What are the stages of ankylosing spondylitis, and when should people contact a doctor?

The Spondylitis Association of America notes that the most common early symptoms involve frequent stiffness and pain in the lower back and buttocks, which slowly manifest over the course of a few weeks or months. In the beginning, a person may only feel discomfort on one side or alternating sides. The pain is typically dull and affects a wider rather than a smaller area.

These symptoms tend to be worse in the morning and night, and they may lessen with exercise or a warm shower.

Other early symptoms include:

• general discomfort
• uveitis, which is inflammation of the middle layer of the eye wall
• loss of appetite
• occasionally, fever

There is no cureTrusted Source, but treatment may include physical therapy and medications.

Physical therapy can offer the following benefits:

• reduction in pain
• improvement in posture
• increased flexibility
• greater strength in back and neck muscles

Medications may include:

• nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil)
• biologic therapies, such as etanercept (Enbrel), which use a targeted approach to reduce inflammation
• steroid injections, such as methylprednisolone (A-Methapred, Depo-Medrol, SoluMEDROL), to provide short-term relief from flare-ups
• janus kinase (JAK) inhibitors, which are a type of disease-modifying antirheumatic drug, such as tofacitinib (Xeljanz) and upadacitinib (Rinvoq), to reduce inflammation when other treatments have not worked

The Spondylitis Association of America notes that over months or years, the pain may spread up the spine to the neck. Tenderness and pain can also spread to the shoulder blades, ribs, hips, thighs, and heels. Tiredness and mild to moderate anemia may develop.

Many people experience bowel inflammation. Other effects include iritis — which is inflammation of the iris, the colored part of the eye — and uveitis, which can occur at any stage of the ankylosing spondylitis. Symptoms of eye involvement are:

• painful, red, and watery eyes
• sensitivity to light
• blurred vision

The medications and physical therapy for the early stage are also appropriate for the progressive stage.

A distinguishingTrusted Source feature of the advanced stage is a fusion of the vertebrae, which are the bones in the spinal column. This causes progressive back stiffness. Other effects include impaired posture and breathing.

Complications of later stages include:

• chronic, or long-term, pain
• pulmonary fibrosis, which is a condition that causes lung damage and scarring
• mood disorders
• aortic regurgitation, which is the backward leaking of blood from the aorta — the main artery that receives blood from the heart
• cauda equina syndrome, which is damage to the nerve roots at the bottom of the spine, causing weakness, pain, and loss of bladder and bowel control

A person may also develop osteoporosis, a condition where bones lose minerals and weaken, notes an older 2016 review.Trusted Source This may lead to fractures.

Treatment can include medications and physical therapy that treat the early and progressive stages. People may needTrusted Source joint repair or replacement surgeries when severe joint damage is present.

In rare instances, surgery to repair fractures or straighten the spine will be necessary.

People should make an appointment with a doctor when they first start to notice symptoms of ankylosing spondylitis. If they have the condition, a doctor can provide a treatment plan for management.

Additionally, they need to notify a doctor if they experience alarming symptoms, such as:

• pain in the chest
• vision problems
• breathing difficulties

A variety of factors may affect progression, such as how a person responds to treatment and their general health.

The followingTrusted Source recommendations may make a difference:

• Exercising regularly: This helps maintain flexibility, preserve joint mobility, and increase muscle strength.
• Quitting smoking: The condition is more severe in people who smoke.
• Practicing good posture: Exercises to maintain and improve posture can help avoid some complications.
• Eating a balanced diet: This is beneficial for all individuals, so it may be very helpful for those with ankylosing spondylitis. Maintaining a moderate weight also decreases stress on painful joints.
• Using assistive devices: Using a cane or walker may reduce pain, as well as promote safety and stability.

Ankylosing spondylitis has three stages: Early, progressive, and late. The Spondylitis Association of America notes that the early stage most commonly starts with frequent pain and stiffness in the lower back and buttocks that slowly develops over weeks or months.

Over time, the inflammation and symptoms may spread up the spine and to other parts of the body. In the late stage, some vertebrae may fuse together, and a person can experience difficulty breathing.

Treatment of all stages may involveTrusted Source physical therapy and anti-inflammatory medications, but treatment options for the late stage include surgery. Some lifestyle practices, such as exercising and quitting smoking, may help slow progression speed.

The condition should be under a doctor’s care, so a person should make an appointment when they first notice symptoms.