Although ankylosing spondylitis (AS) and related spondyloarthritis (SpA) conditions primarily affect the spine, the disease can influence many other parts of the body. Spondylitis does not follow a predictable pattern—two individuals, even within the same family, may experience very different symptoms. While inflammation of the eye (iritis) is quite common, neurological issues occur rarely, and shoulder involvement falls somewhere between. The chronic pain caused by ongoing inflammation varies widely, ranging from mild discomfort to severe, mobility-limiting symptoms.
People who experience their first symptoms of ankylosing spondylitis usually look for help and information by joining communities such as the Arthritis Support Network. The first indications of this condition present themselves in a way which makes them difficult to identify, as they resemble other medical issues. The process of understanding AS enables doctors to distinguish this condition from other related conditions, which include reactive arthritis that shows identical or comparable symptoms.
Inflammation of the entheses (where tendons, ligaments, and joint capsules attach to bone)—is a hallmark sign of AS. These painful “hot spots” may appear along the spine, pelvic area, sacroiliac joints, chest, or heel. Severe heel involvement, especially at the Achilles tendon or plantar fascia, can significantly limit mobility and increase daily discomfort.
This inflammation is also closely related to the ankylosing spondylitis causes, where both genetic and immune-related mechanisms trigger chronic inflammation.
It is the process of healing and repair following inflammation of the enthesis that can eventually lead to scarring of the tissues and, over time, result in extra bone formation. In someone with very severe disease, ongoing inflammation over many years may cause a bony fusion of the ligaments in the spine and sometimes in other joints as well, a condition known as ankylosis. This fusion can increase the risk of spinal fractures due to the restricted range of movement and because the newly formed bone is inherently weaker. Importantly, not everyone with spondylitis will progress to this stage.
Fusion of the spine may sometimes lead to a forward curvature known as kyphosis, causing a forward-stooped posture. While this can occur in the most severe cases of ankylosing spondylitis, it has become far less common today due to significant advances in treatment. Living with ankylosing spondylitis now looks very different than it did in the past, with better disease control and improved quality of life for many patients.
It is essential to follow your doctor’s instructions and take medications as prescribed so you can maintain a regular exercise routine, which over time helps reduce stiffness and improves mobility. Paying close attention to posture is also crucial to help prevent kyphosis. With the advent of newer classes of medications, particularly biologics such as anti–tumour necrosis factor (TNF-α) agents, there is growing evidence that the natural course of spondylitis may be slowed or even halted. Although more long-term studies are needed, these advances have significantly improved outcomes for people living with ankylosing spondylitis.
The hips and shoulders are affected in nearly one-third of people with AS. Hip inflammation often develops slowly, typically presenting as pain in the groin, but may also be felt in the knee or front thigh—this is known as referred pain. Hip involvement is more common when AS begins at a younger age and may indicate a more aggressive disease course. Shoulder involvement, while less severe, can still reduce comfort and daily function.
Understanding these patterns also helps patients recognize Spondylitis long-term effects, which may include progressive stiffness or reduced joint range if left untreated.
Adults with spondylitis often have chest pain that mimics the heavy chest pain of cardiac angina or pleurisy the pain with deep breathing that occurs when the outer lining of the lung is inflamed). Anyone experiencing symptoms should seek medical attention to rule out a more serious condition. What often happens, over time, is that the joints between the ribs and spine, and where the ribs meet the breastbone in front of the chest, develop decreased chest expansion because of long-term inflammation and scarring of the tissues. If the pain is found to be spondylitis-related and you find yourself unable to practice the critical deep breathing exercises, which help maintain chest expansion, there are things that you can do to help yourself:
Around 10% of individuals with spondylitis experience jaw inflammation, leading to pain and difficulty opening the mouth fully. This can affect eating and daily comfort.
About one third to 40% of people with spondylitis will experience inflammation of the eye at least once. Iritis is a serious complication which requires immediate medical attention from an eye doctor.
Signs/Symptoms: Symptoms often occur in one eye at a time, and they may include redness, pain, sensitivity to light and skewed vision. An ophthalmologist (or optometrist) can use a special slit lamp microscope to distinguish iritis from other causes of eye redness or irritation.
While uncommon, some long-term complications require close attention, especially in individuals with prolonged disease duration. Regular annual check-ups with a rheumatologist are essential for monitoring these risks.
A rare complication in advanced AS, Cauda Equina Syndrome results from nerve scarring at the base of the spine. Symptoms may include:
Severe neurological symptoms should be evaluated immediately.
Although rare today, long-term NSAID use or chronic inflammation may occasionally lead to kidney complications such as amyloidosis. Improved medications have made this significantly less common.
A small number of people with spondylitis will display signs of chronic inflammation in the base of the heart – around the aortic valve and origin of the aorta (i.e. that vessel which takes all blood from the heart to be distributed throughout the body). Years of chronic and silent inflammation at these sites can eventually lead to heart block and valve leakage, sometimes requiring surgical treatment. Although recognized, these cardiac lesions probably are seen in fewer than two percent of all patients with spondylitis, and nearly always in males. The lesions are readily detectable by the physician’s examination and when necessary, cardiac testing.
Reduced chest expansion can decrease lung capacity. Some individuals develop upper-lung fibrosis detectable through routine X-rays. Because recovery from respiratory infections may take longer, avoiding smoking is especially critical for anyone with AS.
Many people living with AS are curious about What foods trigger spondylitis symptoms? Although triggers differ among individuals, some commonly reported flare-aggravating foods include:
Keeping a symptom-food diary helps individuals identify personal triggers and maintain better control over daily comfort.
Ankylosing spondylitis affects far more than the spine—it can influence many systems throughout the body. With early recognition of symptoms, awareness of early symptoms of ankylosing spondylitis, understanding the Spondylitis long-term effects, and consistent support from networks like the Arthritis Support Network, people can lead healthier, more empowered lives. Staying informed, active, and connected plays a crucial role in managing the complexities of AS.
