Living with axial spondyloarthritis and ankylosing spondylitis
Updated: Oct 15
By Andy Duckmanton, BOst (Hons), GOsC registered osteopath.
Editorial update: 15 October 2026.
A diagnosis of axial spondyloarthritis can raise questions about work, exercise, treatment and the future. The condition varies between people. Care should reflect disease activity, your symptoms and the things you want to keep doing.
Axial SpA mainly affects the spine and the joints linking it to the pelvis. Ankylosing spondylitis, also called radiographic axial SpA, is a form with characteristic X-ray changes. People without those changes can still have significant symptoms and need appropriate care.
For signs that should prompt an initial assessment, read the shorter axial spondyloarthritis recognition guide. This article focuses on living with an established diagnosis.
Understanding your treatment plan
Rheumatology care considers pain, stiffness, movement, fatigue, inflammation and how the condition affects your life. Blood tests and imaging can contribute, but the whole clinical picture matters.
Treatment may include anti-inflammatory medicines or specialist medicines that target inflammation, alongside exercise and physiotherapy. The choices depend on your disease, other health conditions and response to treatment. Ask what each treatment is intended to achieve, how it will be monitored and whom to contact about side effects or a flare.
Do not stop prescribed medicine because symptoms improve after another treatment. Discuss changes with the prescribing team.
Exercise and movement
Physiotherapy and suitable exercise are important parts of care. A specialist physiotherapist can help with mobility, strength, posture, breathing exercises and aerobic activity appropriate to you. A programme should be achievable and adjusted when symptoms or circumstances change.
Choose activities you value and can sustain. This could include a manageable walk, pool exercise or a suitable class, depending on your assessment and access. The goal is to support function and wellbeing, not to force a stiff spine into a particular shape.
The Getting active guide offers general ideas, but your rheumatology or physiotherapy plan takes account of the condition in a way that a general article cannot.
Work, rest and daily tasks
Discuss changes that make everyday life easier: opportunities to change position, breaks from a demanding task, manageable lifting arrangements or help with fatigue. A small adjustment that you can use consistently may be more valuable than an ideal setup you cannot maintain.
Sleep, mood and persistent pain are worth discussing with your team. They are part of the impact of the condition, not a distraction from it. Occupational therapy or other support may be appropriate when work or self-care becomes difficult.
What about hands-on treatment?
The National Axial Spondyloarthritis Society advises that manipulative therapies are not recommended for people with axial SpA. Spinal fusion, osteoporosis and inflammation can create important risks. Do not seek forceful manipulation to reverse a spinal curve or fusion.
Discuss any additional treatment with your rheumatology team. Tell the practitioner about the diagnosis, medicines, fractures, bone health and any spinal fusion. Osteopathy does not suppress the underlying inflammatory disease or replace medical treatment and specialist rehabilitation.
Flares and changes that need review
Use the flare plan agreed with your team. A temporary adjustment to activity may help, but worsening symptoms or declining function should prompt a discussion about whether disease control or rehabilitation needs changing. Do not assume every new symptom belongs to a familiar flare.
Eye pain, redness, light sensitivity or blurred vision needs urgent same-day medical advice because uveitis is possible. Contact your GP, eye service or NHS 111. Loss of vision requires emergency help at A&E or through 999.
New severe spinal pain after a fall or injury needs urgent medical assessment, particularly if the spine is stiff or fused or you have osteoporosis. Even a relatively minor injury may matter. Do not have spinal treatment before it has been assessed.
New weakness, loss of sensation, difficulty walking or new bladder or bowel disturbance also needs urgent assessment; rapidly worsening symptoms require emergency care.
Questions for your next review
How well is the current plan controlling inflammation and supporting daily life?
Which exercise or activity goal should I focus on next?
What should I do during a flare, and who is my first contact?
Do bone health, fatigue, work or eye symptoms need further attention?
Sources and further information
Sources checked: 13 October 2026.