Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the small bones in your spine (vertebrae) to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. If ribs are affected, it can be difficult to breathe deeply. Ankylosing spondylitis affects men more often than women. Signs and symptoms typically begin in early adulthood. Inflammation also can occur in other parts of your body — most commonly, your eyes. There is no cure for ankylosing spondylitis, but treatments can lessen your symptoms and possibly slow progression of the disease. Symptoms Early signs and symptoms of ankylosing spondylitis might include pain and stiffness in your lower back and hips, especially in the morning and after periods of inactivity. Neck pain and fatigue also are common. Over time, symptoms might worsen, improve or stop at irregular intervals. The areas most commonly affected are: 1. The joint between the base of your spine and your pelvis 2. The vertebrae in your lower back 3. The places where your tendons and ligaments attach to bones, mainly in your spine, but sometimes along the back of your heel 4. The cartilage between your breastbone and ribs 5. Your hip and shoulder joints Causes Ankylosing spondylitis has no known specific cause, though genetic factors seem to be involved. In particular, people who have a gene called HLA-B27 are at a greatly increased risk of developing ankylosing spondylitis. However, only some people with the gene develop the condition. Risk factors 1 Gender. Men are more likely to develop ankylosing spondylitis than are women. 2. Age. Onset generally occurs in late adolescence or early adulthood. 3. Heredity. Most people who have ankylosing spondylitis have the HLA-B27 gene. But many people who have this gene never develop ankylosing spondylitis. Complications In severe ankylosing spondylitis, new bone forms as part of the body's attempt to heal. This new bone gradually bridges the gap between vertebrae and eventually fuses sections of vertebrae. Those parts of your spine become stiff and inflexible. Fusion can also stiffen your rib cage, restricting your lung capacity and function. Other complications might include: 1. Eye inflammation (uveitis). One of the most common complications of ankylosing spondylitis, uveitis can cause rapid-onset eye pain, sensitivity to light and blurred vision. 2. Compression fractures. Some people's bones thin during the early stages of ankylosing spondylitis. Weakened vertebrae can crumble, increasing the severity of your stooped posture. Vertebral fractures can put pressure on and possibly injure the spinal cord and the nerves that pass through the spine. 3. Heart problems. Ankylosing spondylitis can cause problems with your aorta, the largest artery in your body. The inflamed aorta can enlarge to the point that it distorts the shape of the aortic valve in the heart, which impairs its function. Diagnosis During the physical exam, your doctor might ask you to bend in different directions to test the range of motion in your spine. He or she might try to reproduce your pain by pressing on specific portions of your pelvis or by moving your legs into a particular position. Also, your doctor might ask you to take a deep breath to see if you have difficulty expanding your chest. Imaging tests X-rays allow your doctor to check for changes in your joints and bones, though the visible signs of ankylosing spondylitis might not be evident early in the disease. An MRI uses radio waves and a strong magnetic field to provide more-detailed images of bones and soft tissues. MRI scans can reveal evidence of ankylosing spondylitis earlier in the disease process, but are much more expensive. Lab tests Certain blood tests can check for markers of inflammation, but inflammation can be caused by many different health problems. Your blood can be tested for the HLA-B27 gene. But you can have the disease without having the gene too. Treatment The goal of treatment is to relieve your pain and stiffness and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage to your joints. Medications Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as naproxen (Naprosyn) and indomethacin (Indocin, Tivorbex) — are the medications doctors most commonly use to treat ankylosing spondylitis. They can relieve your inflammation, pain and stiffness. However, these medications might cause gastrointestinal bleeding. If NSAIDs aren't helpful, your doctor might suggest starting a biologic medication, such as a tumor necrosis factor (TNF) blocker or an interleukin-17 (IL-17) inhibitor. TNF blockers target a cell protein that causes inflammation in the body. IL-17 plays a role in the body's defense against infection and also has a role in inflammation. TNF blockers help reduce pain, stiffness, and tender or swollen joints. They are administered by injecting the medication under the skin or through an intravenous line. The five TNF blockers approved by the Food and Drug Administration (FDA) to treat ankylosing spondylitis are: Adalimumab (Humira) Certolizumab pegol (Cimzia) Etanercept (Enbrel) Golimumab (Simponi) Infliximab (Remicade) IL-17 inhibitors approved by the FDA to treat ankylosing spondylitis include secukinumab (Cosentyx) and ixekizumab (Taltz). TNF blockers and IL-17 inhibitors can reactivate untreated tuberculosis and make you more prone to infection. If you're unable to take TNF blockers or IL-17 inhibitors because of other health conditions, your doctor may recommend the Janus kinase inhibitor tofacitinib (Xeljanz). This drug has been approved for psoriatic arthritis and rheumatoid arthritis. Research is being done on its effectiveness for people with ankylosing spondylitis. Therapy Physical therapy is an important part of treatment and can provide a number of benefits, from pain relief to improved strength and flexibility. A physical therapist can design specific exercises for your needs. Range-of-motion and stretching exercises can help maintain flexibility in your joints and preserve good posture. Proper sleeping and walking positions and abdominal and back exercises can help maintain your upright posture. Surgery Most people with ankylosing spondylitis don't need surgery. However, your doctor might recommend surgery if you have severe pain or joint damage, or if your hip joint is so damaged that it needs to be replaced.