What are the main symptoms and treatments for ankylosing spondylitis (axial spon

Main symptoms of ankylosing spondylitis (axial spondyloarthritis) include inflammatory back pain, which is often worse at night and improves with activity, stiffness especially in the morning lasting more than 30 minutes, and pain that improves with exercise but not rest ².

Extra-articular symptoms may include uveitis, psoriasis, and inflammatory bowel disease ².

Treatment options involve the use of NSAIDs as first-line therapy, with the aim to use the lowest effective dose, and they may be continued if effective ¹,².

If NSAIDs are ineffective or contraindicated, paracetamol with or without codeine can be considered for residual pain, though evidence of efficacy is limited and there is a risk of dependency ².

For severe or active disease, especially if there is an inadequate response to NSAIDs, biological DMARDs such as TNF inhibitors (e.g., etanercept, infliximab, adalimumab) or IL-17 inhibitors may be prescribed ¹,².

Non-pharmacological management includes physiotherapy with tailored exercises, stretching, postural correction, and possibly hydrotherapy ³.

Surgery is considered only in cases of significant spinal deformity affecting quality of life or severe, unresponsive deformity despite optimal non-surgical management ³.