Ankylosing spondylitis - Symptoms 

Symptoms of ankylosing spondylitis 

The symptoms of ankylosing spondylitis (AS) vary greatly from person to person, but usually take a long time to develop. In some cases, symptoms can take three months to develop fully, in others, several years.

Symptoms usually start during later teenage years, or early adulthood. They may come and go, and improve or get worse over many years.

The main symptoms of ankylosing spondylitis are:

  • back pain and stiffness
  • buttock pain
  • inflammation (swelling) of the joints (arthritis)
  • painful inflammation where tendons or ligaments attach to bone (enthesitis)
  • fatigue (extreme tiredness)

However, you may not develop all these symptoms which are explained in more detail below.

Back pain and stiffness

Back pain and stiffness are usually the main symptoms of ankylosing spondylitis. You may find:

  • your pain gets better with exercise but not with rest
  • your back is particularly stiff in the morning, with episodes lasting for longer than 30 minutes after you start to move
  • you wake up in the second half of the night with pain and stiffness
  • you have pain in your buttocks, which can sometimes be on one side and sometimes on the other


As well as causing symptoms in your back and spine, ankylosing spondylitis can cause arthritis in your hip, knee and other joints. The main symptoms associated with arthritis are:

  • pain on moving the joint
  • tenderness when the joint is examined
  • swelling
  • warmth in the affected area  


Enthesitis is painful inflammation where a bone is joined to:

  • a tendon (a tough cord of tissue that connects muscles to bones)
  • a ligament (a band of tissue that connects bones to bones)

Common sites for enthesitis are:

  • at the top of the shin bone
  • behind the heel (Achilles tendon)
  • under the heel
  • at the ends of the ribs

If your ribs are affected, you will feel chest pain, and you may find it difficult to expand your chest when breathing deeply.


Fatigue is a common symptom of untreated ankylosing spondylitis. It can make you feel tired and lacking in energy.

Page last reviewed: 25/06/2012

Next review due: 25/06/2014


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The 1 comments posted are personal views. Any information they give has not been checked and may not be accurate.

janie123 said on 03 December 2013

Please be aware that AS doesn't always present itself by pain in the spine. My child's (which took 4 years to be diagnosed) took the form of hip pain.
Also the associated eye condition is not always experienced as a 'sharp, stabbing pain in the eyes'. It can look like an allergy and be pain free. If you are unsure about anything keep perservering with the professionals - they do not always get it right first time.

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