Ankylosing spondylitis (AS) can flare up for various reasons, including physical inactivity, poor posture, smoking, and not taking anti-inflammatory medications.

AS is a type of inflammatory arthritis mainly affecting the back. It causes stiffness and pain in the back, rib cage, and neck. In AS, the body produces additional calcium in response to inflammation. This can cause extra bone to form around the spine, leading to increased stiffness and pain.

Both being active and maintaining good posture are important in preventing flare-ups and worsening the condition. This article discusses what can trigger AS symptoms.

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Maintaining good posture is important for preventing AS flare-ups. Physical therapy and postural training are important prevention strategies.

Correct posture helps maintain the spine’s three natural curves but not increase them. The three natural curves are in the neck, middle (mid) back, and low back. The following tips can help people find a good standing posture:

  • standing up straight, keeping the shoulders back
  • pulling in the stomach
  • keeping the head level
  • placing weight mostly on the balls of the feet
  • keeping feet shoulder-width apart
  • allowing the arms to hang down naturally at the sides

Learn about sitting positions for good posture.

According to the Arthritis Foundation, being physically active is vital in preserving range of motion in the back and neck. It also strengthens muscles and helps improve posture.

Physical inactivity means less mobility in the joints and increases the risk of joints fusing together. Additionally, inflammation around the joints causes surrounding muscles to tighten, leading to more pain and stiffness.

A physical therapist can help develop an exercise program for someone with AS. Exercise programs will typically have the following goals:

  • improving range of motion in the back, neck, and joints
  • managing posture
  • strengthening and lengthening muscles
  • improving lung capacity, as breathing is sometimes compromised in people with AS affecting the ribs
  • improving balance
  • increasing and maintaining cardiovascular fitness

Learn about exercises and postures for AS.

Smoking with AS may contribute to flare-ups.

A small 2021 study involving 50 people indicated that smoking while having AS can increase disease activity, inflammatory markers, and evidence of disease progression on imaging tests. It also suggests that smoking may decrease physical function and make breathing more difficult.

According to the Arthritis Foundation, stopping smoking can help improve a person’s overall health and may help slow disease progression.

Find 11 tips for giving up smoking.

Eating a low nutrient diet may contribute to inflammation and AS symptoms. People with AS may wish to limit the following foods:

Food componentExamples
Sugardesserts, cookies, pastries, soda, fruit juice, and sauces
Saturated fatspizza, cheese, full fat dairy products, and meat products
Trans fatsfried products, processed snack foods like cookies and donuts, and stick margarine
Refined carbohydrateswhite bread, white pasta, and french fries
Excess omega-6 fatty acidsmayonnaise, salad dressings, and oils like corn, sunflower, and soy
Monosodium glutamate (MSG)fast foods and processed foods

The AF recommends trying an anti-inflammatory diet, such as the Mediterranean diet, to help prevent and manage inflammation.

Read more about foods to eat and avoid with AS.

Some research suggests that having a higher body mass index (BMI) can contribute to AS flare-ups.

A 2022 study examined the relationship between BMI and AS activity in 183 people with the condition. Researchers found that having a higher BMI correlated with greater disease activity over time. This effect was largely independent of how much exercise people engaged in.

Maintaining a moderate weight may help people with AS manage the condition.

Read about 20 ways to lose weight safely.

Chronic inflammation can lead to extra bits of bone forming on the spine and joints fusing, so taking anti-inflammatory medications is critical.

Daily use of nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and prevent pain and stiffness.

Read about medications and other treatments for AS.

AS is a type of inflammatory arthritis that causes chronic pain and stiffness in the back and neck. These symptoms can temporarily flare up.

Flare-up triggers include physical inactivity, poor posture, eating inflammatory foods, and smoking.

People with AS can manage the condition by exercising regularly, following a physical therapist’s advice, eating nutritious foods, maintaining a moderate weight, avoiding smoking, and taking medications as a doctor prescribes.