Ankylosing spondylitis - Complications 

Complications of ankylosing spondylitis 

Ankylosing spondylitis (AS) is a complex condition that can affect many parts of your body. It can cause complications in your day-to-day life, and lead to additional health conditions.

Some complications associated with ankylosing spondylitis are outlined below.


Uveitis, also known as iritis, is a condition sometimes associated with ankylosing spondylitis. Uveitis is inflammation (redness and swelling) of part of the eye. It usually only affects one eye, not both. If you have uveitis, your eye will become:

  • red
  • painful
  • sensitive to light (photophobia)

Because uveitis can damage your eyesight, if you have ankylosing spondylitis and you develop pain or redness in one eye, or misty vision, you should urgently visit:

  • your GP 
  • an ophthalmologist (a medical doctor who specialises in eye disease and its treatment or surgery), or
  • an optometrist (a person who examines eyes and tests sight)

Uveitis is easily treated using eye drops. If treated quickly, uveitis usually clears up within two to three weeks. However, if uveitis is not treated quickly, it can cause the loss of some or all of your vision.


Osteoporosis is a condition that causes your bones to become weak and brittle. In ankylosing spondylitis, osteoporosis can develop in the spine.

Read more information about osteoporosis.

Spinal fractures

Having ankylosing spondylitis increases your risk of developing fractures (breaks) in the vertebrae of your spine. This risk increases with the duration of your condition.

Cardiovascular disease

If you have ankylosing spondylitis, you may also have an increased risk of developing cardiovascular disease. Cardiovascular diseases include:

  • heart disease – your heart's blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries (the blood vessels that supply blood to the heart)
  • stroke – a serious medical condition that occurs when the blood supply to the brain is interrupted
  • deep vein thrombosis (DVT) – where blood clots develop in one of the deep veins in your body, usually in your legs 

Due to the increased risk, it is important to take steps to minimise your chances of developing cardiovascular disease.

Your rheumatologist (specialist in treating muscle and joint conditions) will be able to advise about lifestyle changes you should make to minimise your risk of developing a cardiovascular disease. These changes may include:

  • giving up smoking (if you smoke)
  • losing weight (if you are overweight or obese)
  • taking more regular exercise – 150 minutes of exercise per week can greatly increase your health
  • keeping other conditions you may have under control, such as diabetes (a long-term condition caused by too much glucose in the blood) or high blood pressure (hypertension)

Reduced flexibility

It is estimated that four in 10 people with ankylosing spondylitis will eventually have severely restricted spinal flexibility. Spinal deformities are likely to take at least 10 years to develop.  

Fixed posture

In very severe cases of ankylosing spondylitis, pain and stiffness in your lower back can also spread to the upper parts of your spine. This can decrease the mobility of your spine, making it difficult to move. As a result, your posture can become fixed in one position. This may:

  • make it difficult to look people in the eye
  • reduce your self-confidence

However, it is unlikely this will cause severe disability unless you also have severe arthritis (inflammation of the joints) in your hips or sometimes your knees.

Surgical treatment

Two types of surgical treatment are sometimes needed by people with ankylosing spondylitis:

  • joint replacement surgery
  • spinal corrective surgery

These are described in more detail below.

Joint replacement surgery

In some cases, it may be necessary to have surgery to replace a joint that has become severely damaged as a result of ankylosing spondylitis. For example, if hip joints are affected, a hip replacement may help to:

  • relieve pain
  • improve mobility

Read about hip replacement for more information about the procedure.

Spinal corrective surgery

It is now rare for people with ankylosing spondylitis to need their spine straightened, but if the spine becomes badly bent this can often be corrected by an operation.

Cauda equina syndrome

Cauda equina syndrome is a very rare complication of ankylosing spondylitis that occurs when nerves at the bottom of your spine become compressed (compacted).

Cauda equina syndrome causes:

  • pain or numbness in your lower back and buttocks
  • weakness in your legs, which can affect your ability to walk
  • urinary incontinence or bowel incontinence (when you cannot control your bladder or bowels)

See your GP as soon as possible if you have ankylosing spondylitis and you develop any of these symptoms.


In very rare cases, it is possible to develop amyloidosis as a complication of ankylosing spondylitis.

Amyloid is a protein produced by cells in your bone marrow (the spongy material found in the centres of some hollow bones). Amyloidosis is a condition where amyloid builds up in organs, such as your:

  • heart – a muscular organ that pumps blood around the body
  • kidneys – two bean-shaped organs that filter out waste products from the  blood
  • liver – the largest organ in the body; it performs many important functions, such as turning food into energy

Symptoms of amylodosis vary because the condition can affect different areas of your body. In some cases, there may be no symptoms at all.

Read more about amyloidosis.


As ankylosing spondylitis advances, it can affect your ability to work. It is estimated that a third of people with ankylosing spondylitis may be unable to work at all. Around one in six people may need changes to their working life in order to continue working, such as:

  • working part-time
  • working from home
  • not taking up physically demanding occupations 

When at work, it is important to maintain a good posture when sitting or standing for long periods of time. You should get up, stretch and move around regularly. This could mean adjusting your work station, or ensuring you take regular breaks.

Read more information about how to sit correctly.

Page last reviewed: 25/06/2012

Next review due: 25/06/2014


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The 12 comments posted are personal views. Any information they give has not been checked and may not be accurate.

pmitc22 said on 07 January 2014

I am 25 years old and have been diagnosed with AS about a month ago. Unfortunately, I've been suffering from this disease for many years (since 17 yoa). Just this last month I have significantly lost my ability to walk. I'm not sure how progressive the disease is for each individual, but my eye sight is being affected as well. Staying mentally strong through the pain and difficulties life has thrown my way, is my main objective. I refuse to be defeated, but keeping this mindset is a challenge of its own. I never expected for my legs to seem to discenegrate and honestly, didn't expect it to happen this fast. Being a mother of two, it is extremely difficult (I'm sure it is for all of us). Has anyone else went "down" so quickly? I'm losing everything and am just waiting for my insurance to approve treatment. Unfortunately, I found out my doctor didn't send in the request as of now and am having to see a new specialist and wait even longer. Seeing all of these comications makes me feel bad because it seems like it is just my luck to deal with them too. Another commentor said you need a good support system and that couldn't be more true. I push myself all day, every day to keep moving and I will crawl if I have to. I don't want people to have to "serve" me, but if this disease continues to aggressively attack my body (mid waist down mostly and neck/shoulders, weak hands, blurred vision, etc.), I feel like I'll have no other choice. Bad things do happen to good people and maybe I'll continue to learn and grow from this lifelong disease. My heart goes out to all of you. May you all find relief and comfort.

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hannahbetz23 said on 06 April 2013

I have had AS now for 7 years. im 23 years old and had my trigger episode at 16 from shingles and putting my back out when exercising. i felt paralyzed for a few weeks having to stay in bed and calling the doctor out. he was baffled this is where it started. I have 2 brothers that have it and my dad. we have all just been diagnosed within the last couple of years. it took me 6 years for my diagnosis. But do not be put off by this you have to stay strong and keep going because this is a life long disease and you will need their support. I have only just recently started to really suss how to combat it with a combination of NHS anti tnf injections and herbal remedies, special diet physio/hydro therapy and exercise. I cannot express how this is a life change not just a quick pill. The injections seem like that but they are not! they are just essentially strong pain killers. Your spine will end up fusing and you will not know as the injections hide it! i had awful reactions to entercept hallucinating and having outter body experiences at night when sleeping. this did not happen immediately it was after taking them for 6 months. I now am off them detoxing for 3 months before they put me on the fort nightly ones which my brother is taking. Everyone is effected differently but the most effective which seems to help everyone is a diet of no sugar or starch ! HARD but works a miracle with exercise. my mum is a herbalist and we have tried everything in the book. only now after 6 years have we mastered which ones are good. but everyone is individual.

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seo286 said on 26 March 2013

Hannahd85 --- just a quick response to your query in the event you should ever return to this page: I would seriously considering looking into the TNF treatment they are offering. I was diagnosed with AS at 17 years when I was in massive amounts of pain and the MRI's showed a huge amount of bone fusion in my sacroiliac joint (I was told it was a big concern considering my age). I was on pain killers and MTX for about a year and complained that they were interferring to much in my day to day life - I was happy to take them at night to manage to sleep ok, what with all of the tossing and turning/pain at night however I was not ok with how much they messed with my head during the day (it was hard to concentrate at uni). I was put on adalimumab every other week at age 18 then weekly from age 19 until 23. This year the TNF wore off a wee bit so to prevent a massive flare I was switched to 50mg Entanercept weekly for the time being to give a change to my body. Both have worked wonders. I realise there are quite a few side effects (I have definitely experienced them!) but to be honest, you have to make the decision whether you are ok with side effects or if you want to continue living in pain. The TNF blockers have not only seriously reduced my pain levels (not 100% but so much better) but they have also slowed the progression of the disease. Do some research, see what others say about being on them, and then make your own decision. It was an easy one for me although I must say I have a lot of other problems and the TNF has made an impact on all of these in a positive way (Bilateral Iritis, Vasculitis, Ulcerative Colitis, Psoriasis and AS) BUT I have never looked back. Good luck!

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Hannahd85 said on 26 March 2013

From the age of 19 Ive suffered with Iritis and a blood test confirmed I was HLAB27 + although initiially all MRIs and Xrays came back clear even though I was in so much pain. So I seemed to just constantly take pain killers. 8 years later I seemed to have had an aggressive onset and now all my MRIs and Xrays show severe deformation of my sacriolatic joints. It seems to be a running trend that GPs turn sufferers away and "fob them off" with pain relief just because the Xrays are not showing the condition, yet I feel intervention when I was a lot younger could have prevented the situation I am in now. It takes time for the bone damage to mature and show up on these tests and by then I feel too much damage has been done. For years ive suffered with my eyes and low back pain but recently its now in my hips and the iritis seems very aggressive (been on drops for 9 months now) and I am constantly visiting Moorfields.Work has become a massive issue and two years into my nursing course Ive been asked to leave as the pain is too much/ the pain killers can make me disorientated. I really believe if some sort of treatment was available when I was 19 I may not be in this position as all the doctors seem to do is prescribe painkillers to "mask" the syptoms resulting in sufferers getting too bad that it is harder to fix...
I have just been offered the ANTI TNF treatment yet im in two minds if I should start this...? im only 27!

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Sisra said on 24 March 2013

I was diagnosed with Iritis in 2006, at the same time they found I have HLA B27. I have been back and forth to my GP with my back for the last 6 months, I was sent for blood tests, x rays and an MRI scan all of which the GP said have come back clear. I saw a physio therapist last week who is referring me for more tests. My Dad had HLA B27 and AS and Iritis! Any suggestions on how to get the GP to listen?

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Shellyni said on 07 March 2013

Ive been diagnosed for 17 years now - took me 12 years plus to get a doctor to believe me and get diagnosed! I could barely walk with the pain and physios weren't helping. Eventually a physio realised my condition and told me to get a HLAB27 blood test and a referral to a rheumatologist. By this stage I was also getting iritis. I was so relieved someone was actually believing me. X-rays wont show anything in the early years - its only in the last number of years my inflammation has started to show along with the calcification.

Best to get referred to a specialist physio who has had specific traing with arthritis patients and hydro therapy is fantastic. GPs can be very dismissive of this so be very insistent if you think you have this condition.

Reflexology is also a good therapy to get as well.

Good luck!

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amfy said on 20 January 2013

I have had the above symptoms of AS for over 4 months now, I have been to the doctors several times, have had blood tests and had an x ray, both of which are clear, I'm at my wits end, I have aged about 10 years through lack of and disrupted sleep every night, I don't know what else to do to convince them, I also have reccurent blisters on the eyeball of my left eye and swelling of the eyelids, which only started at the same time, so am convinced they are linked, but doctors have said all looks ok and probably because I am run down, I wake every morning knowing this is not normal, can anyone suggest how I can get a diagnosis for this.

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sharonwy said on 26 September 2012

Hi Steve, I asked the new GP to refer to a rhematologist , hasnt done it yet . Im now on the treadmill of blood tests , and ECG's, I have been having palpatations.GP seems determined to tackle this himself , still cant get past the bloody doctors, on the point of changing surgerys, if I only felt it wouldnt put me back to square one.
Thanks for replying and the advice , I hopeyou are doing ok. sharon.

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sharonwy said on 31 August 2012

I believe I may have Ankylosing Spondylitis,having been backwards and forwards , seemingly constantly , to my GP and physio depts .When I put my thoughts to my GP he said that I absolutely do not have it, because my back xray shows no signs, it came back as wear and tear.At first he said there were no tests available,then when I burst into tears he rememberd there were.Although he strongly emphasised these ,even if positive , do not in any way mean I have A.S..When I then asked for a referal for a wheelchair,I find it very painfull standing and walking,and have collapsed several times now , he refused,saying he does not believe I am that bad.I am off work ,I was working when I started this quest ,and am getting worse month on month.The Physio dept haven't helped my condition in any way, and I believe they have seriously misdiagnosed my condition.My life is on hold,I cant work rest or play. Am trying a different GP at my practice,but feel I am back at the begining, and I feel so ill.

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RobD said on 18 April 2012

Hi steve Brann,have you seen a rhematologist if you havent it is important that you do.They have expertise in your condition and you may meet the criteria for a type of therapy called Anti- tnf this litterally transformed my life although its not for everyone.It took me 10 years to get diagnosed I was like yourself fobbed off.Try a charity commited to fighting this illness.I am also from Liverpool currently living on the wirral

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steve brann said on 04 April 2012

I would like to know of somewhere in merseyside where i can seek advice and help with regards to this illness i have, i try to work full time in a techical and manual job, so working from home or part time, or in a less strenuous job is not happening, and i've been let down big time by my local gp, and all other departments, i am angry and fed up with being fobbed off with eye drops paracetemol,, and "sorry, there's nothing we can do" there must be someone somewhere who could advise me.............. please

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Michael_9 said on 10 March 2012

I would have liked some advice on what medication to take.

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