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Living with Ankylosing Spondylitis

Ankylosing spondylitis (AS), or axial spondyloarthritis, is an inflammatory disease that primarily affects the spine, causing some vertebrae to fuse over time. This fusion can reduce spinal flexibility, lead to a hunched posture, and, if the ribs are involved, make deep breathing difficult.

It typically begins in early adulthood, with symptoms like back pain and stiffness that worsen in the morning or after inactivity. While there is no cure, managing diet, exercise, sleep and stress can help ease symptoms, slow progression and improve quality of life.

Daily Impact of Ankylosing Spondylitis (AS)

The impact of ankylosing spondylitis extends beyond the joints, often affecting daily function and routine activities. The following are some ways it may present in everyday life:

  • Morning Stiffness

    : Many individuals wake up feeling their joints—especially the lower back, hips and shoulders—are stiff or “glued,” making it hard to get moving. On tough days, even simple tasks like brushing teeth or dressing can feel difficult.

  • Back or Hip Pain

    : Chronic pain in the lower back or buttocks is a common symptom, often easing with movement but worsening after prolonged sitting or lying down. Hip pain may also spread to the thighs or legs, making daily activities uncomfortable.

  • Fatigue

    : Most people with AS experience extreme tiredness, often worse than normal fatigue. This is due to chronic inflammation, pain-disrupted sleep or sometimes anaemia.

  • Difficulty Sitting or Standing Long

    : Staying in the same position for extended periods can worsen pain and stiffness. Taking regular breaks or using supportive options such as ergonomic chairs and sit-stand desks can help ease discomfort.

  • Limited Mobility

    : AS-related inflammation can limit flexibility, and in severe cases, spinal fusion may lead to a rigid posture that restricts movement and even breathing. Simple tasks like tying shoes or reaching overhead may then become difficult.

How To Manage Ankylosing Spondylitis

Managing ankylosing spondylitis usually involves a combination of medication, physiotherapy, exercise and lifestyle adjustments.

Medications

Medications are often the first line of treatment for ankylosing spondylitis, especially when symptoms such as pain, stiffness and inflammation interfere with daily life. Common options include:

  • NSAIDs: Commonly prescribed to reduce pain, stiffness and inflammation. Continuous use is often more effective than taking them only during flare-ups.
  • Biologic Therapies: Address specific inflammation pathways in the body when standard NSAIDs are not enough, helping to control disease progression.
  • JAK Inhibitors: Provide another option to manage inflammation and ease symptoms if biologics are not suitable.
  • DMARDs: More commonly used if joints outside the spine are affected, helping to slow disease activity.
  • Corticosteroids: Used occasionally for short-term relief, often through injections into particularly painful joints.

Physiotherapy and Exercises

Staying active is essential for maintaining flexibility and spinal mobility in ankylosing spondylitis. A physiotherapist can design exercises tailored to your needs, including stretching, strengthening and posture training. Low-impact activities such as hydrotherapy or structured exercise programs also help reduce stiffness and may slow spinal fusion.

Diet

A balanced diet can support overall health and help manage ankylosing spondylitis. Maintaining a healthy weight reduces strain on the joints, while including calcium-rich foods such as dairy, leafy greens, almonds and fish with bones can help strengthen bones. Choosing healthier fats, such as olive oil, nuts, seeds and omega-3–rich fish, may also support heart health and help reduce inflammation.

Lifestyle and Support

Lifestyle changes are key in managing ankylosing spondylitis. Avoiding smoking and limiting alcohol can help reduce complications and support overall treatment. Good posture, regular check-ups, and a healthy daily routine also play a role in reducing strain and tracking disease progression.

Surgery

In rare cases, surgery may be recommended, usually only when there is severe joint damage, such as the need for a hip replacement.

How To Sleep Better with Ankylosing Spondylitis

To improve sleep quality with ankylosing spondylitis (AS), use the following tips:

  • Choose the Right Mattress

    : A medium-firm to firm mattress supports spinal alignment and reduces pressure points.

  • Use Minimal Pillow Support

    : Sleeping without a pillow, or with a thin, firm one, helps keep the neck aligned with the spine. If needed, choose a pillow that supports the natural curve without raising the head too much.

  • Practise Good Sleep Hygiene

    : Keep a consistent bedtime routine, ensure your room is cool, dark and quiet, and avoid screens, caffeine and heavy meals before bed.

  • Create a Relaxing Routine

    : Gentle stretching, yoga or heat therapy (like a warm bath) can ease stiffness. Calming activities such as reading, soft music or meditation can also prepare your body for restful sleep.

How To Sleep Better with Ankylosing Spondylitis

To improve sleep quality with ankylosing spondylitis (AS), use the following tips:

  • Choose the Right Mattress

    : A medium-firm to firm mattress supports spinal alignment and reduces pressure points.

  • Use Minimal Pillow Support

    : Sleeping without a pillow, or with a thin, firm one, helps keep the neck aligned with the spine. If needed, choose a pillow that supports the natural curve without raising the head too much.

  • Practise Good Sleep Hygiene

    : Keep a consistent bedtime routine, ensure your room is cool, dark and quiet, and avoid screens, caffeine and heavy meals before bed.

  • Create a Relaxing Routine

    : Gentle stretching, yoga or heat therapy (like a warm bath) can ease stiffness. Calming activities such as reading, soft music or meditation can also prepare your body for restful sleep.

Working with Ankylosing Spondylitis

Living and working with AS involves more than managing physical symptoms—it also requires caring for your emotional and mental well-being.

Here are some tips to manage this:

  • Pace Yourself

    : Break tasks into manageable parts and spread them out through the day. Prioritise activities and allow time for rest to avoid fatigue and flares. Keeping an activity log can help identify when symptoms worsen, so you can plan breaks accordingly.

  • Make Your Workstation Comfortable

    : Use an ergonomic chair with good lumbar support and adjustable features to maintain proper posture. Position your monitor at eye level to prevent neck strain. Consider a sit-stand desk to alternate positions and reduce spinal stress. Keep frequently used items within easy reach to avoid unnecessary twisting or stretching.

  • Take Frequent Breaks Throughout the Day

    : Avoid sitting or standing for long periods. Aim to stand up, walk around or do gentle stretches routinely to reduce stiffness and improve circulation. Use reminders or timers if needed to stay consistent with breaks.

Conclusion

Ankylosing spondylitis (AS) is a lifelong condition, but with the right approach, it can be managed effectively. Regular low-impact exercise, proper sleep habits, workplace adjustments and a balanced diet, combined with appropriate medical care, can help reduce symptoms and maintain mobility. With consistent management, it is possible to improve your quality of life and stay active.

If you are experiencing symptoms of AS or want personalised guidance, book a consultation with our rheumatology clinic in Singapore today. Early treatment and ongoing support can make a significant difference in living well with AS.

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