ANKYLOSING SPONDYLITIS

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Ankylosing spondylitis (AS) is a chronic form of inflammatory arthritis that causes long-term inflammation of the spine, affecting an estimated 0.1% to 1.4% of people worldwide and around 0.17% in Asia. It commonly begins in the sacroiliac joints, which connect the base of the spine to the pelvis, a condition known as sacroiliitis and often one of the earliest signs of AS. Over time, inflammation can also affect the joints between the vertebrae.

At Singapore Paincare, our pain specialists work with you to manage AS through minimally invasive treatments that relieve pain safely and effectively, offering an alternative to relying on medication alone. Our goal is to help you stay mobile and get back to your daily life with confidence.

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What Causes Ankylosing Spondylitis?

The exact cause of ankylosing spondylitis is not known. However, about 95% of people with AS carry a variation of the human leukocyte antigen-B gene (HLA-B), which produces a protein called HLA-B27 that increases the risk of the condition. Most carriers of this gene variation do not go on to develop AS. In fact, around 80% of children who inherit the gene from a parent with AS do not develop the condition themselves. More than 60 genes have been linked to the disease so far.

Locally, a multi-ethnic Singapore cohort study found that 82% of patients with axial spondyloarthritis tested positive for HLA-B27, and an earlier Singapore study identified HLA-B*2704 as the predominant subtype among Chinese patients here (see Sources below).

Your risk of developing AS may also be higher if you have an autoimmune condition, such as:

  • Psoriasis
  • Crohn’s disease
  • Ulcerative colitis

What Are the Symptoms of Ankylosing Spondylitis?

Pain and stiffness

Persistent or mild pain and stiffness in the lower back, hips, joints, and neck are common early symptoms.

Other symptoms

AS can also cause fatigue, difficulty breathing, loss of appetite, abdominal pain, diarrhoea, skin rash, and vision problems.

Symptoms typically first appear in the early twenties. A study of 150 AS patients in Singapore, published in the Annals of the Academy of Medicine Singapore, found the condition affects men far more often than women, at a ratio of about 7:1, with the majority of patients being of Chinese ethnicity. In that same group, diagnosis was delayed by an average of 6.3 years from symptom onset, which is why it helps to have persistent symptoms assessed early rather than waiting them out.

If you experience persistent back pain and stiffness, it’s best to have it assessed by a pain specialist.

How Is Ankylosing Spondylitis Diagnosed?

There is no single definitive test for ankylosing spondylitis. At Singapore Paincare, our team of primary care doctors, pain specialists, and consulting rheumatologist evaluate your symptoms, medical history, and physical function. An MRI scan and/or blood test, which may include testing for the HLA-B27 gene, can help support the diagnosis.

What Are the Treatment Options for Ankylosing Spondylitis in Singapore?

At Singapore Paincare, we aim to treat your pain with the least invasive option possible after accurately identifying its cause. Our approach centres on removing pain generators through specialised injections and minimally invasive procedures, combined with pharmacological treatment and rehabilitative therapy, to help you improve function and prevent pain from recurring.

Non-Surgical Treatment

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

These medications have anti-inflammatory and analgesic effects that may help relieve pain.

Coreflex Injection

Our Coreflex Injection is a mix of local anaesthetic, anti-inflammatory medication, and muscle relaxant that helps break the pain cycle, reduce inflammation, and support healing.

Pharmacotherapy

Beyond NSAIDs, our physicians and specialists may prescribe disease-modifying anti-rheumatic drugs (DMARDs) to help manage AS.

Physical Therapy

Our physiotherapists use resistance training to help reduce pain, along with stretching exercises to improve joint motion and minimise muscle loss. Exercise intensity and type are tailored to each patient’s condition.

Surgical Treatment

Non-surgical treatment works well for most AS cases, and surgery is rarely required unless pain does not respond to conservative options. As with any surgery, there are risks, complications, and downtime to weigh against the potential benefits.

Kyphoplasty

A minimally invasive procedure performed under general or local anaesthesia to correct a curved spine or treat painful compression fractures in the spine.

How Singapore Paincare Treats Ankylosing Spondylitis?

At Singapore Paincare, our specialists use the proprietary Painostic® method, developed from years of clinical experience, to identify the real source of your pain and map a treatment pathway tailored to your condition. We prioritise the least invasive options first, including targeted injections and minimally invasive procedures, often supported by medication and physical rehabilitation, to help you manage AS and maintain mobility over the long term.

A Message About Ankylosing Spondylitis From Our Pain Specialist

Ankylosing spondylitis is a progressive condition within the autoimmune disease family. Once the HLA-B27 gene is activated, the immune system becomes sensitised and can cause gradual erosion of the sacroiliac and spinal joints, leading to pain and stiffness in the spinal column. Left unmanaged, this can result in a stiff spine that loses its suppleness and ability to bend or rotate.

Once diagnosed, AS requires long-term follow-up to reduce the risk of joint damage and spinal rigidity. Treatment typically includes immune-modulating medication, such as steroids and biologic agents, alongside pain management.

At Singapore Paincare, we combine medical management with minimally invasive pain relief options, so our patients can stay mobile and maintain their quality of life.

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Can Ankylosing Spondylitis Be Prevented?

There is no known way to prevent ankylosing spondylitis, as its exact cause remains unclear. Long-term follow-up with your care team supports early management of symptoms.

Frequently Asked Questions 

Ankylosing spondylitis is a form of inflammatory arthritis that causes chronic inflammation in the spine and sacroiliac joints, often starting in early adulthood. In most patients, it is linked to the HLA-B27 gene, unlike common mechanical back pain.

Genetics play a role. About 95% of people with AS carry the HLA-B27 gene variation, though most carriers never develop the condition. Around 80% of children who inherit the gene from an AS parent do not go on to have it.

There is no single definitive test. Diagnosis is based on clinical assessment by a pain specialist and rheumatologist, supported by an MRI scan and/or blood tests where needed.

Most patients respond well to non-surgical treatment such as medication, injections, and physical therapy. Surgery, such as kyphoplasty, is reserved for cases that do not respond to conservative treatment.

There is currently no cure for ankylosing spondylitis. It is a long-term condition that requires ongoing management to reduce pain, preserve mobility, and prevent joint damage.

Local data shows AS is significantly more common in men than women, at a ratio of about 7:1, with symptoms typically beginning in the early twenties.

References: 

  • Ankylosing Spondylitis in Singapore: A Study of 150 Patients and a Local Update. Annals of the Academy of Medicine Singapore. Read the study
  • Hong C, Kwan YH, Leung YY, Lui NL, Fong W. Comparison of ankylosing spondylitis and non-radiographic axial spondyloarthritis in a multi-ethnic Asian population of Singapore. International Journal of Rheumatic Diseases, 2019. Read on PubMed
  • World Health Organization. Ankylosing Spondylitis: Key Facts. Read the fact sheet

Updated July 2026