Advanced AS can cause joint damage and disability. Chronic, ongoing inflammation eventually leads to bone loss. And when there is new bone tissue growth, new bony growths develop in the areas where ligaments and tendons attach to the joints.

As AS develops and worsens, the spine can become stiff and difficult to move. In addition, ongoing changes to the spinal column will eventually make the spine weak and increase the risk for fractures of the vertebrae (the small bones forming the backbone).

Advanced AS might also mean a higher risk for spine curvature, scarring between the joints of the spine and ribs, breathing problems, neurological issues, and other problems related to inflammation. For some people, it may mean a fused spine from new bone growth between the vertebrae joining them together. The worse this becomes, the more reduced the movement of the spine becomes. 

Additional signs of progressing AS, and signs you will want to address with your healthcare provider, might include: 

• Kyphosis: This is where the spine becomes abnormally curved and causes a person to hunch forward. This occurs because the muscles of the spine have become weakened, and the vertebrae fused.
• Autoimmune disease: Patients may experience psoriasis and/or inflammatory bowel disease.
• Difficulty with breathing: Advanced AS can cause the joints of the ribs and breastbone to become stiff, affecting the ability to breathe deeply.
• Fractures: Bones and joints that have become damaged or weak can break more easily. Fractures of the spine can damage the spinal cord and the surrounding nerves.
• Heart issues: The same inflammation that affects the spine can also spread to your heart and damage your aorta—the main body artery that carries oxygen-rich blood from the left ventricle of the heart to the rest of your body. A damaged aorta can impair the heart’s ability to function properly.

There is plenty to think about and consider when making treatment decisions for ankylosing spondylitis. Let’s discuss the most common concerns related to your AS treatment and how your healthcare provider can help.

• Worries About Side Effects: Your doctor has prescribed your AS treatments because they feel the benefits outweigh the risks. Talk to your doctor to discuss any concerns you may have about treatment so the two of you can work together to choose treatments that work effectively with the least amount of side effects.
• A Fear of Needles: Injectable biologic drug therapies target specific parts of the immune system, which makes them an effective treatment for AS. But injecting yourself can be a daunting task. If injection pain is a concern for you, talk to your doctor about how you can inject yourself safely and painlessly.
• Being Patient With Treatment Response: A new treatment can take up to 3 months for the drug to take effect and start improving your condition. There might be times when you may need to try several treatments before you find one that best works. Remember to be open-minded and flexible when starting a new treatment, and reach out to your doctor with questions about your treatment plan.
• Feeling Like You Need to Compromise for Relief: If you are experiencing severe or ongoing side effects, or if you feel your condition is worsening, reach out to your healthcare provider. You are not required to push through with a medication that is not helping or negatively affecting your life.
• Concerns About Cost: Ankylosing spondylitis treatments can be expensive. Fortunately, many drug manufacturers offer financial assistance programs to assist with drug costs and co-pays for biologic and systemic drug therapies. Prescription savings programs, including GoodRx and RxAssist, can also reduce your AS treatment costs. You can find more information online or through your healthcare provider's office.