Ankylosing spondylitis (AS) commonly affects the shoulders, which may lead to shoulder pain and stiffness.

AS is a systemic disease, which means it affects more than one body system or the entire body in some people. According to the Spondylitis Association of America, it is a relatively rare condition, affecting about 1.3% of the adult population in the United States.

The condition primarily causes inflammation in the spine and sacroiliac joint, which connects the bottom of the spine to the pelvis. However, it may also cause symptoms in other areas, such as the hips, shoulders, and fingers.

While often overlooked, the shoulders are the most commonly affected joint outside the spine in AS. Some research suggests that AS affects the shoulders in about 30% of people with the condition.

This article explores shoulder pain in AS, other symptoms of AS, how to manage shoulder pain from AS, and when to speak with a doctor.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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AS primarily affects the joints in the spine and the nearby soft tissues, such as ligaments and tendons. All cases of AS affect the spine, but as a systemic disorder, it can cause inflammation in other areas. These include major joints outside the spine and the digestive organs, eyes, and skin.

AS may cause pain, stiffness, inflammation, and loss of range of motion in the shoulders. Typically, only one shoulder is affected or is more affected than the other. A small 2022 study found that the shoulder strength and range of motion in males with AS were lower than in males without AS.

According to a 2016 study, shoulder involvement is present in about 15% of people with AS at initial presentation, but this may reach 35% as the condition progresses. The researchers found that shoulder pain in people with AS may result from:

They also suggested that it may be possible for a person with AS to have shoulder involvement without any noticeable clinical signs.

The most common symptom of AS is inflammatory back pain. In contrast with noninflammatory back pain, inflammatory back pain has the following characteristics:

  • The age of onset is below 40 years old.
  • The pain eases with exercise.
  • Development is gradual.
  • A person experiences stiffness in the mornings.
  • The pain has been ongoing for more than 3 months.

Symptoms vary from person to person, and the condition may affect other areas of the body. Other symptoms may include:

Learn more about the different effects of AS in the body.

The first line of treatment for joint inflammation and pain in AS is nonsteroidal anti-inflammatory drugs (NSAIDs).

Corticosteroid injections directly into the tendon sheath or joint may provide fast relief for localized joint swelling.

If NSAIDs are ineffective, doctors may prescribe disease-modifying antirheumatic drugs (DMARDs) to help relieve symptoms and prevent joint damage. Healthcare professionals may also recommend certain types of biologic drugs, which may help treat both spinal and peripheral joint symptoms.

Additionally, doctors may prescribe janus kinase inhibitors, which are medications that send messages to specific cells to stop inflammation from inside the cell itself.

Other treatment options for AS may include:

A person should speak with a healthcare professional for individual advice about treating AS and managing shoulder pain.

Learn more about the diagnosis and treatment of AS.

If a person experiences shoulder pain that does not go away, they should speak with a doctor. A healthcare professional can work out the underlying cause of the pain and perform diagnostic tests for AS if a person has not already received an AS diagnosis.

People should seek the advice of a doctor because another condition may be causing their shoulder pain. Healthcare professionals may ask about a person’s medical history, perform a physical exam, and order imaging and laboratory tests to help diagnose the underlying cause.

AS primarily affects the spine and lower back but may also affect other areas, such as the shoulders and hips. A person with AS may experience pain, stiffness, inflammation, and loss of range of motion in the shoulders.

The primary treatments for AS pain and inflammation are medications such as NSAIDs and DMARDs. Other treatments may include physical therapy, surgery, regular exercise, and lifestyle modifications.

A person should speak with a healthcare professional if they experience any shoulder pain that does not go away, regardless of whether they have received an AS diagnosis. A doctor can help identify the underlying cause of the pain.