Ankylosing spondylitis (AS), also called axial spondyloarthritis, can cause stiffness in the neck and shoulders. Neck and shoulder pain might get worse after lying or sitting for a time, causing difficulty when a person begins moving again.

AS, a form of arthritis, causes inflammation, leading to calcium buildup around the spine.

This buildup contributes to the growth of extra bone in the neck and back, causing stiffness and pain. The bones may fuse together due to excess calcium.

This article explains how AS develops in the neck and shoulders and describes the treatment options.

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Symptoms of AS in the neck and shoulders can include:

These symptoms may:

  • worsen after a period of rest, with pain becoming more severe after sleeping or sitting still for a prolonged period and possibly causing a person to wake during the night
  • cause difficulty carrying out certain motions in daily life, such as turning the head while driving
  • occur in episodes or become constant

Not everyone with AS experiences neck pain. Pain and stiffness most often develop in the lower back and hip.

Neck symptoms

A 2022 study of Japanese participants with AS found that around 10% had pain that started in the neck, while others found that the pain reached the neck as the condition got worse.

Learn more about what can cause neck pain.

Shoulder symptoms

AS usually only develops in a single shoulder or is more severe in one shoulder than the other.

According to a 2016 study, symptoms may start in the shoulder in around 15% of people with AS. As the condition progresses, the study concluded that shoulder pain may go on to affect around 35% of people.

Other symptoms

AS occurs due to bodywide inflammation, meaning that more general symptoms may develop alongside neck and shoulder pain. These can include:

Learn more about AS flare-up symptoms.

AS occurs when inflammation leads to stiffness in the joints and ligaments that usually keep the spine flexible.

The underlying cause is still unclear, and anyone can develop AS. However, certain factors increase the likelihood of developing AS, including:

Researchers have linked one gene called HLA-B27 to AS development, though not everyone with the gene goes on to get AS.

In rare cases, people with AS may experience atlantoaxial subluxation, which is misalignment of the second and third cervical vertebrae. Although this misalignment does not usually cause symptoms, some people may experience neck pain.

The reason that AS symptoms may start in or progress to the neck or shoulder is also not always clear, as everyone with AS has a different experience of the symptoms.

To assist with reaching an accurate diagnosis, a doctor may begin by taking a full medical history and performing a physical exam to check the flexibility of the joints.

They may then order imaging tests, such as an MRI or X-ray. These tests can also help doctors monitor the condition after diagnosis.

A doctor may be able to predict the progression of AS to neck involvement using these scan results. For example, if an X-ray suggests a large slope where the neck and spine vertebrae meet, known as the T1 slope, neck pain may become more likely as the condition gets worse.

A high “McGregor’s slope,” where the neck and head join, can also indicate that neck pain will develop or increase.

Learn more about diagnosing AS.

Gentle exercise and working on posture may help relieve AS pain. A doctor may also recommend medication, physical therapy, and, in rare cases, surgery.

Physical therapy

A physical therapist can create an exercise program for an individual with AS to help improve:

People with shoulder symptoms and stiffness and pain in the spine and hips may also benefit from hydrotherapy, which involves using specific exercises in a warm-water pool.

Medication

Medications may help relieve pain and discomfort and reduce the inflammation that causes AS symptoms in the neck and shoulder. A doctor may recommend the following:

  • Pain relief medications: These may include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
  • Biologics: Doctors may use biological therapy injections of targeted anti-inflammatory drugs when NSAIDs and physical therapy have not helped. Biologics for AS may include anti-tumor necrosis factor (anti-TNF) drugs or interleukin 17 (IL-17) inhibitors.
  • Disease-modifying anti-rheumatic drugs (DMARDs): These drugs include sulfasalazine and methotrexate, which can reduce inflammation and prevent joint damage.
  • Short-term steroid treatments: During flare-ups, doctors may recommend these in the following forms:

Surgery

Surgery is rarely necessary with AS, especially in the neck and shoulders. However, a person may require a knee or hip replacement if AS severely affects those parts of the body.

People with consistent pain, inflammation, and stiffness should contact a doctor.

If the doctor suspects AS, they may refer an individual to a rheumatologist, a doctor who specializes in treating muscle and joint problems.

How long does neck spondylitis last?

A 2017 study found that people with AS experience around three 2-week flare-ups within a 3-month period. Although there is currently no cure for AS, treatments can help reduce flare-ups and improve quality of life.

What is the main cause of ankylosing spondylitis?

Researchers do not know the main cause of ankylosing spondylitis. However, the effects on the spine joints and ligaments result from extra bone growth as a response to body-wide inflammation.

Certain people have a higher risk of developing AS, such as those with a family history of the condition, people under age 45 years, those with inflammatory conditions such as Crohn’s disease or psoriasis, and those who carry an AS-linked gene.

Ankylosing spondylitis (AS) is an inflammatory condition that most commonly affects the lower back but may also cause neck and shoulder symptoms.

Neck or shoulder pain may develop at the onset of AS symptoms. However, it is more likely to develop as the condition progresses.

Treatment for AS includes physical therapy, medication, and posture adjustments. A doctor can create a suitable treatment plan to help a person manage neck and shoulder pain and other symptoms of AS.