Clinical update

Ankylosing spondylitis

Our guide to new NICE guidance on ankylosing spondylitis, a chronic condition affecting 200,000 people in the UK.

Our guide to new NICE guidance on ankylosing spondylitis, a chronic condition affecting 200,000 people in the UK.

Essential facts

About 200,000 people have ankylosing spondylitis in the UK, with approximately 2,300 new diagnoses each year in England and Wales. A form of arthritis, the chronic condition causes inflammation in the spine and other areas of the body. It is about three times more common in men than in women.

Ankylosing spondylitis is a chronic condition, causing inflammation of the spine. Photo: Science Photo Library 

What’s new

New draft guidance from the National Institute of Health and Care Excellence (NICE) means thousands of people with ankylosing spondylitis will soon have access to an innovative new drug. Secukinumab, which helps patients by reducing inflammation and pain and improving mobility, is the first in a new class of drug to treat the condition. It comes in pre-filled pen syringes and is injected by the patient.


The condition typically starts in the joints between the spine and pelvis, but can spread up the spine to the neck, and other areas of the body. Typical symptoms include lower back or neck pain and stiffness, pain in the sacroiliac joints where the spine meets the pelvis and buttocks, and tiredness. It can also cause pain and swelling in other joints, the heels, swollen fingers and toes, pain or tightness in the chest and eye inflammation.

Causes/risk factors

It is most common in young men, and most frequently develops during the late teens or 20s. Exact causes are not known but there is believed to be a genetic link.

How you can help your patient

Understand the early signs of inflammatory back pain and refer people promptly who may have the condition. Many people are not receiving the best care due to delayed diagnosis and lack of access to appropriate expertise. Look out for back pain and stiffness, which is usually gradual, and becomes especially severe at night and following rest.

Expert comment

Portsmouth Hospitals NHS Trust matron for musculoskeletal outpatient department services Colin Beevor:

‘Many nurses do not know much about ankylosing spondylitis, but they should know what it is, especially in primary care, and the basics about its inflammatory causes and the differences with mechanical back pain.

'If a nurse sees patients with inflammatory bowel disease, iritis (inflammation of the front part of the eye) or skin condition psoriasis, ask about back pain, as these conditions are often associated with ankylosing spondylitis. About 50% of people with ankylosing spondylitis suffer from associated disorders such as these at areas away from the spine.

'Patients may be alarmed at diagnosis by previous information they have heard about extreme cases of ankylosing spondylitis. But it is important that they know that the condition can generally be managed effectively with medication, self-management and exercise.

'Patients need to be given advice on managing flare-ups, fatigue and pain. Information and guidance should also be provided if they have concerns about passing the condition on through their genes to their children. Many people are also concerned about the impact it will have on their work.

'Nurses should involve families when providing information and advice.’

Find out more

National AS Society (NASS)

Looking ahead – a report from the NASS on best practice and management of AS

RCNi articles

Ankylosing spondylitis: diagnosis and management (Nursing Standard, December 2013)

Limitations associated with managing chronic low back pain (Nursing Standard, April 2016)

This article is for subscribers only