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Can You Be Making Your Ankylosing Spondylitis Worse?

Ankylosing spondylitis is a type of arthritis that affects the spine and other joints of the body. The disease causes inflammation of the vertebrae or the spinal joints that leads to chronic pain, swelling, and severe discomfort. The condition is more commonly observed in men and is known to begin in early adulthood usually. This type of arthritis is characterized by inflammation and pain in the pelvic and spine region.

Can You Be Making Your Ankylosing Spondylitis Worse?

Can You Be Making Your Ankylosing Spondylitis Worse?

While there is no cure for ankylosing spondylitis and treatment helps manage your symptoms. However, even if you are taking prescribed medications and other therapies for managing your ankylosing spondylitis and improving the quality of life, there are still many things you might be doing to worsen your symptoms. Is it possible that you can be making your ankylosing spondylitis worse? Let’s take a look.

Sedentary Lifestyle and Lack of Physical Activity or Exercise

When you have ankylosing spondylitis, you are used to living with chronic back pain. In many cases, patients start feeling like exercising is an impossible task and will only aggravate their pain. However, the fact is that avoiding exercise and living a sedentary lifestyle is only going to exacerbate the symptoms of the disease. Regular physical activity is necessary to help improve your joint flexibility and also reduce the stiffness and pain caused by ankylosing spondylitis.

At the same time, this does not mean that you have to engage in high impact activity in order to feel better. But, adding some level of physical activity or low impact exercises to your daily and weekly schedule is necessary.

You can try to aim for getting at least 30 minutes of activity for at least four to five days in a week. Activities such as walking, biking, swimming, and even strength training with tai chi, yoga, and pilates, will help.

If you are unsure about what you should be doing, then you can always ask your doctor for recommendations on what activities you can do before you start your exercise regimen, but it is definitely important that you keep on exercising regularly even through the pain and stiffness.(1)

Smoking is Going to Interfere With Your Treatment

If you have ankylosing spondylitis and you are a smoker, then this is as good a time as any to quit. According to medical experts, smoking is one of the worst things you can do for your condition and your symptoms. People who have a genetic susceptibility towards ankylosing spondylitis are usually unaware that the disease only needs an environmental factor to trigger it. Smoking is one such factor that is capable of triggering the disease, and it also causes the condition to respond poorly to medications and other treatments.

Research done by the Universidad Francisco de Vitoria in Spain and published in 2017 in the Seminars in Arthritis and Rheumatism found that people who smoke 10 cigarettes or more in a day are likely to report feeling more pain and disease activity, problems with range of motion and overall mobility, and also a worse quality of life when suffering from ankylosing spondylitis.(2)

Another, more recent, study done by the Cairo University in Egypt in 2015 established a link between disease activity of ankylosing spondylitis and smoking.(3) The study followed 30 participants who were smokers and non-smokers and were living with ankylosing spondylitis. According to the researching team, smokers who were having the disease report experiencing more extended and worse periods of morning stiffness, greater disease activity, as well as a poorer quality of life as compared to the non-smoking participants of the study.

This is believed to be because of the inflammatory effect(4) that smoking has on the body. This is why medical experts around the world firmly believe that quitting smoking should also be included as part of the treatment plan for ankylosing spondylitis.

Poor Posture

You might not pay much attention to this factor, but having a poor posture is also likely to worsen your symptoms of ankylosing spondylitis. It is essential that you keep your body aligned correctly so as to strengthen the muscles in your back. This will help in preventing any further anterior flexion deformity, a condition where the spine becomes fixed in a stooping posture. A correct posture will also help relieve pain and stiffness.

So you should pay attention to practicing proper posture while sitting or while standing. Ensure that when you are sitting in a chair, your back is straight, shoulders kept back, and your buttocks should be touching the backend of the chair. You should also try to keep your knees bent at a 90-degree angle and place your feet flat on the ground.

While standing also, you should practice good posture. Keep in mind the old fashion way of practicing good posture by walking around with a book on your head. While this is an ancient technique, it will, nevertheless, still teach you how to stand tall and in a correct posture so that your body is aligned correctly.

In 2006, a study was published in the Rheumatology journal that looked at whether patients who have ankylosing spondylitis have poorer balance when it comes to having a proper posture and whether a poor balance throws off their posture.(5) The study, though, found that ankylosing spondylitis has no adverse effect on a person’s postural stability, further confirming the fact that if you practice poor posture, it is only going to worsen your disease symptoms.

Drinking Alcohol

Alcohol is bad for people who have ankylosing spondylitis for many reasons. First of all, alcohol is known to affect the ratio of good to bad bacteria present in the gut. Many autoimmune diseases are known to be related to the gut health of a person, and if the ratio of good bacteria to bad bacteria gets disrupted, it is likely to throw off your health, worsening the symptoms of ankylosing spondylitis.

Secondly, many alcoholic beverages, such as lagers, ales, beers, and even malt beverages, are manufactured from grains that contain gluten. Many people who have ankylosing spondylitis have an increased sensitivity to gluten, which, again, worsens the symptoms of the disease.

This is why it is best if you start cutting down on drinking once you get your ankylosing spondylitis diagnosis.

Taking On Too Much

Ankylosing spondylitis is a condition that causes inflammation, joint pain, and stiffness. Due to this, it is essential that you do not overdo physically and also learn how to understand your limitations. If you fail to pace yourself out during the day, it could result in a burnout, or you might end up engaging in activities that put a bit too much strain on the affected joints. Putting too much of stress on your joints makes it difficult for your body to recover and for the medications to be effective. This further triggers long-term stiffness, pain, and joint immobility.

So while it is essential that you keep moving and indulge in some physical activity, but at the same time, learn to pace yourself and do not take on too much. Listen to your body and rest when you feel fatigued and burnt out.

Staying up Late and Lack of Sleep

If you have ankylosing spondylitis, then getting a good night’s sleep is going to be difficult. The condition interferes with your sleep in many ways, including disrupting your sleep due to the pain as well as because of depression that usually accompanies this disease. However, it still remains crucial that you get plenty of rest.

Sleep is known to have a restoring effect on the body and is vital to maintaining your overall health. A study published in Rheumatology International in 2013, investigated the quality of sleep in patients who have ankylosing spondylitis to evaluate the relationship of the disease parameters with sleep disturbance. There were 80 participants in the study. The researching team found that poor quality of sleep was positively associated with increased pain, higher prevalence of depressed mood, reduced overall quality of life, mobility restrictions, and higher disease activity as well. Due to all these factors, the participants sleep quality was disturbed, and the poor quality of sleep was further associated with increased pain, depression, disease activity, poor quality of life, and a greater limitation of mobility.(6)

It has been observed that people with ankylosing spondylitis who are sleep deprived tend to have a more difficult time dealing with their symptoms, and they also experience more frequent flare-ups. Getting at least seven to eight hours of sleep each night is therefore highly recommended for patients of ankylosing spondylitis.

You may find that you are able to sleep better and longer if you have a comfortable mattress and a pillow. Also, give yourself time to wind down and relax for at least an hour before bedtime.

Also, avoid taking caffeine or alcohol before your bedtime and do not consume any large meals at least two to three hours before you plan to go to bed. Make a comfortable sleeping environment by keeping your room temperature cool, turning off all lights, avoid the use of any mobile phones or tablets, and having a quiet environment for resting.

If you find that in spite of all your efforts you are still unable to sleep properly, then you can discuss with your rheumatologist. Sometimes pain and other symptoms of the disease keeps you awake at night, and this is a good indication to your doctor that your condition is not being well controlled by the present treatment plan. Changing treatment plan may help you sleep better as your symptoms are better controlled.

Neglecting To Take Your Medication Properly

It is essential to understand that there is no cure for ankylosing spondylitis. You will need to remain on ongoing medication and other therapies for managing your symptoms. Your doctor will design a treatment plan for your condition and prescribe medication and required dosage depending on your individual condition. It is absolutely essential that you take your medicines as your doctor has advised. Do not skip any doses. Taking your medication as directed by your doctor will not only help relieve some of your symptoms, but it will also slow down the progression of the disease.

If you feel like the medication is not helping and there is no improvement in your condition, then be sure to bring it up with your doctor. There might be a need to adjust the dosage of your medication or put you on a different type of medicine altogether.

Being Obese or Overweight

Being obese or overweight is likely to worsen the symptoms of ankylosing spondylitis. If you have excess weight, then it is going to put too much pressure on the body’s joints. This, in turn, is going to increase your pain level. Furthermore, obesity is also closely linked with greater inflammation within the body.

If you are obese or overweight, then adding certain physical activities to your daily routine will help in losing a couple of pounds. Even a loss of five pounds can make a drastic difference to your symptoms and overall condition. At the same time, modify your diet to decrease the intake of processed foods and fatty and oily foods.

Also reduce your intake of sugary foods, which is known to boost inflammation in the body. Sugary foods, in particular, are considered to be dangerous if you have ankylosing spondylitis because sugar disrupts the body’s insulin levels. Insulin levels are directly connected to the body’s hormone activity, which affects the flare-ups of the disease. This is why avoiding sugary foods is always recommended in ankylosing spondylitis.

You should increase your intake of fresh fruits and vegetables, lean meats, whole grains, and healthy fats such as avocados, olive oil, and nuts.

According to the American Gastroenterological Association, taking probiotics may also help.(7) Probiotics are known to help heal the guts of people who have ankylosing spondylitis. You can find probiotics in yogurt, many other dairy products, powders, supplements, capsules, and juices. However, only start taking probiotics after discussing with your doctor about which probiotic will be right for you.

Keep in mind that the higher your body mass index is in ankylosing spondylitis, the greater will be the burden of your symptoms, especially the pain levels.(8)


Symptoms of ankylosing spondylitis vary from person to person. They can be mild to severe and depending on the severity of your condition, carrying out day to day activities may become challenging, especially during a flare-up.

At the same time, try and keep your stress levels to a minimum as chronic stress is known to worsen the symptoms of ankylosing spondylitis. Managing your stress levels will also help reduce inflammation, giving relief from some of the symptoms of the disease.

Get more rest, practice deep breathing exercises to relax your mind and body, learn to say ‘no’ when required. Spend time in nature, go for a walk by yourself, talk about your problems with a friend or family, and set reasonable goals for yourself.

Making these changes in your life will bring about a significant difference in your outlook and also slow down the progression of the disease.

While medication and therapy helps you feel better, making certain lifestyle changes will not only help improve your disease prognosis, but it will also allow you to enjoy your life to the fullest in spite of having a disease like ankylosing spondylitis.


  1. Millner, J.R., Barron, J.S., Beinke, K.M., Butterworth, R.H., Chasle, B.E., Dutton, L.J., Lewington, M.A., Lim, E.G., Morley, T.B., O’Reilly, J.E. and Pickering, K.A., 2016,
  2. February. Exercise for ankylosing spondylitis: An evidence-based consensus statement. In Seminars in arthritis and rheumatism (Vol. 45, No. 4, pp. 411-427). WB Saunders.
  3. Villaverde-García, V., Cobo-Ibanez, T., Candelas-Rodríguez, G., Seoane-Mato, D., del Campo-Fontecha, P.D., Guerra, M., Muñoz-Fernández, S. and Canete, J.D., 2017, April. The effect of smoking on clinical and structural damage in patients with axial spondyloarthritis: a systematic literature review. In Seminars in arthritis and rheumatism (Vol. 46, No. 5, pp. 569-583). WB Saunders.
  4. Gaber, W., Hassen, A.S., Abouleyoun, I.I. and Nawito, Z.O., 2015. Impact of smoking on disease outcome in ankylosing spondylitis patients. The Egyptian Rheumatologist, 37(4), pp.185-189.
  5. Barigye, O., Pasquini, L., Galea, P., Chambers, H. and Chappell, L., Synopses of Research Articles.
  6. Aydog, E., Depedibi, R., Bal, A., Eksioglu, E., Unlu, E. and Cakci, A., 2005. Dynamic postural balance in ankylosing spondylitis patients. Rheumatology, 45(4), pp.445-448. Batmaz, I., Sarıyıldız, M.A., Dilek, B., Bez, Y., Karakoç, M. and Cevik, R., 2013. Sleep quality and associated factors in ankylosing spondylitis: relationship with disease parameters, psychological status and quality of life. Rheumatology international, 33(4), pp.1039-1045.
  7. Gastro.org. (2019). American Gastroenterological Association. [online] Available at: https://www.gastro.org/practice-guidance/gi-patient-center/topic/probiotics [Accessed 6 Aug. 2019].
  8. Archive, M., Meeting, 2., Meeting, 2., PRSYM, 2., Meeting, 2., Meeting, 2., Meeting, 2., Meeting, 2., Meeting, 2., Meeting, 2., Meeting, 2., Meeting, 2., Abstracts, D., Index, K., Search, A., Favorites, Y., favorites, V., favorites, C. and Center, M. (2019). Increased Body Mass Index in Ankylosing Spondylitis Is Associated with a Greater Burden of Symptoms and Poor Perceptions of the Benefits of Exercise – ACR Meeting Abstracts. [online] ACR Meeting Abstracts. Available at: https://acrabstracts.org/abstract/increased-body-mass-index-in-ankylosing-spondylitis-is-associated-with-a-greater-burden-of-symptoms-and-poor-perceptions-of-the-benefits-of-exercise/ [Accessed 6 Aug. 2019].

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Sheetal DeCaria, M.D.
Sheetal DeCaria, M.D.
Written, Edited or Reviewed By: Sheetal DeCaria, M.D. This article does not provide medical advice. See disclaimer
Last Modified On:October 10, 2019

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