Understanding Ankylosing Spondylitis (AS)

Who gets AS?

AS is more common in men than in women. Unlike other rheumatoid diseases, symptoms of AS can appear as early as childhood, although onset usually occurs between the ages of 17 and 35. It's important to note that the course of AS varies from person to person. There are risk factors for AS, such as having a family member with AS.

AS can be difficult to diagnose because symptoms are similar to other diseases. Only a rheumatologist can decide if your symptoms are caused by AS. Rheumatologists are specialists who treat arthritic conditions and other joint diseases. If you're diagnosed with AS, your rheumatologist may prescribe REMICADE® as part of your treatment plan.

Symptoms and diagnosis

The symptoms of AS vary from person to person. During your examination, your doctor will look for spinal symptoms and additional symptoms (sometimes called peripheral symptoms). Spinal symptoms affect your spine, while the additional symptoms of AS may occur in your joints or internal organs. Talk to your doctor if you experience any of the following:

Spinal symptoms

When AS affects the spine, it may lead to:

  • Pain at the sacroiliac joints, the places where the spine joins your pelvis
  • Forward-stooped shoulders
  • Pain or stiffness of the lower back and buttocks
  • Pain or restrictive stiffness in the neck, hips, thighs, shoulder blades, and heels

Additional symptoms

People with AS may also experience the following symptoms:

  • Spinal pain
  • Joint pain
  • Heel pain
  • Morning stiffness
  • Range of motion decreased
  • Difficulty performing daily activities


Since the symptoms you may experience in the early stages of AS can resemble those of other conditions, your rheumatologist may draw on information from many different sources, including:

  • A physical examination, including blood work
  • X-ray images to determine changes to your bones and joints
  • Your medical history

In confirming your AS diagnosis, your doctor may also look for the following symptoms:

  • Lower back pain lasting for more than 3 months
  • Back pain and stiffness that worsens after periods of inactivity, especially in the early morning or at night
  • Back pain and stiffness that often eases with physical activity

NEXT: Treatment Options


Only your doctor can recommend a course of treatment after checking your health condition. REMICADE® (infliximab) can cause serious side effects such as lowering your ability to fight infections. Some patients, especially those 65 years and older, have had serious infections caused by viruses, fungi or bacteria that have spread throughout the body, including tuberculosis (TB) and histoplasmosis. Some of these infections have been fatal. Your doctor should monitor you closely for signs and symptoms of TB during treatment with REMICADE®.

Unusual cancers have been reported in children and teenage patients taking TNF-blocker medicines. Hepatosplenic T-cell lymphoma, a rare form of fatal lymphoma, has occurred mostly in teenage or young adult males with Crohn’s disease or ulcerative colitis who were taking REMICADE® and azathioprine or 6-mercaptopurine. For children and adults taking TNF blockers, including REMICADE®, the chances of getting lymphoma or other cancers may increase.

You should discuss any concerns about your health and medical care with your doctor.

What should I tell my doctor before I take REMICADE®?

You should let your doctor know if you have or ever had any of the following:

  • Tuberculosis (TB) or have been near someone who has TB. Your doctor will check you for TB with a skin test. If you have latent (inactive) TB, you will begin TB treatment before you start REMICADE®.
  • Lived in a region where certain fungal infections like histoplasmosis or coccidioidomycosis are common.
  • Infections that keep coming back, have diabetes or an immune system problem.
  • Any type of cancer or a risk factor for developing cancer, for example, chronic obstructive pulmonary disease (COPD) or had phototherapy for psoriasis.
  • Heart failure or any heart condition. Many people with heart failure should not take REMICADE®.
  • Hepatitis B virus (HBV) infection or think you may be a carrier of HBV. Your doctor will test you for HBV.
  • Nervous system disorders (like multiple sclerosis or Guillain-Barré syndrome).

Also tell your doctor if you:

  • Use the medicines Kineret (anakinra), Orencia (abatacept) or Actemra (tocilizumab) or other medicines called biologics used to treat the same problems as REMICADE®.
  • Are pregnant, plan to become pregnant, are breast-feeding, or have a baby and were using REMICADE® during your pregnancy. Tell your baby’s doctor about your REMICADE® use before the baby receives any vaccine because of an increased risk of infection for up to 6 months after your last dose of REMICADE® you received during your pregnancy.
  • Recently received or are scheduled to receive a vaccine. Adults and children taking REMICADE® should not receive live vaccines or treatment with a weakened bacteria (such as BCG for bladder cancer) while taking REMICADE®.

What should I watch for and talk to my doctor about before or while taking REMICADE®?

The following serious (sometimes fatal) side effects have been reported in people taking REMICADE®.

You should tell your doctor right away if you have any of the signs listed below:

  • Infections (like TB, blood infections, pneumonia)—fever, tiredness, cough, flu, or warm, red or painful skin or any open sores. REMICADE® can make you more likely to get an infection or make any infection that you have worse.
  • Lymphoma, or any other cancers in adults and children.
  • Skin cancer—any changes in or growths on your skin.
  • Heart failure—new or worsening symptoms, such as shortness of breath, swelling of your ankles or feet, or sudden weight gain.
  • Reactivation of HBV—feeling unwell, poor appetite, tiredness, fever, skin rash and/or joint pain.
  • Liver injury—jaundice (yellow skin and eyes), dark brown urine, right-sided abdominal pain, fever, or severe tiredness.
  • Blood disorders—fever that doesn’t go away, bruising, bleeding or severe paleness.
  • Nervous system disorders—numbness, weakness, tingling, changes in your vision or seizures.
  • Allergic reactions during or after the infusion—hives, difficulty breathing, chest pain, high or low blood pressure, swelling of face and hands, and fever or chills.
  • Lupus-like syndrome—chest discomfort or pain that does not go away, shortness of breath, joint pain, rash on the cheeks or arms that gets worse in the sun. The more common side effects with REMICADE® are respiratory infections (that may include sinus infections and sore throat), headache, rash, coughing and stomach pain.
  • Psoriasis—new or worsening psoriasis such as red scaly patches or raised bumps on the skin that are filled with pus.

Please read the accompanying Medication Guide for REMICADE® and talk with your doctor. You are encouraged to report negative side effects of prescription drugs to the FDA.

Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.