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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Partly. A doctor can recognise inflammatory back pain, arrange the first tests and a referral, and help with flares and pain relief; the diagnosis and biological medicines are led by a rheumatologist.
- What it is: a long-term inflammatory condition of the spine and of the joints where the spine meets the pelvis, one form of axial spondyloarthritis.
- Who gets it: it usually starts in the late teens or 20s, most people have symptoms before the age of 45, and it is more common in men.
- Typical sign: back pain and stiffness that are worse in the morning and after rest, can wake you in the second half of the night, and ease with movement.
- Emergency: call 112 or go to an emergency department for new severe neck or back pain after a fall or injury, or a painful red eye with reduced vision.
Do not book a video appointment if you have new severe neck or back pain after a fall or injury, especially with numbness, tingling or weakness in your arms or legs, a painful red eye with blurred or reduced vision, chest pain or difficulty breathing, or a hot, swollen joint with a fever. Call 112 or go to an emergency department.
Can an online doctor treat ankylosing spondylitis?
Partly. A doctor by video can tell whether your back pain has the inflammatory pattern of axial spondyloarthritis, using the same checklist specialists use, arrange blood tests and the right referral, and help you manage pain and flares with exercise and anti-inflammatory medicines. The diagnosis needs an X-ray or MRI scan and usually a rheumatologist, who also decides on biological medicines. If you already have a diagnosis, the doctor can help with flares, side effects and medicine questions, and checks first for the warning signs that need urgent care.
How an online consultation helps with ankylosing spondylitis
- Inflammatory back pain recognised: Pain that wakes you in the second half of the night and eases when you move points to a different cause from a strained back.
- The right tests and referral: Blood tests, including the HLA-B27 gene test when it helps, and a referral to a rheumatologist when your symptoms meet the criteria.
- Pain relief that suits you: Anti-inflammatory painkillers come first. The doctor checks your stomach, kidneys, heart and other medicines before suggesting one.
- Flares and eye problems: Help with flares in diagnosed ankylosing spondylitis, and clear direction for a red, painful eye that needs an eye specialist.
What the doctor checks in an online ankylosing spondylitis consultation
The doctor asks about the warning signs first, then about the pattern of your pain. The doctor asks about:
- Warning signs: new severe pain after a fall or injury, numbness or weakness in the arms or legs, a red, painful eye with blurred vision, chest pain, and a hot, swollen joint with a fever.
- The pattern of the pain: when it started, how long it has lasted, whether it wakes you in the second half of the night, and whether it eases with movement and gets worse with rest.
- Stiffness: how long it lasts in the morning; stiffness of 30 minutes or more is typical of inflammatory back pain.
- Other joints and tendons: pain or swelling in the hips, knees, ankles or shoulders, and pain where tendons attach to bone, such as at the back of the heel or under the foot.
- Linked conditions: psoriasis, Crohn’s disease or ulcerative colitis, earlier eye inflammation, and spondyloarthritis in a parent, brother, sister or child.
- What you have tried: whether anti-inflammatory painkillers eased the pain within 48 hours, and any blood tests or scans you have had.
Before the call, note when the pain is worst and how long your morning stiffness lasts on a typical day, and have any blood test or scan results to hand.
What is ankylosing spondylitis?
Ankylosing spondylitis (AS) is a long-term condition in which the spine and other parts of the body become inflamed. It most often affects the sacroiliac joints, where the base of the spine meets the pelvis, and the lower back. In severe cases, the bones of the spine slowly fuse, which makes the spine rigid.
Ankylosing spondylitis or axial spondyloarthritis?
Ankylosing spondylitis is one form of axial spondyloarthritis (axial SpA): the form in which changes to the spine and pelvis show on an X-ray. In non-radiographic axial spondyloarthritis, the symptoms are similar, but the changes do not show on an X-ray and can sometimes be seen on an MRI scan. Both usually start in teenagers and young adults.
Who gets it, and what causes it?
It usually starts in the late teens or 20s, and most people have their first symptoms before the age of 45. Men are more likely to have it than women. The cause is not known, but genes play a large part: more than 90% of people with ankylosing spondylitis carry a gene variant called HLA-B27. Many people with HLA-B27 never develop the condition, so a positive test does not confirm it on its own.
Having psoriasis, Crohn’s disease or ulcerative colitis, or a parent, brother, sister or child with spondyloarthritis, makes it more likely.
Is ankylosing spondylitis hereditary?
It can run in families. Children of a parent with ankylosing spondylitis have a small chance of developing it, and routine HLA-B27 testing of children is not recommended.
What are the symptoms of ankylosing spondylitis?
The three most common symptoms are back pain and stiffness, pain and swelling in other joints and where tendons attach to bone, and extreme tiredness. Symptoms usually develop gradually, over several months or years, and may come and go.
- Back pain and stiffness: usually in the lower back and buttocks, worse in the morning or after sitting or lying still, and better with exercise. It can wake you in the second half of the night.
- Pain and swelling in other joints: most often the hips, knees, ankles, ribs, shoulders and feet.
- Enthesitis: pain where a tendon or ligament attaches to bone, such as at the back of the heel or in the arch of the foot, which can feel like plantar fasciitis.
- Extreme tiredness: fatigue that does not improve with sleep or rest.
- A stiff chest: difficulty taking a deep breath when the joints of the ribs are affected.
- Eye inflammation (uveitis): a red, painful eye that is sensitive to light, sometimes with blurred vision.
- Other symptoms: loss of appetite and weight loss, skin rashes such as psoriasis, and tummy pain with loose poo.
What does ankylosing spondylitis pain feel like?
Most people describe an ache and stiffness in the lower back and buttocks that is worst when they get up or after sitting still, eases as they move about, and comes back with rest. Morning stiffness typically lasts 30 minutes or more, and neck pain is common as the condition goes on.
Flares and remission
Symptoms tend to come in flares, when pain and stiffness get worse for a while, followed by calmer spells. Some people improve over time, and others slowly get worse. Smoking makes the disease worse and makes treatment less effective.
See a doctor about diarrhoea that lasts more than 2 weeks, or bloody or slimy poo: inflammatory bowel disease is linked to ankylosing spondylitis, and the inflammatory bowel disease page explains it.
How is ankylosing spondylitis diagnosed?
There is no single test. A rheumatologist makes the diagnosis from your symptoms, an examination, blood tests and imaging. To decide who should see one, doctors use a checklist from NICE, the guideline body in England, for back pain that started before the age of 45 and has lasted more than 3 months:
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| Feature | Counts as |
|---|---|
| Back pain that started before the age of 35 | One feature |
| Waking in the second half of the night because of the pain | One feature |
| Pain in the buttocks | One feature |
| Pain that gets better with movement | One feature |
| Pain that gets better within 48 hours of an anti-inflammatory painkiller | One feature |
| A parent, brother, sister or child with spondyloarthritis | One feature |
| Arthritis, now or in the past | One feature |
| Enthesitis (inflamed tendon attachments), now or in the past | One feature |
| Psoriasis, now or in the past | One feature |
With 4 or more of these features, NICE advises referral to a rheumatologist. With 3, an HLA-B27 blood test is advised, and a positive result means referral. With fewer, the doctor explains which new symptoms mean you should be checked again.
The tests
- an X-ray of the sacroiliac joints, which shows the changes of ankylosing spondylitis
- an MRI scan of the spine and sacroiliac joints if the X-ray is normal, which can show inflammation that an X-ray misses
- blood tests for inflammation (CRP and ESR) and for HLA-B27; normal results do not rule spondyloarthritis out
Many people put up with the pain for some time before they ask about it, so the diagnosis is often delayed. If your back pain fits the pattern above, it is worth raising with a doctor.
Is ankylosing spondylitis serious?
The outlook varies a lot. Many people stay fully independent, while some become disabled when the bones of the spine fuse in a fixed position and other joints, such as the hips or knees, are damaged. With modern treatment, ankylosing spondylitis does not normally affect life expectancy significantly, but it is linked to a higher risk of some serious problems:
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| Complication | What happens | What to watch for |
|---|---|---|
| Uveitis | Inflammation inside the eye, one of the most common complications | A red, painful eye, light sensitivity or blurred vision: see an eye specialist promptly |
| Osteoporosis | Weaker bones | A broken bone after a minor fall |
| Spinal fractures | Weakened bones of the spine can break or collapse, and the break can press on the spinal cord or nerves | New severe neck or back pain after a fall or injury |
| Heart and blood vessels | Inflammation of the aorta and its valve, and a higher risk of heart disease | Chest pain or breathlessness |
| Breathing | Stiff rib joints limit how far the chest can expand | Breathlessness when you are active |
Regular reviews with your specialist team check for these problems, even when you feel well.
Which ankylosing spondylitis treatment might the doctor recommend?
What happens next depends on whether you have a diagnosis, how active the condition is and which medicines you have tried. This is the framework the doctors use:
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| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Back pain for more than 3 months that wakes you at night and eases with movement, no diagnosis | Checking it against the NICE checklist, blood tests, and an anti-inflammatory if it suits you | Yes, to assess | A rheumatologist and an X-ray or MRI scan if it fits |
| Diagnosed ankylosing spondylitis with a flare of pain and stiffness | Daily exercise, an anti-inflammatory if it suits you, and contact with your specialist team | Yes | If the flare does not settle, or new joints swell |
| Anti-inflammatories no longer controlling it | A review with your rheumatologist about biological medicines | Partly | For specialist assessment and the start of biological medicines |
| A red, painful eye that is sensitive to light | Prompt assessment by an eye specialist | No | Get medical advice the same day; call 112 if your vision is reduced |
| New severe neck or back pain after a fall or injury | Emergency assessment | No | Call 112 or go to an emergency department |
Could your back pain be inflammatory? A doctor can tell you in one consultation which tests make sense.
See available times →Treatment options for ankylosing spondylitis
There is no cure, and damage that has happened cannot be reversed, but treatment eases pain and stiffness and aims to slow the condition down. It usually combines exercise, physiotherapy and medicines.
What you can do yourself
- Exercise every day: stretching, swimming, Pilates, yoga and tai chi all help keep the spine flexible.
- Follow a structured exercise programme from a physiotherapist, with stretching, strengthening, posture and deep breathing exercises.
- Break up long spells of sitting with short movement breaks, at work and on long journeys.
- Stop smoking: it makes the disease worse, makes treatment less effective and can affect your lungs.
- Stop an exercise straight away if it causes pain or you feel unwell.
Prescription treatment
A prescription is never issued without a consultation. Anti-inflammatory painkillers (NSAIDs), such as ibuprofen, are the first medicine for ankylosing spondylitis, at the lowest dose that works. If the doctor prescribes one, the doctor checks your stomach, kidneys, heart, blood pressure and other medicines first, and may add a medicine to protect your stomach. If one anti-inflammatory does not help enough after 2 to 4 weeks, another can be tried. Biological medicines and other specialist treatments are started by your rheumatologist. If the doctor prescribes, use the prescription at a pharmacy near you.
Treatments from your specialist team
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| Treatment | What it is used for |
|---|---|
| TNF inhibitors (anti-TNF biological medicines) | Severe active disease that anti-inflammatories have not controlled or cannot be taken for; the response is checked after 12 weeks |
| IL-17 inhibitors, such as secukinumab | An option when anti-inflammatories, or a TNF inhibitor, have not worked |
| Sulfasalazine or methotrexate | Pain and swelling in the arms and legs rather than the spine; they can take weeks to months to work |
| Steroid injections | Short-term relief of a flare in a joint or tendon |
| Physiotherapy and hydrotherapy | Pain, stiffness, posture and the flexibility of the spine |
| Surgery | Uncommon: a hip or knee replacement for a badly damaged joint, or correcting a severe bend in the spine |
What does not help
Resting for long periods, which makes pain and stiffness worse. Stopping your exercises during a flare without advice. Smoking. Taking a normal blood test or a negative HLA-B27 test as proof that you do not have it.
Special situations
Pregnancy
If you are planning a pregnancy, talk to your specialist early: methotrexate needs to be stopped several months before trying to conceive, and biological medicines are generally stopped later in pregnancy. A stiff spine can sometimes rule out an epidural, so tell your maternity team.
Work and driving
Short movement breaks help at work, and so does avoiding long spells in one position. On long drives, stop regularly to walk about and stretch.
Travelling in Europe
Take enough of your medicines for the whole trip, and get up and move regularly on long flights and coach journeys. Other holiday health problems are covered on the travel illnesses page.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When ankylosing spondylitis is treated online, and when you need in-person care
Treated online: back pain that may be inflammatory, checking it against the referral checklist, blood tests and referral, anti-inflammatory medicines, flares in diagnosed ankylosing spondylitis, exercise and work advice, and medicine questions.
In-person care: diagnosis by a rheumatologist, X-rays and MRI scans, starting and monitoring biological medicines, physiotherapy, eye examinations for uveitis, and any warning sign.
When to get in-person care
Call 112 or go to an emergency department now for:
- new severe neck or back pain after a fall or injury, especially with numbness, tingling or weakness in the arms or legs
- a painful red eye with blurred or reduced vision
- chest pain, or difficulty breathing
- a hot, swollen joint with a fever or feeling very unwell
Get medical advice the same day for:
- a red, painful eye that is sensitive to light
- back pain with a fever, or weight loss you cannot explain
- a joint that suddenly becomes very painful and swollen
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about your back: describe when the pain is worst, how long the morning stiffness lasts and what eases it, and have any test results to hand.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s ankylosing spondylitis? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
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Similar symptoms, different condition? Back pain can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about ankylosing spondylitis
What is ankylosing spondylitis?
Ankylosing spondylitis is a long-term inflammatory condition that mainly affects the spine and the sacroiliac joints, where the spine meets the pelvis. It causes back pain and stiffness, and in severe cases the bones of the spine slowly fuse.
What are the first signs of ankylosing spondylitis?
The first signs of ankylosing spondylitis are back pain and stiffness that started before the age of 45, has lasted more than 3 months, is worse in the morning or after rest, wakes you in the second half of the night and eases with movement. Pain in the buttocks is common.
What are the three most common symptoms of ankylosing spondylitis?
The three most common symptoms of ankylosing spondylitis are back pain and stiffness, usually in the lower back and buttocks and worse in the morning or after rest; pain and swelling in other joints and where tendons attach to bone, such as the heel; and extreme tiredness. They usually develop gradually over months or years and can come and go.
What does ankylosing spondylitis pain feel like?
Ankylosing spondylitis pain is an ache and stiffness in the lower back and buttocks that is worst in the morning or after sitting still and eases as you move about. Morning stiffness typically lasts 30 minutes or more.
Is ankylosing spondylitis the same as axial spondyloarthritis?
Ankylosing spondylitis is one type of axial spondyloarthritis: the type in which changes in the spine and pelvis show on an X-ray. In non-radiographic axial spondyloarthritis, the changes do not show on an X-ray but can sometimes be seen on an MRI scan.
Is it ankylosing spondylitis or ordinary back pain?
Ordinary mechanical back pain is worse with activity and better with rest, comes on at any age and usually settles within 6 weeks. Ankylosing spondylitis does the opposite: the pain and stiffness are worse in the morning and after rest, improve with movement and exercise, wake you in the second half of the night, started before the age of 45 and have lasted more than 3 months. Buttock pain that switches sides, heel pain, a painful red eye or psoriasis strengthen the suspicion.
What causes ankylosing spondylitis?
The cause is not known. Genes play a large part: more than 90% of people with ankylosing spondylitis carry the HLA-B27 gene variant, but many people with HLA-B27 never develop it.
Is ankylosing spondylitis hereditary?
It can run in families, and having a parent, brother, sister or child with spondyloarthritis makes it more likely. Children of someone with ankylosing spondylitis have a small chance of developing it.
How is ankylosing spondylitis diagnosed?
Ankylosing spondylitis is diagnosed by a rheumatologist, from your symptoms, an examination, blood tests and imaging: an X-ray of the sacroiliac joints, and an MRI scan if the X-ray is normal. There is no single test, and normal blood tests do not rule it out.
Can ankylosing spondylitis be cured?
No, ankylosing spondylitis cannot be cured, and damage that has happened cannot be reversed, but daily exercise, physiotherapy, anti-inflammatory medicines and, when needed, biological medicines ease the symptoms and aim to slow it down.
What can I do myself about ankylosing spondylitis?
Exercise every day, because movement is the treatment that matters most in ankylosing spondylitis: stretching, back and posture exercises, swimming and walking keep the spine mobile, and a physiotherapist can set a programme. Stop smoking, which makes the disease progress faster; take breaks from sitting; use heat or a warm shower for morning stiffness; and take your anti-inflammatory as agreed. Keep an eye on your eyes, because a painful red eye can be uveitis and needs care without delay.
What is the life expectancy with ankylosing spondylitis?
With modern treatment, ankylosing spondylitis does not normally affect life expectancy significantly, but it raises the risk of some serious problems, such as osteoporosis, spinal fractures and heart disease, which is why regular reviews matter.
What is the outlook with ankylosing spondylitis?
Most people with ankylosing spondylitis keep working and stay active, especially when it is diagnosed early and treated with daily exercise and the right medicines; it does not shorten life for most, though it raises the risk of heart disease, osteoporosis and eye inflammation, so those are checked. The course varies: some people have mild symptoms that come and go for decades, others have flares and gradually stiffen, and a minority develop a fused, rigid spine, which modern biological medicines make less likely.
Is ankylosing spondylitis more common in men?
Yes. Men are more likely to have ankylosing spondylitis than women, and it usually starts in the late teens or 20s, before the age of 45.
Can ankylosing spondylitis be prevented?
No. Ankylosing spondylitis runs in families, and most people with it carry the HLA-B27 gene variant, so it cannot be prevented, but its progress can be slowed. Regular exercise and physiotherapy keep the spine moving, which is why ankylosing spondylitis stiffness improves with movement; stopping smoking matters, because smoking makes the disease worse, makes treatment less effective and can affect your lungs; and anti-inflammatory and biological medicines ease the symptoms and aim to slow it down. Stop an exercise straight away if it causes pain.
Can an online doctor help with ankylosing spondylitis?
Partly. A doctor by video can check whether your back pain fits the pattern of ankylosing spondylitis, arrange blood tests and a referral, prescribe an anti-inflammatory if it suits you, and help with flares; the diagnosis and biological medicines are led by a rheumatologist.
- Ankylosing spondylitis, NHS, National Health Service (UK), reviewed 5 January 2023.
- Spondyloarthritis in over 16s: diagnosis and management (NG65), National Institute for Health and Care Excellence (NICE), 2017.
- Ankylosing spondylitis (axial spondyloarthritis), Versus Arthritis (UK), accessed 15 October 2026.
- Ankylosing spondylitis: symptoms and causes, Mayo Clinic (US), 30 October 2025.
- Ankylosing spondylitis, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), US National Institutes of Health, accessed 15 October 2026.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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