treatment aims to prevent.
Symptoms
- Low back and buttock pain lasting more than three months
- Morning stiffness lasting over 30 minutes that eases with movement
- Pain that wakes you in the second half of the night
- Buttock pain that switches sides
- Heel pain or other tendon insertion pain
- A painful red eye sensitive to light (uveitis)
- Fatigue, and reduced chest expansion in later disease
Causes and risk factors
The cause is an overactive immune response in people with a genetic tendency. Most patients carry the HLA-B27 gene, but so do many healthy people, so the gene alone does not make the diagnosis. The condition is linked with psoriasis, Crohn's disease, ulcerative colitis and uveitis, and these often run in the same families. Smoking is associated with faster spinal damage. It is not caused by posture, lifting or injury.
How it is diagnosed
- Clinical history: The pattern of inflammatory back pain, its age of onset and the response to anti-inflammatory drugs carry most weight.
- Blood tests: HLA-B27, CRP and ESR support the diagnosis but can all be normal.
- X-ray of the pelvis: Shows established sacroiliac joint damage, which may take years to appear.
- MRI of the sacroiliac joints: Detects active inflammation early, before X-ray changes, and is the key test in younger patients.
Treatment options
- Exercise and physiotherapy: Daily stretching, posture work and swimming are core treatment at every stage, not an optional extra.
- Anti-inflammatory drugs: NSAIDs at a full dose are the first medicine and help most people.
- Biologic therapy: Anti-TNF or IL-17 inhibitor injections are used when NSAIDs are not enough. They need screening for tuberculosis and hepatitis first.
- JAK inhibitors: Tablets used in selected patients when biologics fail or are unsuitable.
- Surgery: Hip replacement for a destroyed hip is fairly common. Corrective spinal surgery is rare and reserved for severe fixed deformity.
When it is urgent
A person with a stiff, fused spine can fracture it after a minor fall. New severe neck or back pain after any trauma, weakness, numbness, or loss of bladder control needs emergency imaging locally. A painful red eye with blurred vision needs an eye doctor the same day.
Travelling to Türkiye for treatment
Ankylosing spondylitis is managed over decades, so your rheumatologist at home remains the centre of care. A visit abroad is sensible for a focused diagnostic work-up if you have waited years for an answer, for a second opinion on biologic treatment, or for a planned hip replacement. Biologic drugs need continuous supply and monitoring, so confirm that your home system will prescribe what is recommended before you start.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
الأسئلة المتكررة
Will my spine definitely fuse?
No. Many people never develop fusion, particularly with early treatment, regular exercise and not smoking.
Is HLA-B27 positive the same as having the disease?
No. Only a small minority of people with the gene ever develop it.
Can I stop biologics once I feel well?
Stopping usually leads to relapse within months. Dose spacing is sometimes possible under supervision.
Does it affect pregnancy?
Most women do well. Some medicines need changing beforehand, so plan with your rheumatologist.