Ankylosing Spondylitis

What is Ankylosing Spondylitis?

Ankylosing spondylitis (AS) is a chronic inflammatory disease that mainly affects the spine and the sacroiliac joints, where the spine meets the pelvis. The hallmark features are long-lasting back pain and progressive stiffness of the spine, and over time the condition can limit movement and change posture.^[1]

Common symptoms

Chronic back pain and spinal stiffness are the main symptoms, and buttock and hip pain are common.^[1] The pain typically starts gradually, is worse at night or after rest, and eases with movement. Fatigue is common.

AS can also involve tissues outside the spine:

• Inflammation where tendons attach to bone (enthesitis), swollen "sausage" fingers or toes, and arthritis in other joints^[1]
• Acute anterior uveitis, a painful red eye, seen in roughly a quarter to a third of people^[1]
• Inflammatory bowel disease and psoriasis, which occur in some people^[1]
• Reduced chest expansion, which can lead to breathing limits^[1]

Causes and risk factors

The exact cause is not fully understood. Inherited susceptibility, especially the HLA-B27 gene, and immune signaling involving Th17 cells are central, and gut bacteria and abnormal bone formation are being studied.^[2] Many people with the gene never develop AS, and some people with AS do not carry it.

How it is diagnosed and treated conventionally

Diagnosis rests on your history, an examination, imaging of the spine and sacroiliac joints, and sometimes blood tests, and is made by a physician, usually a rheumatologist. MRI may help when disease activity is unclear.^[3]

Education, exercise and NSAIDs are confirmed as effective in axial spondyloarthritis, and targeted drugs called JAK inhibitors have also shown benefit.^[4] A 2019 guideline recommends TNF inhibitors as the first biologic, with secukinumab or ixekizumab recommended if the first TNF inhibitor does not work.^[3] Exercise programs of any type have a moderate effect on disease activity, function and spinal mobility.^[5]

Why Ankylosing Spondylitis calls for a whole-person approach

AS is driven by immune inflammation, but pain, stiffness, sleep, mood and general health all shape how a person feels day to day. Medicines aimed at inflammation do not address all of these, and treatment results vary between patients.^[2]

Care that also supports movement, rest and stress is therefore a reasonable addition to the medical plan, not a substitute for it.

Immune inflammation

AS is an autoimmune rheumatic disease in which Th17-related inflammatory signaling plays a major role, and current approved treatments focus mainly on controlling inflammation.^[2]

Sleep

Sleep problems are common in AS. A meta-analysis of 18 studies with 5,840 patients found a pooled prevalence of about 53 percent, and the authors note that poor sleep can worsen symptoms and quality of life.^[6]

Mood and other health conditions

Other conditions are more common in people with axial spondyloarthritis than in comparison groups, including depression and heart disease, and having more of them is linked to worse disease severity and quality of life.^[7]

Movement and stiffness

Regular exercise that combines flexibility and strength work appears to help spinal mobility most.^[5] Stiffness and pain can make it hard to stay active, which is one reason pain relief is a practical goal.

Acupuncture for Ankylosing Spondylitis

What the research shows

Studies suggest acupuncture, usually added to medication, may reduce pain and improve function in AS, but the evidence is limited by study quality. A 2025 review of 52 randomized trials found that acupuncture alone or with medication reduced pain, morning stiffness, disease activity scores and blood markers of inflammation. Only 20 trials had low risk of bias, and results varied a lot between trials.^[8]

Other reviews agree in direction. A review of 21 trials with 1,884 patients restricted to higher-scoring trials found better pain, function and quality-of-life scores, while still noting a high risk of bias.^[9] A review of acupuncture added to Western medicine found better disease activity, pain and inflammatory markers than Western medicine alone, with fewer reported adverse reactions.^[10] A 2026 network meta-analysis of 31 trials found acupuncture and moxibustion improved disease activity scores and pain compared with conventional therapy, but rated the certainty as limited and said adverse events were incompletely reported.^[11]

Moxibustion, the warming of acupuncture points with burning mugwort, has been studied separately. A review of 26 trials with 1,944 patients found better response rates, inflammatory markers and spinal mobility when moxibustion was added to Western medicine, and called for larger multicenter trials.^[12] Most of these trials were open comparisons with medication rather than sham-controlled, so some of the benefit may come from expectation or extra attention. We found no sham-controlled acupuncture trials in AS.

How acupuncture may work

Researchers propose that acupuncture changes inflammatory signaling. In the 2025 review, acupuncture was associated with lower levels of the inflammatory molecules IL-6, IL-17 and TNF-alpha.^[8] This is an observed association in trials, not proof of how acupuncture works, and the changes in blood markers have not been shown to slow joint or spinal damage.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the back, hips and limbs, usually left in place for about 20 to 40 minutes. We reassess after a short course of visits. Moxibustion may be used on the back in some plans.

Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[13] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). People with fused or fragile spines, or on immune-suppressing biologics, should also tell us so needling can be adjusted and infection risk considered.

Ayurvedic medicine for Ankylosing Spondylitis

The Ayurvedic view

Ayurveda has no classical name identical to AS. A published case report described a patient as having Asthimajja gata vata, a Vata disorder involving bone and marrow.^[14] In this traditional framework, Vata is the principle said to govern movement, and stiffness and pain are read as signs of aggravated Vata. A 2024 review also discussed the Ayurvedic idea of vyadhikshamatva, the body's capacity to resist disease, in relation to why some people with HLA-B27 develop AS and others do not.^[15] These are traditional frameworks, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine meant to calm Vata, such as warm, regular meals, gentle daily movement and steady sleep hours
• Warm oil massage and local heat over the back and hips
• Herbs prescribed individually by a qualified practitioner, such as ashwagandha-based oils or formulas traditionally used for Vata conditions
• Panchakarma therapies such as medicated oil enemas (basti), traditionally chosen case by case

Panchakarma is not appropriate during pregnancy, acute illness or frailty, and should be considered only with your rheumatologist's knowledge. It is not suitable for someone with active flare, uveitis or unmanaged bowel disease.

What the research shows

Research on Ayurveda for AS is very limited. A PubMed search found no controlled trials of Ayurvedic treatment for AS. The only clinical report we found is a single case in which a patient given Panchakarma procedures and Ayurvedic drugs for two months showed improvement on standard assessment scores. A single case cannot show that the treatment caused the change.^[14]

A meta-analysis of curcumin in autoimmune disease included one trial in AS, which reported improvement, but the authors said the number of trials and patients per disease was too small to draw conclusions.^[16]

Herbal medicine for Ankylosing Spondylitis

Herbs and formulas that have been studied

Duhuo Jisheng decoction, a classical formula traditionally used for chronic joint and low back pain, has been tested with Western medicine in AS.^[17] Tripterygium glycoside tablets, made from the thunder god vine (Tripterygium wilfordii), have also been tested in many randomized trials.^[18] Curcumin, from turmeric, has been tested in a small number of autoimmune conditions including one AS trial.^[16]

What the research shows

The evidence is limited and mixed. A meta-analysis found that Duhuo Jisheng decoction added to Western medicine gave higher response rates, lower pain and lower inflammatory markers than Western medicine alone, with fewer adverse reactions.^[17] In contrast, a meta-analysis of 11 trials (807 participants) of Tripterygium glycoside tablets concluded that they could not treat AS effectively, and pooled results for several outcomes did not favor the herb.^[18]

The curcumin evidence for AS rests on a single trial.^[16] Other herbs have no AS trials that we found.

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines, including the NSAIDs, methotrexate, sulfasalazine and biologics commonly used for AS. Case reports describe bleeding when warfarin was combined with herbs including dang gui, dan shen, ginger, ginseng and Boswellia.^[19] Herbs aimed at the immune system, such as Tripterygium, should not be combined with your prescribed immune treatment without your rheumatologist's agreement.

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, or have surgery planned.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes AS as a pattern of kidney deficiency with cold-damp obstruction of the governing vessel along the spine. Researchers studying acupuncture and moxibustion in AS measure things that loosely parallel this picture: pain scores, spinal mobility, and inflammatory signals such as CRP, IL-6, IL-17 and TNF-alpha.^{[8, 12]}

Ayurveda's aggravated Vata describes pain and stiffness that limit movement, and the concept of vyadhikshamatva has been discussed alongside the HLA-B27 gene.^[15] No study has shown that a dosha or a TCM pattern corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for AS is complementary. Keep your rheumatologist and any physical therapist, and do not stop or change prescribed medicines, including NSAIDs and biologics, without your prescriber. We do not diagnose or monitor AS, and exercise and education remain a core part of treatment.^[4]

Please bring your diagnosis, imaging reports, a full list of medicines and supplements, and any eye or bowel history. Tell us about new pain, eye symptoms or changes in your medicines at each visit.

When to seek urgent medical care

Some symptoms need prompt medical assessment because AS can affect the eyes, spine and other organs.^[1]

• A painful red eye, light sensitivity or sudden change in vision
• Back or neck pain after a fall or injury, because a stiff spine fractures more easily^[1]
• New weakness or numbness in the legs, or loss of bladder or bowel control
• New chest pain or shortness of breath
• Fever with severe back pain or a new swollen, hot joint

If any of these occur, call 911 or go to the nearest emergency department.