Ankylosing spondylitis (AS) is a painful type of arthritis affecting the spine and pelvis. Many common things can worsen the symptoms of AS.

Ankylosing spondylitis (AS) is a type of arthritis characterized by pain and inflammation of the spine and pelvic region. This condition can also cause spine sections to grow and fuse together, resulting in stiffness and immobility.

There’s no cure for AS, but medications can help you manage your symptoms. Certain lifestyle choices may worsen your symptoms, though, even if you take prescription medication to improve your quality of life.

Here are eight things that can make your ankylosing spondylitis worse and what you can do about them.

When you’re living with chronic back pain, exercise may seem impossible. However, leading a sedentary lifestyle can aggravate symptoms. Physical activity can help improve joint flexibility and reduce the pain and stiffness caused by AS.

You do not have to engage in high impact activity to feel better but consider adding some form of physical activity to your daily or weekly schedule.

Aim for about 30 minutes of activity at least five days a week, but ask your doctor for recommendations before beginning an exercise regimen.

AS can negatively affect your balance and posture. Working on keeping a good posture with a focus on extending your spine can help reduce the chance that your spine will fuse in a bent position.

Everyone’s AS progresses differently. Since it’s impossible to tell if you have a higher or lower chance of spinal fusion or when it might develop, the earlier you can work on your posture, the more helpful it will be.

Whenever you can, try to practice good posture, whether you’re sitting or standing. This can help:

  • alleviate pain
  • strengthen your back muscles
  • help prevent anterior flexion deformity, where your spine is fixed in a stooped position

When sitting in a chair, your back should be straight, your shoulders should be back, and your buttocks should be touching the back of your chair. Keep your knees bent at a 90-degree angle and your feet flat on the floor.

Practice good posture while standing the old-fashioned way: Walk around with a book on your head. This teaches you how to stand tall with your body aligned. In addition, try not to sit for very long at a time, taking breaks to move around and stretch your back.

Researchers have found a link between smoking and disease activity in people with AS.

A 2021 study of smokers and nonsmokers found that smoking was associated with signs and symptoms such as:

  • less spinal mobility
  • less chest expansion
  • a statistically significant reduction in chest expansion
  • higher disease activity, as measured by the BASDAI and Ankylosing Spondylitis Disease Activity Score (ASDAS)
  • a higher number of inflammatory markers

This could be due to the inflammatory effect smoking has on the body. The researchers believe that smoking cessation should be included in treatment plans for AS.

Because AS can cause inflammation, stiffness, and joint pain, it’s important that you do not overdo it and learn how to recognize your limitations.

Failure to pace yourself could result in burnout, or you might engage in activities that put too much strain on your joints. This can make it harder for your body to recover and even trigger long-term stiffness and joint immobility.

So while activity is recommended, pace yourself. Listen to your body and rest when you feel tired or burnt out.

There’s no cure for AS, so you may need ongoing medication therapy to help manage your symptoms.

Your doctor will recommend medication and dosages based on your individual condition. It’s important to take your medication as directed to slow disease progression, so try not to skip doses.

If you feel that your medication is not improving your condition, speak with your doctor. They may need to adjust your dosage or recommend a different type of medication.

Medications for ankylosing spondylitis (AS)

Treatments for this condition include:

  • anti-inflammatory medications
  • over-the-counter pain relievers
  • immunosuppressants
  • biologics, which target specific proteins causing inflammation
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Being overweight may also worsen the symptoms of AS. In a 2022 study, researchers found that having a higher body mass index (BMI) was associated with more symptoms of AS.

Carrying more weight can put too much pressure on your joints and increase your pain levels. In addition, obesity is associated with increased inflammation.

Adding physical activity to your schedule can help you achieve or maintain a moderate weight.

Consider modifying your diet as well.

Reduce your intake of processed foods, sugary foods, and fatty foods, which can inflame your body. Increase your consumption of the following foods:

  • fruits
  • vegetables
  • whole grains
  • lean meats
  • healthy fats like nuts and avocados

Learn more about weight and AS.

Sleeping is hard when you’re in pain. You may have trouble falling asleep, or you may wake up frequently throughout the night. Sleep is how your body repairs itself, so lack of sleep may worsen AS symptoms.

To reduce nighttime pain and boost sleep, you may need to get a mattress that provides more comfort and support, such as a medium-firm mattress. To lessen neck pain during the night, limit the number of pillows you use.

Other tips for creating a comfortable sleep environment:

  • Keep your room cool.
  • Turn off all lights.
  • Create a quiet environment as best you can. A white noise machine can help block out noises.

The aim is to develop a bedtime routine that encourages sleep and to practice measures that will help to prevent overstimulation. Other steps you can take:

  • Have a hot bath or shower before bed.
  • Turn off the TV and other electronic devices about 1 hour before going to bed, as recommended by the National Sleep Foundation.
  • Avoid alcohol or caffeine before bed.
  • Do not eat large meals 2-3 hours before you hit the hay.

If none of these tips help you sleep better, it’s a good idea to see a sleep specialist to rule out sleep apnea. Research from 2020 suggests that AS may increase your chance of developing a sleep condition.

Stressful situations may unknowingly worsen symptoms of AS. A meta-analysis from 2020 found that people with AS have a higher chance of experiencing depression and anxiety, which can be worsened by stress.

Stress triggers the release of stress hormones such as cortisol and adrenaline, which send your body into fight-or-flight mode. This increases your blood pressure and heart rate.

Stress hormones also stimulate your immune system to release cytokines, which are proteins that cause inflammation. Chronic stress can keep your body in an inflammatory state and worsen AS.

To manage stress and reduce inflammation:

  • Practice deep breathing exercises and meditation to relax your mind and body.
  • Learn how to say “no.”
  • Reduce your personal obligations.
  • Set reasonable goals for yourself, physically and otherwise.
  • Get more rest.
  • Talk about your problems with a friend.
  • Distract yourself with a fun activity whenever you’re feeling stressed out.
  • Spend time in nature.
  • Adopt a pet.

What causes ankylosing spondylitis to flare up?

If you’re living with AS, it’s a good idea to avoid foods containing added sugar or high sodium, foods with saturated fats or trans fats, and foods containing preservatives. It’s also a good idea to quit smoking and avoid or limit drinking alcohol.

What are the red flags of ankylosing spondylitis?

AS primarily causes back stiffness and pain, especially upon waking, along with joint inflammation and issues affecting the eyes. In severe cases, it also leads to bone growth or hardening of ligaments, resulting in a loss of flexibility.

What are the coping mechanisms for ankylosing spondylitis?

Living with a chronic illness like AS can be challenging and can lead to increased stress and psychological distress. Some coping strategies include trying stress-reducing activities such as meditation or a warm bath, making a routine that encourages better sleep, and seeing a therapist for regular mental health support.

Learn more about self-care with AS.

Symptoms of AS can range from mild to severe. Depending on the severity of your condition, symptom flare-ups can make everyday activities challenging.

Medication can help you feel better, but certain lifestyle changes are also essential to helping you improve your outlook and enjoy life to the fullest.