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Ankylosing Spondylitis (AS)

Ankylosing spondylitis is a chronic, inflammatory, rheumatologic disorder that primarily affects the spinal column and sacroiliac joints. Sacroiliac pain is a common complaint along with progressive morning stiffness and prolonged stiffness after inactivity.

It is progressive and may cause functional limitations if not treated.


Typically, the onset of symptoms is in early adulthood with thoracolumbar or lumbosacral back pain. Pain may extend from lower back to upper back and buttocks. This pain is felt more in the mornings while waking up. The beginning is insidious, and it tends to be constant over time. Morning stiffness accompanies the pain. This stiffness may persist until the noon, and even continue all day by decreasing. Pain and morning stiffness alleviate with movement. Pain increases in the nights and with long time resting, and the patient may wake up due to the pain. There may be fatigue, loss of appetite, and mild fever (rarely observed). In the diagnosis of AS, radiography, MRI, scintigraphy, and lab tests accompany the examination.


In AS, it is possible to achieve a good result with a regular and long-lasting treatment program. Patients can have a life similar to a healthy person if they comply with the treatment doctor instructs. The most important task is on the patient during the treatment. The patient must not smoke and follow his/her exercises exactly. Although AS is chronic disease, it usually has a good prognosis. Physical therapy is an important part of the treatment. Maintaining the functions and preventing deformities can be achieved by implementing a regular physical therapy. In order to prevent spinal deformities, patients should lie on a hard and smooth mattress. The pillow must be thin. However, sleeping without a pillow should be recommended.


Mainly two types of medications are used.


  1. •Nonsteroidal anti-inflammatory drugs (NSAIDs). These are medications like aspirin and are considered the first-line treatment of AS patients. NSAIDs provide symptomatic relief and have been shown to slow radiographic progression.
  2. •Main medication. These are the medications that can stop the prognosis or treat the disease completely. These are the medications such as methotrexate, sulfasalazine, and biological agents (etanercept, infliximab etc.). In some cases, surgical indications are applied in order to correct deformities. Spinal osteotomy can be performed to correct spinal deformities. Hip arthroplasty is effective for patients with intractable pain, limitations in mobility. Systemic or local ozone therapy can be implemented as supportive therapy.