Axial spondyloarthritis (ankylosing spondylitis)

Get help straight away if

These are uncommon, but they need same-day care — go to an emergency department, do not wait for an appointment.

• A painful red eye with blurred vision or pain in bright lightGo to an emergency department or an eye casualty the same day. This is inflammation inside the eye, it is common in this condition, and it needs treating within hours to protect your sight.
• New numbness around the groin or inner thighs, or loss of bladder or bowel controlGo to an emergency department.

Contact us promptly if

Not an emergency, but worth being seen sooner rather than waiting it out.

• Back pain that improves with movement and worsens with rest, wakes you in the second half of the night, and leaves you stiff for more than half an hour in the morningThis is the pattern that distinguishes inflammatory from mechanical back pain, and it is worth being assessed for.
• New swelling of a whole finger or toe, heel pain, or a flare of bowel or skin symptoms alongside the back pain

What usually happens

Inflammatory back pain behaves backwards compared with an ordinary bad back. It is worse after rest and better once you move, it wakes people in the small hours, and the morning stiffness lasts. If your back is at its worst getting out of bed and loosens up through the morning, that is worth saying explicitly.

The average delay to diagnosis is measured in years, largely because back pain in a young adult is so common that the inflammatory pattern gets missed. Being clear about the pattern is the single most useful thing you can do to shorten it.

Exercise is genuinely part of the treatment here rather than general advice — regular movement and specific stretching preserve the mobility of the spine, and the effect is real enough that it counts alongside medication.

It often comes with things that seem unrelated: inflammation inside the eye, psoriasis, and inflammatory bowel disease all travel with it. Mentioning them is useful even when they feel like a different doctor's problem.

Normal X-rays early on do not rule it out. Changes on plain films can take years to appear, which is part of why the diagnosis is so often delayed, and other imaging or blood tests may be used instead.

At your appointment

We will ask about the pattern of the pain in detail, and about the age it started, because those matter more than where exactly it hurts.

We will ask about eyes, skin, bowels and heels, since the associated conditions often make the picture clear.

Blood tests and imaging, understanding that early plain X-rays are frequently normal and do not settle the question.

Referral to rheumatology where the picture fits, and a plan for exercise regardless of what medication is decided.

Worth asking

• —Does my pattern of pain fit inflammatory back pain?
• —What exercise should I be doing, and how often?
• —What should I do if I get a painful red eye?
• —What would make you refer me to rheumatology?