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Has Your Patient Had Inflammatory Back Pain for 3+ Months?

If back pain is not improving and is inflammatory in nature, –– a patient may have an undiagnosed rheumatic disease –– ankylosing spondylitis (AS) –– that primarily affects the spine, which can make them highly prone to spinal fracture.

“If you suspect your patient may have AS, please have them see a rheumatologist ASAP.”
—Spondylitis Association of America’s Medical & Scientific Advisory Board

Inflammatory back pain is a hallmark of AS and other closely related diseases within the spondyloarthritis family of diseases.

Characteristics of Inflammatory Back Pain

Inflammatory back pain is usually a dull ache, difficult to localize, and felt deep in the buttocks or lower back. The back pain is frequently associated with stiffness and spasm of the paraspinal muscles and inflammation of the sacroiliac (SI) joints. In some cases, ankylosing spondylitis symptoms can also start in the neck or peripheral joints such as the hips and shoulders.

Prolonged inactivity usually worsens the pain and stiffness, while exercise and physical activity tend to ease them. Pain may awaken the patient at night. Some patients find it necessary to exercise or move about for a few minutes before returning to bed and may have difficulty getting out of bed in the morning.

AS patients may have a fused spine and an 11 times higher risk of spinal fracture.

“Ankylosing spondylitis causes inflammation of the joints between the vertebrae of the spine and the sacroiliac joints in the pelvis. It can also cause inflammation and pain in other parts of the body. As the condition worsens and the inflammation persists, new bone forms as a part of the healing process. The bone may grow from the edge of the vertebra across the disc space between two vertebra, resulting in a bony bridge. This may occur throughout the spine so that the spine may become stiff and inflexible, effectively fusing the spine.”
—Bryan E. Bledsoe, DO, FACEP

Important Points to Look For

  • Onset is usually under 45 years of age and is insidious
  • Pain persists for more than three months (i.e., it is chronic)
  • Back pain and stiffness worsen with immobility, especially at night and early morning
  • Back pain and stiffness tend to ease with physical activity and exercise

Other Signs and Symptoms of Ankylosing Spondylitis


Inflammation of the entheses, where joint capsules, ligaments, or tendons attach to bone, is a hallmark of ankylosing spondylitis (AS) and other forms of spondyloarthritis. This can be felt in multiple areas of the body from the shoulders down to the feet. The two areas of the foot that can be affected are the Achilles tendon at the back of the heel and the plantar fascia at the base of the heel.

Dactylitis (Sausage Digits)

Inflammation of an entire digit (a finger or toe.)


Inflammation of the eye. It is a serious complication that requires immediate medical attention from an eye doctor. Symptoms often occur in one eye at a time, and they may include redness, pain, sensitivity to light, and skewed vision.

Psoriasis and Inflammatory Bowel Diseases

These conditions are also associated with AS and related diseases, and can serve as additional clues.

Additional Resources for You and Your Patients

Learn more about ankylosing spondylitis and the group of diseases known as spondyloarthritis.

Overview of AS and Related Diseases

The Spondylitis Association of America (SAA) can assist in a search for a rheumatologist by providing our free Rheumatologist Directory: A Patient-to-Patient Recommended List. This booklet contains a state-by-state list of patient-recommended, board-certified rheumatologists.

Rheumatologist Directory

We have produced a wealth of educational materials on ankylosing spondylitis and related diseases — all vetted by our Medical and Scientific Advisory Board.

Educational Materials

Stay Informed



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Contact Us

Spondylitis Association of America

16360 Roscoe Blvd.  Ste. 100
Van Nuys, CA 91406


Information Requests

(800) 777-8189 U.S. only
or (818) 892-1616
*Please note: This is not a Crisis Hotline. If you are in a life-threatening crisis, please dial 911 for immediate help in the US. Please follow this link for crisis intervention resources.

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