Ankylosing spondylitis

Ankylosing spondylitis (often shortened to AS) is a long-term, or chronic, type of arthritis that mainly affects the spine. "Arthritis" simply means inflammation in a joint. In AS, the inflammation tends to start in the sacroiliac joints — the two joints at the base of the spine where it connects to the pelvis (the large bones of your hips). Over time it can also affect the joints higher up the spine.

The word "ankylosing" refers to a process called ankylosis, where, in some people, the body lays down extra bone in response to long-standing inflammation. This can cause sections of the spine to gradually stiffen or, less commonly, fuse together so they move as one. "Spondylitis" means inflammation of the spine. So the name describes inflammation of the spine that can, over years, lead to stiffening.

It helps to know what AS is not. It is not caused by an injury, by lifting something heavy, or by "wear and tear" the way ordinary mechanical back pain often is. Instead it is an autoimmune and inflammatory condition, meaning the immune system — the body's defence system — becomes overactive and causes inflammation in the joints and in the places where ligaments and tendons attach to bone.

AS is part of a wider family of related conditions, and doctors now usually describe it under the umbrella term axial spondyloarthritis. According to the Spondylitis Association of America, drawing on US health survey data, an estimated 1.7 million American adults have ankylosing spondylitis and around 3.2 million have axial spondyloarthritis in some form. It is a recognised, well-studied condition with established treatments.

Doctors today think of ankylosing spondylitis as the more advanced, X-ray-visible form of a larger condition called axial spondyloarthritis (axSpA). "Axial" refers to the central skeleton — the spine and pelvis. There are two main forms:

• Radiographic axial spondyloarthritis — this is what has traditionally been called ankylosing spondylitis. Here, the inflammation has caused changes in the sacroiliac joints that can be seen on a plain X-ray (a "radiograph").
• Non-radiographic axial spondyloarthritis (nr-axSpA) — here a person has the same kind of inflammatory back pain, but the changes are not yet visible on a standard X-ray. They may, however, show up on an MRI scan, which is more sensitive. Some people with this form later develop the X-ray changes of AS; many do not.

AS also belongs to a broader group called the spondyloarthritis family. The Spondylitis Association of America lists related conditions in this group, including psoriatic arthritis (linked to the skin condition psoriasis), reactive arthritis (which can follow certain infections), enteropathic arthritis (linked to inflammatory bowel diseases such as Crohn's disease and ulcerative colitis), and juvenile spondyloarthritis (which begins in childhood). These conditions share features such as inflammation at tendon attachments and a link to a gene called HLA-B27.

One older but still-used term you may hear is "bamboo spine". This describes the appearance on an X-ray when, in advanced cases, parts of the spine have fused and look smooth and column-like. It is worth knowing that with modern treatment, this severe degree of fusion is far less common than it once was.

The exact cause of ankylosing spondylitis is not fully known. Most experts, including the NHS and Cleveland Clinic, agree that it develops from a combination of genes and, probably, environmental triggers acting together. It is not contagious, and it is not caused by anything you did.

The strongest known link is to a gene variation called HLA-B27. HLA genes help the immune system tell the body's own cells apart from invaders. The Spondylitis Association reports that HLA-B27 is found in more than 95% of white people who have AS, and Cleveland Clinic notes that more than 90% of white people with AS carry it. However — and this is important for reassurance — carrying HLA-B27 does not mean you will get AS. Most people who carry the gene never develop the condition. Cleveland Clinic notes that around 80% of children who inherit the gene from a parent with AS do not go on to develop the disease. Researchers have also identified more than 60 other genes that may play a part, so HLA-B27 is only one piece of the picture.

Known risk factors include:

• Family history — having a close biological relative with AS or a related condition increases the chance.
• Age — symptoms usually begin in late teens to early adulthood. Cleveland Clinic notes more than 80% of people are diagnosed before age 40, and onset after age 45 is unusual.
• Related conditions — having psoriasis, Crohn's disease, or ulcerative colitis is associated with a higher chance of AS.
• Sex — AS has traditionally been considered more common in men, though research now suggests the gap is smaller than once thought, and women are often diagnosed later.

The most common early symptom is back pain and stiffness, usually low in the back and in the buttocks, that develops slowly over weeks to months rather than coming on suddenly. The pain of AS has a particular pattern that doctors call inflammatory back pain, and recognising it can help with an earlier diagnosis. Typical features described by Cleveland Clinic include:

• Pain that has lasted three months or longer.
• Stiffness that is worse in the morning or after rest, and that can wake you in the second half of the night.
• Pain and stiffness that improve with movement and exercise, rather than getting worse — the opposite of most mechanical back strain.
• Pain that may spread into the hips and buttocks.

Other symptoms can include extreme tiredness (fatigue), pain and swelling in other joints such as the shoulders, knees, ribs, or heels, and tenderness where tendons attach to bone — a feature called enthesitis (for example, pain at the back of the heel). Some people also experience symptoms outside the joints, such as a painful red eye (see the section on living with the condition), tummy problems, or a psoriasis skin rash.

When to see a doctor: the NHS advises seeing a GP or doctor if you have back pain that started gradually, has lasted more than three months, is worse in the morning or improves with exercise, and is not better after resting. It is worth getting checked even if the symptoms seem mild, because earlier diagnosis allows earlier treatment. Seek prompt medical attention if you develop a painful, red, light-sensitive eye, as this can be a sign of eye inflammation that needs quick treatment.

There is no routine population screening programme for ankylosing spondylitis, the way there is for some cancers. It is not a condition that is picked up by a standard health check unless you have symptoms. Instead, the key to early detection is recognising the pattern of inflammatory back pain described above and raising it with a doctor.

Early detection matters because AS often affects young, active adults, and back pain in this age group is common and easy to dismiss as a strain. Studies have repeatedly found that there can be a long delay — sometimes several years — between the first symptoms and a firm diagnosis. The delay tends to be longer in women, partly because AS was historically thought of as a mainly male condition.

If you carry the HLA-B27 gene or have a close relative with AS or a related spondyloarthritis, it is worth mentioning this to your doctor if you develop persistent back pain, as it may prompt a more focused assessment. However, testing for HLA-B27 on its own is not a screening test for the general population: many healthy people carry the gene and never develop any joint problem, so a positive result by itself does not mean you have or will get AS.

There is no single test that proves someone has ankylosing spondylitis. Diagnosis is made by a doctor — usually a rheumatologist, a specialist in joint and autoimmune conditions — who puts together several pieces of information.

History and examination. The doctor will ask about the pattern of your pain and stiffness, your family history, and any related symptoms such as eye inflammation, psoriasis, or bowel problems. They will examine your spine, posture, and how far your back and hips can move, and may measure your chest expansion when breathing.

Imaging. Scans look at the sacroiliac joints and spine for signs of inflammation or bone change:

• X-rays can show damage or changes in the sacroiliac joints, but these changes take time to develop, so an early X-ray can be normal.
• MRI scans are more sensitive and can detect active inflammation before any damage shows on an X-ray. This is how non-radiographic axial spondyloarthritis is often identified.

Blood tests. A test for the HLA-B27 gene can support the diagnosis, though, as noted, it is not conclusive on its own. Tests for inflammation in the blood, such as CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate), may be raised but are normal in some people with AS, so a normal result does not rule it out.

Doctors also use simple questionnaires to measure how active the disease is and how much it affects daily life — for example, a tool called the BASDAI (Bath Ankylosing Spondylitis Disease Activity Index). Unlike cancers, AS is not given a numbered "stage"; instead, doctors describe how active the inflammation is and how much movement or structural change has occurred, and use this to guide and adjust treatment.

There is currently no cure for ankylosing spondylitis, but — and this is the key message — there are effective treatments that can control inflammation, relieve pain and stiffness, keep you moving, and in many cases slow the condition down. Care is usually delivered by a multidisciplinary team, which may include a rheumatologist, a physiotherapist, an occupational therapist, an ophthalmologist (eye specialist) if the eyes are affected, and sometimes an orthopaedic surgeon. Treatment is tailored to each person and reviewed over time.

Exercise and physiotherapy. This is the foundation of treatment, not an optional extra. Because AS pain typically eases with movement, regular exercise and a physiotherapist-designed programme of stretching and posture work can reduce stiffness, maintain mobility, and help keep the spine flexible. The NHS describes options including individual and group exercise programmes, daily stretching, swimming, and hydrotherapy (exercising in a warm pool).

Medications. The NHS and Cleveland Clinic describe a stepped approach:

• Anti-inflammatory painkillers (NSAIDs) such as ibuprofen, naproxen, diclofenac, or etoricoxib are usually the first medicines tried, to reduce pain and inflammation. Doses are individualised and monitored by a doctor.
• Biological medicines are used when NSAIDs and exercise are not enough. These are targeted treatments, usually given by injection, that block specific signals driving the inflammation. They include anti-TNF medicines and monoclonal antibodies that target a protein called IL-17 (such as secukinumab and ixekizumab).
• JAK inhibitors are newer tablet medicines that block enzymes involved in inflammation; they may be an option for people who do not respond to anti-TNF treatment.
• Corticosteroid injections into a specific inflamed joint can give short-term relief; their use is limited because of potential side effects.
• DMARDs such as sulfasalazine or methotrexate are mainly used when joints outside the spine (such as the knees or hands) are affected, as they are less helpful for spinal symptoms.

Surgery. Surgery is uncommon in AS and is reserved for specific situations, such as replacing a severely damaged hip joint or, rarely, correcting a significant spinal deformity. Most people never need an operation.

The course of ankylosing spondylitis varies a great deal from one person to another, and this is genuinely good news: it means a diagnosis does not tell you how things will turn out for you as an individual. Some people have mild, intermittent symptoms; others have more troublesome disease. Many people have periods when symptoms flare up and periods when they settle down (sometimes called remission).

The NHS notes that the outlook is variable: in some people symptoms improve or stay stable, while in others the condition slowly progresses. Importantly, the NHS also states that with modern treatment, AS does not typically have a major effect on life expectancy. Cleveland Clinic emphasises that most people with AS can lead productive, active lives, including working and exercising.

These statements describe groups of people studied over time. They are not a prediction for any one person, and your own outlook depends on many factors, including how early the condition is found, how well inflammation is controlled, and your overall health. Because the condition behaves so differently in different people, the most reliable picture of your own situation will come from a rheumatologist who knows your history and examination findings.

What is well established is that early diagnosis, staying physically active, and effective control of inflammation give the best chance of keeping mobility and quality of life over the long term.

Ankylosing spondylitis is a lifelong condition, so most care happens day to day, at home and in regular reviews, rather than in a single procedure. The aim is to keep you moving comfortably and to catch any problems early.

Staying active. Keeping up the exercise and stretching programme set by your physiotherapist is one of the most useful things you can do, even on days when you feel well. Good posture habits and a supportive sleeping setup can also help.

Regular follow-up. The Spondylitis Association recommends regular rheumatology review even when symptoms are mild, so that disease activity and any complications can be monitored. Reviews may include assessing your symptoms and mobility, blood tests, and sometimes imaging, and adjusting medication as needed.

Watching for complications. AS can sometimes affect other parts of the body, and knowing the warning signs helps you act early:

• Eye inflammation (uveitis or iritis) — a sudden painful, red, light-sensitive eye should be assessed urgently by an eye specialist.
• Osteoporosis (thinning of the bones) is more common in AS and can raise the risk of spinal fractures; your team may monitor bone health.
• Less commonly, long-standing AS can affect the heart, the lungs (especially if rib joints are stiff), or other areas, which is another reason regular review matters.

Living well with AS is also about the whole person — managing fatigue, pacing activity, looking after mental wellbeing, and leaning on support networks and patient organisations. Many people find that once treatment is settled, the condition becomes something they manage rather than something that dominates their life.

Ankylosing spondylitis is a long-term condition managed mostly with medication and physiotherapy rather than a one-off operation, so planning care abroad is a little different from planning a single surgery. People most often travel for a thorough specialist assessment, to start or review biologic therapy, or for a structured rehabilitation programme. Because every case is individual, BergemHealth does not list fixed prices; instead, we arrange a personalised estimate after a free consultation.

Several factors influence the overall cost of care:

• What you actually need — an initial diagnostic work-up, ongoing medication, or a more involved treatment plan all differ considerably.
• Investigations — the number and type of tests, such as MRI, X-rays, and blood work.
• Medication — whether treatment involves standard anti-inflammatory tablets or longer-term biologic medicines, which are more costly and given over time.
• Specialist and therapy time — rheumatology consultations and physiotherapy or rehabilitation sessions.
• Length of stay and logistics — how long you stay, accommodation, translation, and follow-up arrangements after you return home.

How to prepare your records. Gathering your information in advance makes any assessment faster and more accurate. Useful items include: a summary of your symptoms and when they started; copies of any previous X-ray, MRI, or scan reports (and the images themselves if possible); blood test results, including any HLA-B27, CRP, or ESR results; a list of medications you have tried and how you responded; and details of any other conditions such as psoriasis or bowel disease. Having these ready helps a specialist give clear, realistic advice and a tailored estimate.

Turkiye has become a well-known destination for international patients seeking specialist medical care, with experienced rheumatology and orthopaedic teams, modern hospitals, and established services for arranging travel, translation, and accommodation. For a long-term condition like ankylosing spondylitis, the most important thing is finding a centre that can provide careful diagnosis, evidence-based treatment, and a clear plan for follow-up — including how your care will continue once you are back home.

When choosing where to have your care, it is sensible to verify a few practical points rather than relying on marketing claims:

• Accreditation — check whether the hospital holds recognised quality accreditation (for example, international accreditation such as JCI, alongside national standards).
• The specialist team — confirm that a qualified rheumatologist will lead your care, and that physiotherapy and other relevant specialists (such as ophthalmology for eye involvement) are available.
• An evidence-based approach — treatment should follow recognised guidelines and be tailored to you, with realistic explanations rather than promises of a cure.
• Clear communication — reliable translation, written treatment plans, and clarity about what is and is not included.
• Continuity of care — a plan for ongoing monitoring and how findings will be shared with your doctor at home.

A good concierge service should help you compare options transparently, organise your records, and make sure you understand each step. Be cautious of any provider that guarantees a cure or uses "best" or "number one" claims — reputable specialists focus on controlling the condition and protecting your quality of life, not on superlatives.

Alongside medical treatment, day-to-day self-care plays a real part in living well with ankylosing spondylitis. The most consistently recommended steps are simple and within your control:

• Keep moving. Regular exercise, daily stretching, and the specific routine your physiotherapist sets are central to maintaining mobility and easing stiffness.
• Stop smoking. Smoking is linked to worse outcomes in AS and is bad for the lungs, which can already be affected if rib movement is reduced. Stopping is one of the most helpful changes you can make.
• Look after your posture and bones. Good posture habits, a supportive sleeping arrangement, and attention to bone health (including discussing vitamin D and weight-bearing exercise with your doctor) can all help.
• Pace yourself and rest when you need to. Managing fatigue and flares, and balancing activity with rest, helps you stay consistent over the long term.
• Take care of your general health. Because AS can affect the heart and increase cardiovascular risk over time, attention to blood pressure, weight, and overall fitness is worthwhile.

Second opinions. Because AS is a lifelong condition and treatment decisions — especially around starting biologic medicines — can be significant, it is completely reasonable to seek a second opinion from another qualified rheumatologist if you are unsure or if your symptoms are not improving. A good doctor will welcome this. Patient organisations such as the Spondylitis Association of America and Versus Arthritis offer trustworthy, plain-language information and support to help you make decisions with confidence.