The early manifestation of AS is the inflammation (arthritis) of the sacroiliac joints that connect the base of the spinal column (sacrum) and upper part of the hip or pelvis (ilium). Later on, the inflammation may spread to joints or tissues in the upper regions of the spine and in other parts of the body. “Ankylosing” means joining together, while “spondylitis” means arthritis of the spine. These terms allude that as the disease progresses over time, the inflammation drives the affected joints and smaller bones to “fuse” and harden together, eventually becoming inseparable piece(s) of larger, immobile bone.

Signs and symptoms include:

• Lower back pain and stiffness that is more severe at night, early morning and at rest
• Stooped posture (bended-forward body when sitting or standing which gives relieves back pain) that can worsen and become permanent
• Pain, swelling and stiffness in other musculoskeletal regions of the body (especially at later stages of the disease)
  • Joints that connect the spine and the ribs, the inflammation of which causing pain and can lead to difficulty in deep breathing
  • Dactylitis (“sausage digits”) or painful swelling of a finger or toe
  • Large joints such as the hips, knees and shoulders, leading to pain and range of motion decline
  • Other areas such as the neck, Achilles tendon, patellar tendon and plantar fascia
• Numbness or weakness in areas of the body supplied by nerves being “pressed” by the inflamed bones of the spinal column
• Fatigue and malaise
• Appetite and weight loss

• Anemia determined by pallor or blood testing
• Frequent inflammation of and pain in at least one eye that is unlikely to impair vision if treated right away
• Skin rashes
• Recurrent fever and/or gastrointestinal complaints
• Abnormalities in the heart and/or the aorta

Diagnosis of AS and further assessment of its severity are made by a physician through medical history-taking, physical examination, imaging (such as x-ray or magnetic resonance imaging/MRI) and blood tests. The treatment goals are to relieve pain and maintain functional range of motion in affected joints, correcting or preventing further deformities in posture, and preventing damage in other organs. With regular guidance from physicians and other health professions, the following interventions may be utilized:

• Regular safe exercise, movement and physical therapy to maintain optimal posture and joint mobility; these are also thought to slow down disease progression and reduce pain severity
• Eating healthy food with less or no fried, processed, high-fat and high-sugar content which may reduce chronic inflammation (such as the Mediterranean diet)
• Maintenance of healthy weight to control pressure being placed to affected bones and joints
• Avoiding or cessation of smoking (which can worsen AS and its symptoms, as well as making breathing more difficult)
• Painkillers and/or anti-inflammatory medications for immediate or short-term relief of symptoms
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen, mefenamic acid and celecoxib
  • Other painkillers such as paracetamol or tramadol, which can be used solely for mild pain episodes or together with NSAIDs for worse/poorly-controlled pain
  • Muscle relaxants
• Steroids directly injected into affected joints or administered as drops in recurrently-inflamed eyes
• Disease-modifying anti-rheumatic drugs (DMARDs) to directly control AS
  • Methotrexate, sulfasalazine
  • Biologics against and small-molecule inhibitors of tumor necrosis factor (TNF) and interleukin-17 (IL-17) actions in the body
• Surgery which may involve joint replacement, placement of metal support, and/or removal of thickened/fused bone fragments
• Participation and fellowship in patient-led and patient advocacy groups such as the Axial Spondylarthritis Association of the Philippines (ASAP)

As the precise genetic and environmental triggers for AS have yet to be identified, evidence-based approaches for preventing the onset of AS are lacking.