There are three ankylosing spondylitis stages — early, progressive, and late. As the condition progresses, people tend to experience more pain and stiffness. Getting treatment earlier can help reduce complications.

Symptoms of the early stage may include lower back stiffness and pain, while those of the progressive stage can affect other parts of the body. A sign of the late stage involves the fusion of some of the bones in the spine.

Treatment of all three stages may entail physical therapy — to reduce pain, improve posture, and increase flexibility — as well as various medications to decrease inflammation. In the late stage, surgical repair or joint replacement may also be necessary.

Keep reading to learn more about ankylosing spondylitis stages, including factors that affect progression speed and when to speak with a doctor.

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The most common early symptoms involve frequent stiffness and pain in the lower back and buttocks, which slowly manifest over the course of a few weeks or months. In the beginning, a person may only feel discomfort on one side or alternating sides. The pain is typically dull and affects a wider rather than a smaller area.

These symptoms tend to be worse in the morning and night, and they may lessen with exercise or a warm shower.

Other early symptoms include:

  • fever
  • general discomfort
  • loss of appetite

There is no cure, but treatment may include physical therapy and medications.

Physical therapy can offer the following benefits:

  • reduction in pain
  • improvement in posture
  • increased flexibility
  • greater strength in back and neck muscles

Medications may include:

  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil, Midol)
  • disease-modifying antirheumatic drugs, such as sulfasalazine (Azulfidine, Azulfidine Entabs, Sulfazine), to reduce inflammation
  • biologic therapies, such as etanercept (Enbrel), which use a targeted approach to reduce inflammation
  • steroid injections, such as methylprednisolone (A-Methapred, Depo-Medrol, SoluMEDROL), to provide short-term relief from flare-ups

Over months or years, the pain may spread up the spine to the neck. Tenderness and pain can also spread to the shoulder blades, ribs, hips, thighs, and heels. Tiredness and mild to moderate anemia may develop.

Many people experience bowel inflammation. Other effects include iritis — which is inflammation of the iris, the colored part of the eye — and uveitis, which is inflammation of the middle layer of the eye wall. Symptoms of eye involvement are:

  • painful, red, and watery eyes
  • sensitivity to light
  • blurred vision

The medications and physical therapy for the early stage are also appropriate for the progressive stage.

A distinguishing feature of the advanced stage is a fusion of the vertebrae, which are the bones in the spinal column. This causes progressive back stiffness. Other effects include impaired posture and breathing.

Complications of later stages include:

  • chronic, or long-term, pain
  • pulmonary fibrosis, which is a condition that causes lung damage and scarring
  • mood disorders
  • aortic regurgitation, which is the backward leaking of blood from the aorta — the main artery that receives blood from the heart
  • cauda equina syndrome, which is damage to the nerve roots at the bottom of the spine, causing weakness, pain, and loss of bladder and bowel control

A person may also develop osteoporosis, a condition where bones lose minerals and weaken, notes an older 2016 review. This may lead to fractures.

Treatment can include medications and physical therapy that treat the early and progressive stages. People may need joint repair or replacement surgeries when severe joint damage is present.

In rare cases, surgery to repair fractures or straighten the spine will be necessary.

It is best that people make an appointment with a doctor when they first start to notice symptoms. If they have the condition, a doctor can provide a treatment plan for management.

Additionally, they need to notify the doctor if they experience alarming symptoms, such as:

A variety of factors may affect progression, such as how a person responds to treatment and their general health.

The following recommendations may make a difference:

  • Exercising regularly: This helps maintain flexibility, preserve joint mobility, and increase muscle strength.
  • Quitting smoking: The condition is more severe in people who smoke.
  • Practicing good posture: Exercises to maintain and improve posture can help avoid some complications.
  • Eating a healthy diet: This is beneficial for all individuals, so it may be very helpful for those with ankylosing spondylitis. Maintaining a typical weight also decreases stress on painful joints.
  • Using assistive devices: Using a cane or walker may reduce pain, as well as promote safety and stability.

Learn more about treatments for ankylosing spondylitis.

Ankylosing spondylitis has three stages: Early, progressive, and late. The early stage most commonly starts with frequent pain and stiffness in the lower back and buttocks that slowly develops over weeks or months.

Over time, the inflammation and symptoms may spread up the spine and to other parts of the body. In the late stage, some vertebrae may fuse together, and a person can experience difficulty breathing.

Treatment of all stages may involve physical therapy and anti-inflammatory medications, but treatment options for the late stage include surgery. Some lifestyle practices, such as exercising and quitting smoking, may help slow progression speed.

The condition should be under a doctor’s care, so an individual needs to make an appointment when they first notice symptoms.