Spondylitis (also called spondyloarthritis) is a group of inflammatory diseases that primarily affect the joints of the spine, hips, and other areas where ligaments and tendons attach to bone. The inflammation can cause pain and stiffness that gradually worsen over time. In more advanced stages, chronic inflammation can lead to reduced flexibility or fusion of the spine.

Depending on the type of spondylitis, inflammation may also affect other parts of the body, such as the eyes, skin, or intestines.

If you’re living with ongoing back pain, stiffness, or fatigue that doesn’t improve with rest, pay attention to your symptoms and talk with your healthcare provider. Early diagnosis and treatment can help protect your mobility and overall quality of life.

1. Back Pain

Back pain caused by inflammation is the primary symptom of spondylitis. This pain often gets worse after long periods of rest, such as when you sleep. You may feel tempted to rest more or avoid movement, but too much inactivity can actually make symptoms worse. Gentle stretching, light exercise, or taking a warm shower can help ease stiffness and pain.

Back pain from spondylitis tends to be long-lasting — usually three months or more — and does not fully improve with rest. The pain often affects both sides of the lower back rather than one specific area and may feel like a dull ache. It can also spread to the neck, shoulder blades, hips, or other joints.

One member of MySpondylitisTeam shared, “I suffered with pain under my right shoulder blade and was having trouble with numbness and tingling down my right arm. I started using a neck pillow when in the recliner or sleeping, which helped. I finally figured out that sitting hunched over was contributing to the problem.”

2. Posture Changes

Stiffness is another common symptom of spondylitis that often comes with back pain. Over time, inflammation can cause damage to the spine, which may lead to ankylosis (fusion of the vertebrae) and posture changes. The term “ankylosing spondylitis posture” is sometimes used to describe the forward-stooped or curved (“question-mark”) posture that can develop when the spine becomes less flexible.

Paying attention to your posture every day can help reduce stiffness and may prevent long-term changes to the shape of your back. Regular exercise and stretching help preserve flexibility and range of motion. Targeted exercises that strengthen the back and core muscles also support better stability and spinal alignment.

Talk with your healthcare provider about a referral to a physical therapist who can teach you safe, effective exercises designed for people with spondylitis.

Other tips to maintain good posture include:

• Adjust monitors and TVs so your eyes are level with the screen, not looking up or down.
• Keep your ears aligned with your shoulders to avoid pushing your neck forward.
• Use a lumbar (lower back) cushion when sitting.
• Try a sit-stand desk or take breaks to stretch and move often.

Your sleep position also matters. Try lying on your back with a pillow under your knees, or if you prefer sleeping on your side, place a pillow between your knees to reduce pressure on your hips and lower back.

3. Other Joint Pain

Peripheral spondyloarthritis is a form of spondylitis that affects joints outside the spine. It can cause inflammation, pain, and swelling in joints such as the fingers, toes, wrists, ankles, knees, elbows, and hands. Although it’s less common, some people with radiographic axial spondyloarthritis (r-axSpA) — also called ankylosing spondylitis (AS) — experience more peripheral (limb) symptoms than axial (spinal) symptoms. Peripheral involvement is also more common among children and teens living with spondyloarthritis.

Types of peripheral spondyloarthritis include:

• Psoriatic arthritis
• Reactive arthritis
• Enteropathic arthritis
• Undifferentiated spondyloarthritis

Your healthcare provider can order tests and imaging to help identify which type of spondylitis you have and whether it’s connected to another underlying condition. For example, in psoriatic arthritis, small joints in the hands and feet are often affected, and many people also notice scaly skin patches related to psoriasis.

4. Bowel Issues

Enteropathic arthritis is a type of spondyloarthritis that occurs in people with inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis. Because inflammation affects both the joints and the digestive tract, gastrointestinal symptoms are common and may include:

• Bloating
• Bloody stool (poop)
• Diarrhea and cramping
• Stomach pain
• Unexpected weight loss
• Signs of malnutrition

IBD can also occur in people with AS. Studies show that between 5 percent and 10 percent of people with AS also have IBD. Although a clear cause is not yet known, researchers believe shared immune system pathways and gut microbiome changes may play a role.

If you live with spondyloarthritis and notice new digestive symptoms, talk with your healthcare provider. They may recommend testing for IBD and review your medications to help prevent stomach irritation. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) can ease joint pain and inflammation but may worsen digestive symptoms in some people. Your doctor can suggest alternative pain-relief options or adjust your treatment plan to better protect your gut health.

5. Intense Fatigue

Fatigue is a common and sometimes overwhelming symptom of spondylitis. It refers to a deep sense of tiredness or weakness that doesn’t improve with rest.

Studies show that 50 percent to 70 percent of people with AS report fatigue as one of their main symptoms. One study found that 85 percent of people with AS reported some fatigue, and in 32 percent of cases, the fatigue was severe.

People with spondylitis may describe fatigue and related symptoms as:

• Brain fog (trouble thinking clearly)
• Difficulty concentrating
• Low levels of motivation
• Low physical energy
• Persistent mental and physical exhaustion
• Trouble making decisions

Inflammation is one of the main reasons fatigue develops in spondylitis. However, research shows that even when inflammation improves with medication, many people still experience fatigue. This finding suggests that other factors may also play a role, including:

• Poor sleep
• Chronic pain
• Mood changes

It’s important to remember that fatigue isn’t “just in your head.” It’s a real, biologically driven symptom that affects people with spondylitis and other chronic conditions. Your healthcare provider can help you identify and manage potential causes — such as sleep issues, stress, or medication side effects — and find practical ways to conserve energy and feel more in control.

6. Heart Complications

Inflammatory conditions like spondylitis are linked to a higher risk of heart and blood vessel disease. Research shows that people with AS have about a 25 percent higher risk of heart disease and up to a 60 percent higher risk of stroke compared with people without the condition.

One reason may be inflammation of the aorta, the body’s largest artery, which carries blood from the heart to the rest of the body. In some people with spondylitis, inflammation can affect the aortic valve (the flap that controls blood flow from the heart into the aorta). Over time, this can cause the valve to thicken or lose flexibility, leading to a condition called aortic insufficiency. In severe cases, surgery may be needed to repair or replace the valve.

NSAIDs — commonly used to manage pain and stiffness — can also affect heart health. Some studies suggest that long-term use of certain NSAIDs may increase the risk of heart attack, stroke, or death from heart disease. However, not all NSAIDs carry the same level of risk, and using the lowest effective dose for the shortest time may reduce side effects. It’s important to discuss your medications and heart health with your doctor or rheumatologist.

Knowing your risks can help you make heart-healthy choices. People living with spondyloarthritis may benefit from:

• Checking blood pressure and cholesterol regularly
• Staying physically active most days of the week
• Eating a heart-healthy diet rich in fruits, vegetables, and whole grains
• Avoiding tobacco and limiting alcohol

These steps, along with controlling inflammation, can lower your chances of developing heart complications and improve overall well-being.

7. Osteoporosis

There’s a well-established connection between osteoporosis (a condition that causes weakened bones) and spondylitis. Between 19 percent and 62 percent of people with AS have osteoporosis. Bones may become weaker over time, especially if pain, stiffness, or fatigue lead to less physical activity.

Osteoporosis can also occur early in the course of spondylitis — even before spinal fusion develops — and researchers are still studying why. Keeping bones strong is important to prevent fractures and other complications. When vertebrae become weak, they are more likely to develop compression fractures. These tiny breaks in the bone can worsen posture, increase back pain, and, in severe cases, affect the spinal cord.

Your healthcare provider may recommend lifestyle and medical strategies to protect bone health, including taking vitamin D and calcium supplements and doing muscle-strengthening exercises. Early bone health screening may also be helpful, especially for those at higher risk.

8. Eye Problems

Around 1 in 3 people with AS develop eye inflammation. This condition is called uveitis or iritis.

Common symptoms include:

• Blurred vision
• Eye pain
• Light sensitivity
• Redness
• Watery eyes

Although common, these symptoms can come on suddenly and catch you off guard.

Call your healthcare provider right away if you notice any changes or problems with your eyes. They can prescribe treatment to help protect your vision.

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On MySpondylitisTeam, people share their experiences with spondylitis, get advice, and find support from others who understand.

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