What Is the Prognosis for Ankylosing Spondylitis?

Reviewed by: HU Medical Review Board | Last reviewed: March 2019 | Last updated: October 2021

Ankylosing spondylitis (AS) is a type of chronic, inflammatory arthritis that mainly affects the spine. It usually begins in the 20s or 30s with persistent lower back pain and stiffness. This pain is caused by inflammation of the sacroiliac joints, which are the joints between the pelvic bones and spine.1,2

The inflammation gradually spreads to the joints further up the spine, eventually causing the vertebrae to fuse together. This later stage of the disease drastically limits mobility and causes great pain.

How does ankylosing spondylitis progress?

It is hard to predict how AS will impact one person versus another because it varies so widely. However, the outcomes are generally better than people who develop other forms of inflammatory disease such as rheumatoid arthritis.3

Some people have a few mild symptoms. Their AS never progresses past the early stages of the disease and their pain and stiffness comes (flares) and goes (remission). Those with this mild form of the disease generally retain almost full functional capacity of their movements.

Others see their AS gradually get worse, with the pain and stiffness becoming more severe and more constant. These people develop a chronic, progressive form of AS and become disabled as the inflammation leads to spinal fusion.

In the more serious form of AS, the inflammation may also affect the neck and shoulders, ribs, hips, knees, arms, and feet; as well as the eyes (uveitis or iritis), and bowel (inflammatory bowel disease or colitis). Some people with AS develop osteoporosis (thinning of the bones). In very rare cases, the inflammation from AS can damage the heart valves and lung tissue.1,2

People who have had AS for a long time, or whose vertebrae have fused, are at increased risk of spinal fractures following a fall or car accident. Spinal fractures can cause nerve damage, so it’s important to watch for new tingling or weakness in your arms and legs after a fall.2

About 1 percent of people with AS enter long-term remission.1

Most functional loss occurs during the first 10 years of the illness.3

What we know

While your doctor may not be able to predict the exact course of your AS, there may be some indicators of whether you’ll have a more severe form of the disease.

For instance, the younger you develop AS, the more likely it will progress to a more severe stage more quickly. This is especially true of children and teens who develop AS.3

Other indicators of a poor outcome include:

  • If the hip is involved
  • If NSAIDs don’t work to control your pain
  • If there is limited mobility in your lumbar or lower spine
  • If you smoke cigarettes
  • If your ESR test is elevated
  • If other diseases such as psoriasis or IBD are also present

Men and women appear to have AS in equal rates, but men are more likely to develop a severe form of AS than women. Women with AS are more likely to develop depression than men.3

The good news

Stretching and physical activity can be especially helpful in easing the pain and prolonging your ability to do the things you want to do.

Most people with AS are able to continue working after they begin experiencing symptoms, though some vocational counseling may be necessary to help you adjust to your current abilities. Up to 37 percent change to less physically demanding jobs if their symptoms progress.3

The evidence is not entirely clear but there is some indication that some NSAIDs may slow progression of the disease in some people.4

Life expectancy for those with AS is the same as that of the general population, except for patients who have the most serious forms of the disease or in whom complications develop.5,6

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