Ankylosing Spondylitis Prognosis
Understanding how chronic AS affects quality of life
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Medically reviewed by David Ozeri, MD
Ankylosing spondylitis is a chronic form of arthritis. The disease causes joint pain and stiffness mostly in the spine though it can also affect other areas of your body.
The course of disease progression and its impact vary from person to person. Predicting the way this disease will advance after it begins can prove difficult. For most people, early diagnosis and treatment can help improve disease symptoms and slow the damage it causes.
Knowing how the disease progresses and the effects it may have on your body can help you plan for the changes that may occur. It can also help you feel more in control of your disease and the effect it has on your body.
This article describes how the disease progresses and the impact it can have on your quality of life.
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AS Progression: Everyone Is Different
Though about 1.7 million U.S. adults share a diagnosis of ankylosing spondylitis, it's likely that no two people experience the same disease course. Ankylosing spondylitis affects everyone differently, even when it occurs among members of the same family.
Because the causes of ankylosing spondylitis are not fully understood, your healthcare provider may find predicting an exact prognosis difficult. A prognosis is an educated prediction about the course or outcome of your disease, as well as the chances of recurrence or recovery.
Early signs of ankylosing spondylitis often involve back pain and stiffness. Some people have success in relieving symptoms and slowing disease progression to the state of remission with treatment. Others experience more active progression that leads to chronic pain and progressive damage that causes disability over time.
Researchers who observed a cohort of patients with ankylosing spondylitis over time concluded that the following factors contributed to a high risk of disease progression:
Male sex
Baseline damage
Active disease state
Higher inflammatory biomarkers in blood tests
HLA-B27 positivity (this suggests a greater-than-average risk for developing or having certain autoimmune disorders, like ankylosing spondylitis)
Learn More:Ankylosing Spondylitis
Time of Diagnosis
Research shows that a delay of five to 10 years to get an accurate diagnosis of ankylosing spondylitis from the onset of symptoms is relatively common for patients. This is because imaging results often do not show signs of ankylosing spondylitis, such as changes in the spine, in the early stages of the disease. Insufficient awareness of ankylosing spondylitis among primary care providers may also contribute to this delay.
Early diagnosis of ankylosing spondylitis can ensure that you can take advantage of early and timely initiation of treatments. Research indicates that treatment is enhanced in the early stages of the disease, and treatment at this stage may help slow the rate of progression. The greater the delay in diagnosing and treating the disease, the more likely it progresses to the point that damage advances and turns up in imaging studies.
Learn More:How Ankylosing Spondylitis Is Diagnosed
Tumor Necrosis Factor (TNF) Inhibitors
When patients with ankylosing spondylitis were observed over time, data suggested that treatment with a tumor necrosis factor (TNF) inhibitor slowed the rate of disease detectable on X-rays in the patients observed. TNF inhibitors reduce inflammation by targeting a substance called tumor necrosis factor, which causes inflammation.
Data showed that the patients who took TNF inhibitors had far less disease progression compared to those who did not take the TNF inhibitors. Researchers concluded that the data showed that TNF inhibitor therapy helped limit disease progression.
The benefits of TNF inhibitors may also extend past the period of dosage. In a comparative study, researchers in Spain reported that patients in remission for at least six months who took reduced-dose TNF inhibitors maintained the same level of low disease activity as those who continued to take the standard dosage.
TNF inhibitors for treating ankylosing spondylitis include:
Learn More:How Are Enbrel, Remicade, and Humira Different?
Changes to Anticipate, Keep in Mind, and Evaluate
Understanding how ankylosing spondylitis affects your body can allow you to monitor common symptoms of the disease. This can help you know the changes to anticipate and track. The information is important to share with your healthcare provider so they can adjust your treatment plan to accommodate changes as they occur.
Though the disease progresses differently in everyone, some common symptoms of ankylosing spondylitis include:
Lower back and/or hip pain
Joint pain that worsens during periods of inactivity
Difficulty taking a deep breath as a result of affected joints that connect the ribs
Pain and stiffness in your ribs, shoulder, knees, and other joints
Eye pain and inflammation of the eye
Skin rashes
Unexplained weight loss and loss of appetite
Loose bowel movements and/or abdominal pain
You may or may not have all of these symptoms, and the symptoms that you experience can vary from mild to extreme based on your unique disease course.
Learn More:Symptoms of Ankylosing Spondylitis
Mobility Needs
Research suggests that ankylosing spondylitis can change your mobility needs. In a study that examined the course of impaired spinal mobility in patients with long-standing ankylosing spondylitis, the data suggest that impaired spinal mobility is common in people who have had the disease for 10 years.
Ankylosing spondylitis changes mobility because of the tendency of ligaments to form scar tissue and new bone tissue in reaction to inflammation. Bony overgrowth that leads to the fusion of one spinal vertebra to the one above or below it may then follow the scar tissue. As the vertebrae fuse, the spine stiffens, and you may experience a gradual loss of spinal mobility.
Changes in your mobility needs are a sign of disease progression, which you should communicate to your healthcare provider the moment you notice them so that they can modify your treatment plan.
Vision Changes
The eye ranks as the organ most often affected by ankylosing spondylitis. Regular checkups with a healthcare provider can help you recognize the early signs of vision damage to avoid permanent vision damage.
Research indicates the prevalence of uveitis. Inflammation that occurs in the center of the eye may occur in as many as 33% of people with ankylosing spondylitis. Without treatment, the condition can damage normal vision and possibly lead to blindness.
Symptoms of uveitis in ankylosing spondylitis can include the following changes:
Learn More:How Does Ankylosing Spondylitis Affect the Eyes?
The Impact of Chronic Pain on Mental Health
Ankylosing spondylitis can cause chronic pain that begins in early adulthood. The physical effects of this type of pain can impact your daily life and your ability to function normally. The result of living with chronic pain can also harm your mental health.
Living with chronic pain can increase your risk of developing depression. Research indicates that between 30% and 45% of patients with chronic pain experience depression.
Though calculations regarding the impact of ankylosing spondylitis on mental health vary widely, the highest estimates indicate that people with ankylosing spondylitis have a 51% higher risk of depression than the general population.
Research suggests that the degree of mastery, which is the degree of control you feel you have over your life and disease, is important in your risk of developing depression. Feeling that you have little control over your circumstances can increase your risk of depression. The following characteristics are also linked with a higher rate of depression among people with ankylosing spondylitis:
Higher functional impairment
Higher disease activity
Delay in disease diagnosis from the onset of symptoms
Co-occurring condition(s) such as cardiovascular disease
Learn More:The Link Between Depression and Chronic Pain
Co-Occurring Conditions
Though everyone's experience with ankylosing spondylitis is unique, it is not considered a health problem. There is no difference between the life expectancies of those with ankylosing spondylitis and those of the general population.
However, a diagnosis of ankylosing spondylitis increases your risk of several co-occurring conditions because it is a systemic disease. A system disease can affect your entire body and trigger other conditions that can impact your overall well-being.
Your disease course and your risk of developing these other conditions are affected by many factors including your age, general health, and family history.
Common co-occurring conditions with ankylosing spondylitis include:
Spinal problems: Ankylosing spondylitis affects the joints and bones in your spine. Spinal fractures, kyphosis (curvature of the spine), and spinal stenosis (narrowing of the spinal column) can occur as a result of this damage.
Osteopenia and osteoporosis: Osteopenia and osteoporosis often occur in people with ankylosing spondylitis. In a study of 204 Swedish patients with ankylosing spondylitis, these conditions together affected 50% of the study population. In a comparative study of people with ankylosing spondylitis and a disease-free group, researchers observed osteoporosis in 27% of people with ankylosing spondylitis, while 47% had osteopenia, and 26% had normal values of bone mineral density. Among the control group, 2.66% had osteoporosis, 29.33% had osteopenia, and 68% of patients had normal values of bone mineral density.
Inflammatory bowel disease (IBD): Research suggests that there is a link between gut health, specifically inflammatory bowel disease (IBD), and ankylosing spondylitis. Studies show that up to 10% of people with ankylosing spondylitis develop Crohn's disease or another form of inflammatory bowel disease within 20 years of their diagnosis. Even without gastrointestinal symptoms, 60% of the people with ankylosing spondylitis have some level of detectable gut inflammation.
Psoriasis: About 10% of people with ankylosing spondylitis develop psoriasis. Both are autoimmune diseases that are similar in the way they trigger your immune system to attack healthy tissues. With ankylosing spondylitis, your immune system attacks your spine. With psoriasis, the immune system attacks your skin cells.
Cardiovascular problems: People with ankylosing spondylitis have an increased risk of cardiovascular mortality which includes a twofold higher prevalence of ischemic heart disease, also called coronary artery disease, than controls in the general population. Though the link is unclear, inflammation and the effects of anti-TNF medications may have an impact on this increased risk of cardiovascular problems.
Lung problems: Ankylosing spondylitis can cause trouble breathing when your body curves forward and the disease stiffens the chest wall, preventing full expansion of your chest when you breathe. The disease can also cause an increased risk of lung infection and pulmonary fibrosis, which is scarring in the lungs.
Heart problems: Specifically aortitis (inflammation of the aorta) and aortic regurgitation (leaky valve).
Though ankylosing spondylitis affects everyone differently, there are consistent differences between the way men and women experience this disease. Women typically have the following symptoms, which occur less often in men:
Increased fatigue
More pain at night
Increased stiffness
Enthesitis (inflammation of the connective tissue where ligaments and tendons attach to bones)
Women are also more likely to experience systemic conditions linked with ankylosing spondylitis, such as the following:
Inflammatory bowel disease
Psoriasis
Uveitis
Living Well With Ankylosing Spondylitis
A 2022 study of how lifestyle factors affected patients with spondyloarthritis suggested that a healthy lifestyle can contribute to improved outcomes among people with ankylosing spondylitis. Outcomes that included higher disease activity, worse physical pain, more intense pain and fatigue, and lower quality of life were more common among people who had two or more unhealthy lifestyle factors.
The following strategies can help you maintain a healthy lifestyle with ankylosing spondylitis:
Help decrease inflammation and maintain a healthy weight by consuming a healthy diet.
Practice yoga, meditation, or other relaxation techniques to manage stress.
Eat more foods that are high in antioxidants, like fruits and vegetables.
Avoid highly processed foods and food that contain high amounts of sugar, fat, and salt.
Limit alcohol consumption and quit smoking because these habits are linked with more severe disease activity.
Movement can help you maintain mobility and counter some of the effects of ankylosing spondylitis. Regular exercise can provide the following benefits for people with this disease:
Improve posture
Help reduce pain
Improve spinal mobility
Enhance flexibility
Improve physical functioning
Expand breathing capacity
The Spondylitis Association of America recommends that your exercise routine includes the following types of movement in your workout:
Aerobic or cardiovascular
Balance
Strengthening
Stretching or range of motion
Summary
Ankylosing spondylitis varies in its effects from person to person. Joint pain and stiffness often begin in the spine, but the disease can also impact other areas of your body.
It is hard to know how the disease will affect your physical and mental well-being. Early diagnosis and treatment are key to getting the best results. Early treatment can also improve your chances of reducing symptoms and stalling symptoms of the disease.
Knowing common symptoms and how they can change can help you monitor disease progression. It can also help you modify treatment early to avoid damage before it starts. From a mental health perspective, feeling you have some control over the course of your disease can help offset the risk of depression.
Frequently Asked Questions
How often does ankylosing spondylitis stop progressing?
Ankylosing spondylitis can stop progressing as a result of natural causes or medication, though it is not always possible. A study of people with ankylosing spondylitis found that structural progression was not evident in 25% of patients over a two-year period, though progression was unpredictable. Other research indicates that 20–50% of people with ankylosing spondylitis have some degree of disease progression in the spine over a period of two years.
Do patients with ankylosing spondylitis qualify for disability?
Ankylosing spondylitis is considered a disability by the Social Security Administration (SSA). However, to receive benefits, you must meet the strict criteria for disability defined by the organization. Generally, these criteria require that you are unable to work as a result of a medical condition.
What makes ankylosing spondylitis painful?
Much of the pain in ankylosing spondylitis results from inflammation of the sacroiliac joints. These joints sit between your pelvic bones and the base of your spine. When these joints become inflamed, they cause swelling and activate nerves in the joints. As the disease progresses, it can move up the spine, eventually fusing the bones of the spine, making it rigid and inflexible.
