Triggers That Can Send Ankylosing Spondylitis Pain Into Overdrive

1. Physical Overexertion

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For people living with ankylosing spondylitis, physical overexertion poses a significant risk. Excessive exercise, prolonged activity, or heavy lifting can place tremendous strain on already inflamed spinal joints and surrounding tissues. This strain can trigger sharp pain, swelling, and even trigger a full-blown flare-up that lingers for days. Athletes with AS often describe how pushing past their limits—whether during an intense workout, running a marathon, or lifting heavy weights—can set off debilitating symptoms.
Everyday activities such as moving furniture, gardening, or even carrying groceries can also prove problematic. The key is to recognize personal limits and practice activity pacing. By alternating periods of movement with scheduled rest, individuals can maintain function while minimizing the risk of pain escalation.
Healthcare professionals recommend gentle, low-impact activities like swimming, walking, or yoga, which strengthen muscles and improve flexibility without overloading the joints. Listening to your body and prioritizing recovery is essential to avoid the setbacks that come from doing too much. For more about safe exercise and pacing with AS, visit the Spondylitis Association of America.

2. Poor Posture

Maintaining proper posture is crucial for individuals with ankylosing spondylitis. The way you sit, stand, or even sleep directly affects spinal alignment, and poor posture can exacerbate inflammation and pain. When posture is compromised—such as slouching at a desk or hunching over a screen—added stress is placed on the already vulnerable spinal joints and surrounding ligaments.
Office workers and those with sedentary lifestyles are particularly at risk. Hours spent sitting in unsupportive chairs or working at improperly set-up desks can lead to increased stiffness, muscle fatigue, and even permanent changes in spinal structure over time. This not only worsens discomfort but can also accelerate the progression of spinal fusion, a hallmark of advanced AS.
To counteract these risks, experts recommend making ergonomic adjustments to workspaces. This includes using chairs with lumbar support, keeping screens at eye level, and taking frequent breaks to stretch and move. Simple changes, such as placing feet flat on the floor and keeping shoulders back, can make a tangible difference. For practical ergonomic tips tailored to AS, visit the Arthritis Foundation.

3. Infection

Systemic infections are a well-known trigger for ankylosing spondylitis flare-ups. When the body is fighting off an infection—such as a common cold, flu, or even a mild respiratory virus—the immune system ramps up its activity. This heightened immune response can inadvertently intensify inflammation in the joints and spine, causing a sudden increase in pain and stiffness for those with AS.
During an infection, people with AS may notice their usual symptoms worsening or new areas of pain emerging. This is because the immune system, already prone to dysfunction in AS, becomes more active and may mistakenly attack healthy tissue in the process. Even seemingly minor illnesses can have a significant impact.
It’s essential for individuals with AS to closely monitor their health during any bout of illness. Promptly addressing infections, staying hydrated, and getting adequate rest can help minimize the risk of a flare. If symptoms suddenly worsen, consulting a healthcare provider is wise to rule out complications. For more on the relationship between infection and autoimmune flare-ups, see the NHS guide to living with AS.

4. Stress (Psychological)

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Psychological stress is a powerful trigger that can send ankylosing spondylitis pain into overdrive. When the body perceives stress, it releases cortisol and other hormones that, in the short term, are meant to help us cope. However, chronic stress disrupts this system, leading to hormonal imbalances that can amplify inflammation and subsequently worsen AS symptoms.
Research has shown a clear relationship between stress and increased pain in individuals with chronic illnesses, including AS. A study published in Frontiers in Immunology highlights how stress alters immune function, contributing to more frequent and severe flares. Patients often report that emotionally challenging times—such as work deadlines, family issues, or financial worries—correlate with heightened pain and stiffness.
Fortunately, stress management techniques can help break this cycle. Practices such as deep breathing, mindfulness meditation, yoga, and gentle movement have been found to ease both psychological and physical symptoms. Even simple routines, like maintaining a regular sleep schedule and connecting with supportive friends or a counselor, make a difference. For more on stress and pain, the Arthritis Foundation provides helpful resources.

5. Inadequate Sleep

Quality sleep is a cornerstone of good health, but for those with ankylosing spondylitis, it is especially critical. Poor sleep quality or chronic sleep deprivation can dramatically increase sensitivity to pain and leave individuals more vulnerable to flare-ups. When the body doesn’t get enough restorative sleep, it struggles to repair inflamed tissues and regulate immune function, both of which are essential in managing AS.
Studies have shown that sleep-deprived individuals experience greater pain intensity and reduced pain tolerance. In contrast, those who consistently achieve deep, uninterrupted sleep often report milder symptoms and improved function. Common barriers to good sleep in AS include nighttime pain, stiffness, and frequent awakenings, which can set off a vicious cycle of fatigue and heightened discomfort.
Establishing strong sleep hygiene habits is key. This means maintaining a regular bedtime, creating a comfortable sleep environment, and limiting caffeine or screen time before bed. Even small changes—like using supportive pillows or practicing relaxation techniques—can make a significant difference. For further guidance on improving sleep with chronic pain, visit the Sleep Foundation.

6. Sudden Weather Changes

Many people with ankylosing spondylitis notice that their pain levels fluctuate with the weather. Sudden shifts in barometric pressure, temperature drops, or damp conditions can intensify joint discomfort, making daily tasks more challenging. While the exact mechanism remains under investigation, scientists believe that changes in atmospheric pressure may alter joint fluid dynamics and nerve sensitivity, amplifying pain and stiffness.
This phenomenon isn’t unique to AS; it’s also reported by individuals with other musculoskeletal conditions like osteoarthritis and rheumatoid arthritis. For some, an impending storm or rapid drop in temperature is a reliable predictor of increased pain. Understanding these patterns can empower people to plan ahead and adjust their activity levels or self-care routines accordingly.
Keeping a symptom diary that records pain intensity alongside weather conditions can help identify personal triggers. Over time, this information may reveal trends that support proactive pain management. For more insight into the science of weather and joint pain, see the Arthritis Foundation’s overview on weather and arthritis.

7. Sedentary Lifestyle

A sedentary lifestyle is one of the most insidious triggers for ankylosing spondylitis pain and stiffness. Inactivity allows inflammation to settle and joints to stiffen, leading to reduced mobility and greater discomfort over time. People who spend long hours sitting—whether at a desk, in front of the television, or during extended travel—often notice their symptoms intensifying.
Studies have shown that AS patients who remain physically active experience improved joint flexibility, better posture, and less overall pain compared to those who are sedentary. Gentle, consistent movement helps maintain muscle strength and joint range of motion, slowing the progression of spinal rigidity. Activities like stretching, walking, swimming, or tailored physical therapy exercises are not only safe but highly beneficial for most people with AS.
Breaking up prolonged periods of sitting with short walks or light stretching can make an immediate difference. The goal is not intense exercise, but rather regular, gentle movement that keeps the body supple and responsive. For recommendations on safe exercises and movement strategies for AS, visit the NHS guide to ankylosing spondylitis treatment.

8. Smoking

Smoking is a significant—and often underestimated—trigger that can worsen ankylosing spondylitis activity. Clinical studies have demonstrated that individuals with AS who smoke tend to experience more severe symptoms, increased pain, and faster progression of spinal damage compared to non-smokers. The inflammatory chemicals introduced by smoking are believed to heighten immune system activity, making existing inflammation even more difficult to control.
Research from the National Institutes of Health (NIH) shows that smoking not only increases the risk of developing AS but also accelerates disease progression, particularly the fusion of spinal vertebrae. This can result in greater loss of mobility and a diminished quality of life. Smokers with AS are also at higher risk for complications such as cardiovascular disease and reduced lung function.
Quitting smoking is one of the most effective ways to slow disease progression and improve symptom control. Even longstanding smokers notice benefits after quitting, including reduced pain and improved response to medication. For support and resources on quitting, the CDC’s quit smoking guide offers practical advice.

9. Alcohol Consumption

Alcohol consumption, even in moderate amounts, can have a noticeable impact on ankylosing spondylitis symptoms. Alcohol may increase inflammation in the body and interfere with the effectiveness of commonly prescribed medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and biologics. This interference can reduce the benefits of treatment, making pain and stiffness more difficult to control.
Social situations—like celebrations, dinners, or weekends out—often involve alcohol, which can make moderation challenging. Some individuals with AS report increased joint pain and fatigue after even a few drinks, while others find their symptoms worsen the day after drinking. Additionally, alcohol can disrupt sleep quality, compounding its negative effects on the body’s ability to recover.
Medical experts urge people with AS to be mindful of their alcohol intake and to discuss safe levels with their healthcare providers. Moderation is key, as excessive consumption poses risks for liver health, especially if taking medications that are metabolized by the liver. For more information on the relationship between alcohol and arthritis, visit the Arthritis Foundation’s alcohol and arthritis page.

10. Poor Diet

Diet plays a significant role in managing inflammation, and for people with ankylosing spondylitis, poor dietary choices can quickly worsen symptoms. Consuming large amounts of processed foods, refined carbohydrates, and sugary snacks can fuel the body’s inflammatory response, leading to more frequent and severe pain flare-ups. These foods are often high in unhealthy fats and additives that disrupt immune balance.
Comparative studies show that individuals who follow a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats tend to experience fewer inflammatory symptoms than those who consume a standard Western diet, which is high in processed and sugary foods. The Mediterranean diet, for instance, is praised for its anti-inflammatory effects and potential to reduce chronic pain.
Adopting a balanced nutrition plan is not about strict restrictions, but about making mindful choices that support long-term health. Simple swaps—like choosing water instead of soda, whole grains over white bread, and incorporating more leafy greens—can make a meaningful difference. For more detailed guidance, see the Arthritis Foundation’s anti-inflammatory diet recommendations.

11. Skipping Medication

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Adhering to prescribed medication regimens is essential for controlling ankylosing spondylitis and preventing painful flares. Missing doses—whether of NSAIDs, disease-modifying antirheumatic drugs (DMARDs), or biologics—can cause inflammation to surge, undoing hard-won progress. Skipping medication, even occasionally, jeopardizes long-term joint health and increases the risk of irreversible damage.
Real-life barriers to adherence are common. Some patients may struggle with side effects, forgetfulness, complicated dosing schedules, or the cost of medication. Others might feel tempted to skip doses when symptoms seem under control, only to experience a rapid return of pain and stiffness. Consistency is critical, as many treatments work by maintaining steady levels of medication in the body.
Healthcare providers recommend setting reminders, using pill organizers, and discussing any concerns openly. If side effects or financial constraints are an issue, your doctor or pharmacist can often help find solutions or alternatives. For more information about medication adherence for chronic arthritis, visit the CDC’s guide to medication adherence.

12. Overuse of NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a mainstay for managing ankylosing spondylitis pain, but excessive or prolonged use can backfire. While these medications provide short-term relief, overuse increases the risk of gastrointestinal bleeding, kidney problems, and cardiovascular complications. Some patients may self-medicate, taking higher doses or using NSAIDs more frequently than prescribed, hoping to control relentless pain.
This approach can be dangerous. Not only can side effects accumulate, but relying on NSAIDs may also mask signs that the disease is progressing or that other treatments are needed. For example, someone using over-the-counter NSAIDs daily may miss the subtle onset of new joint damage or inflammation elsewhere in the body. Self-medication presents real pitfalls—from missing a serious underlying issue to developing medication dependency.
Doctors recommend using NSAIDs only as directed and reporting any ongoing pain or new symptoms. If medications seem less effective or if you need frequent dosing, it may be time to discuss alternative therapies or adjustments. For more on NSAID safety and alternatives, see the FDA’s NSAID information page.

13. Gut Health Issues

Emerging research highlights a strong connection between gut health and ankylosing spondylitis, often referred to as the gut-joint axis. People with AS are at increased risk for gastrointestinal issues, including irritable bowel syndrome (IBS) and inflammatory bowel diseases. When gut health is compromised, the delicate balance of the gut microbiome shifts, which can trigger immune responses and worsen joint inflammation.
Studies have shown that disruptions in gut bacteria may play a role in the onset and progression of AS. Researchers are actively investigating how microbiome imbalances can aggravate symptoms and influence disease activity. Some patients report that their joint pain flares up during bouts of digestive discomfort, highlighting the intricate interplay between the gut and immune system.
It’s important for those with AS to monitor digestive symptoms, such as bloating, abdominal pain, or changes in bowel habits. Addressing gut health—through diet, probiotics, or medical treatment for conditions like IBS—can positively impact overall disease management. To learn more about the gut-arthritis connection, see the Arthritis Foundation’s overview on gut health and arthritis.

14. Hormonal Changes

Hormonal fluctuations can play a significant role in triggering ankylosing spondylitis flares. Events such as puberty, menstruation, pregnancy, or menopause can all cause shifts in the immune response, sometimes leading to increased inflammation or pain. Female patients, in particular, often report that their AS symptoms worsen during certain phases of their menstrual cycle or become more unpredictable during menopause.
For example, some women notice increased stiffness and joint discomfort in the days leading up to menstruation or during hormonal transitions. These changes are believed to be related to variations in estrogen and progesterone, which can influence immune system activity and inflammation. Puberty and pregnancy are also times of hormonal upheaval that may alter the course of AS.
Because the relationship between hormones and autoimmune disease is complex and varies from person to person, it’s crucial to track symptoms and discuss any patterns with a healthcare provider. Open communication can help tailor treatment approaches, such as adjusting medications or exploring supportive therapies. For more on women’s experiences with arthritis and hormonal changes, visit the Arthritis Foundation’s women and arthritis resource.

15. Dehydration

Dehydration is an often-overlooked trigger that can worsen ankylosing spondylitis symptoms. When the body lacks adequate water, tissues become less elastic and more prone to stiffness. Joints and cartilage rely on fluid to cushion movement and maintain flexibility, so insufficient hydration can lead to increased discomfort and decreased mobility.
Comparing hydration levels, people who consistently drink enough water tend to report less joint pain and greater ease of movement compared to those who are frequently dehydrated. Even mild dehydration can intensify the sensation of stiffness, especially in the morning or after periods of inactivity. This effect can be particularly pronounced in hot weather or during physical activity, when fluid loss accelerates.
To support joint health and minimize pain flares, experts recommend drinking water regularly throughout the day, aiming for clear or pale yellow urine as a general guide. Including water-rich foods like fruits and vegetables also helps maintain optimal hydration. For more advice on the importance of hydration in arthritis management, visit the Arthritis Foundation’s hydration and arthritis page.

16. Excess Weight

Carrying excess weight places additional mechanical stress on the spine, hips, and other major joints—areas already vulnerable in ankylosing spondylitis. This extra load can accelerate joint damage, increase pain, and worsen mobility. For people with AS, even a modest reduction in body weight can yield significant improvements in symptoms and overall function.
Clinical studies have shown that patients who lose weight often report reduced pain, greater ease in movement, and better response to medications. Shedding just a few pounds can lessen inflammation and relieve pressure on the joints, especially in the lower back and pelvis. Weight loss may also help lower the risk of other health complications, such as heart disease and diabetes, which are more common in people with chronic inflammatory conditions.
Making small lifestyle changes—such as swapping sugary drinks for water, incorporating more vegetables into meals, or increasing daily steps—can set the stage for sustainable weight management. For more guidance on weight loss and arthritis, see the Arthritis Foundation’s overview on why weight matters.

17. Allergies

Allergic reactions, whether to pollen, dust mites, foods, or pet dander, can trigger a surge in the body’s immune activity. For those with ankylosing spondylitis, this heightened immune response can spill over into the joints, leading to increased inflammation and the potential for pain flares. During peak allergy seasons—such as spring and fall—many people with AS notice their symptoms become more pronounced or unpredictable.
The body’s release of histamines and other inflammatory chemicals during an allergic reaction doesn’t just affect the respiratory tract or skin; it can also contribute to systemic inflammation, making existing autoimmune conditions worse. For example, someone prone to hay fever may find that joint pain and stiffness intensify when pollen counts are high.
Managing allergies is an important aspect of controlling AS flares. Strategies may include minimizing exposure to known allergens, using antihistamines or prescribed allergy medications, and keeping windows closed during high pollen days. For more comprehensive tips on allergy control and its impact on inflammatory arthritis, visit the Arthritis Foundation’s guide to allergies and arthritis.

18. Poor Footwear

Footwear is more than a fashion choice—especially for people living with ankylosing spondylitis. Shoes that lack proper support or cushioning can disrupt posture, increase strain on the spine and hips, and worsen joint pain. Unsupportive shoes, such as flat sandals, worn-out sneakers, or high heels, can cause the body to compensate with unnatural gait patterns, amplifying stress along the entire musculoskeletal chain.
Individuals in professions that require prolonged standing or walking, such as teachers, retail workers, or healthcare staff, are particularly vulnerable. Over time, poor footwear choices can contribute to chronic pain, fatigue, and even structural changes in the feet or back. Some AS patients report that switching to supportive shoes or custom orthotics significantly reduced their discomfort and improved mobility.
Experts recommend investing in well-fitted, cushioned shoes with good arch support and shock absorption. Orthotic inserts can further enhance comfort and alignment, reducing the risk of pain flares during daily activities. For practical tips on choosing supportive footwear and using orthotics, refer to the Arthritis Foundation’s footwear tips for arthritis.

19. Prolonged Sitting

Long periods of sitting are a common trigger for increased spinal stiffness in people with ankylosing spondylitis. When the body remains stationary for extended stretches, especially in unsupportive chairs or poor postures, blood flow to the spine decreases and muscles can tighten, intensifying discomfort. Over time, this lack of movement can lead to greater loss of flexibility and even contribute to the fusion of spinal joints—a hallmark of advanced AS.
Office workers and those with desk-bound jobs face particular challenges. Many spend hours at a time in front of computers, often without realizing how much time has passed. This sedentary routine can cause pain to build gradually throughout the day, making it harder to move freely when finally standing up. In contrast, individuals who take frequent movement breaks report less stiffness and improved comfort.
Experts recommend setting alarms or using reminders to stand up, stretch, or walk every 30 to 60 minutes. Simple desk exercises, posture adjustments, and alternating between sitting and standing positions can help. For more guidance on maintaining spinal health at work, visit the Arthritis Foundation’s desk job ergonomics page.

20. Cold Temperatures

Cold temperatures can be particularly challenging for people with ankylosing spondylitis. Exposure to chilly air often causes muscles and joints to tighten, reducing circulation and increasing stiffness. Many patients report that winter months or cold weather spells bring on heightened pain and make movement more difficult, especially in the morning or after periods of inactivity.
Common winter scenarios—such as waiting at a bus stop, walking in icy winds, or even sitting in a cold office—can trigger discomfort that lingers long after exposure. For some, the mere anticipation of cold weather is enough to prompt a pain flare. This response is thought to be due to the body’s natural tendency to conserve heat by constricting blood vessels, which inadvertently reduces flexibility in the muscles and connective tissues.
To combat these effects, experts recommend layering warm clothing, using heating pads, and keeping living spaces comfortably heated. Gentle stretching or light indoor exercise can also help maintain circulation and reduce stiffness. For more advice on managing arthritis in cold weather, explore the Arthritis Foundation’s weather and arthritis resource.

21. High Humidity

High humidity can have a profound effect on people with ankylosing spondylitis. Muggy weather increases the moisture in the air, which some patients find leads to more pronounced joint swelling and a sense of heaviness or aching throughout the body. Unlike dry climates, where sweat evaporates quickly and the body can maintain a steady temperature, humid environments can make it harder for the body to cool down, potentially exacerbating inflammation.
Many individuals report that their symptoms worsen on particularly humid days, especially during summer or during rainstorms. The sensation of “weather-related pain” is well-documented in arthritis communities, and while the exact mechanisms are still being studied, researchers believe that changes in air pressure and humidity may affect joint tissues and nerves.
To reduce discomfort, using indoor climate control—such as air conditioning or a dehumidifier—can help maintain a more comfortable environment. Staying indoors during peak humidity, wearing loose clothing, and staying well-hydrated are also helpful strategies. For additional insights on how weather affects arthritis, see the Arthritis Foundation’s weather and arthritis overview.

22. Travel Fatigue

Travel can be especially taxing for those with ankylosing spondylitis, as it often disrupts daily routines and forces the body into cramped or awkward positions for extended periods. Whether traveling by plane, train, or car, prolonged sitting and limited movement can intensify spinal stiffness, muscle tension, and overall pain. The stress of navigating airports, carrying luggage, or even sleeping in unfamiliar beds can further contribute to discomfort.
Airplane travel is a common example: narrow seats, limited legroom, and infrequent opportunities to stand or stretch can quickly trigger a flare. Many people with AS report increased stiffness and pain after long flights, particularly if they are unable to maintain their usual stretching or exercise routines.
To minimize the impact, experts recommend planning ahead by booking aisle seats for easier access to standing and moving, using neck or lumbar support pillows, and performing simple stretches during travel. Regularly standing up and walking the aisle, even for a few minutes, can help keep joints limber. For more practical travel tips for people with arthritis, visit the Arthritis Foundation’s guide to traveling with arthritis.

23. Medication Side Effects

While many medications for ankylosing spondylitis are effective in reducing inflammation and pain, some can paradoxically cause new or worsening symptoms. For example, TNF-inhibitors—commonly prescribed biologics—have helped countless patients achieve better disease control but can occasionally trigger adverse reactions, such as increased fatigue, joint pain, or even secondary infections. Some individuals may develop allergic responses, digestive problems, or mood changes while on certain therapies.
It’s not uncommon for a patient to experience unexpected side effects shortly after starting a new medication or changing doses. These reactions can sometimes mimic an AS flare, making it difficult to distinguish between disease progression and medication-related problems. In rare cases, medications meant to control inflammation may actually worsen symptoms in a subset of users.
Promptly reporting any unusual or severe side effects to your healthcare provider is crucial. Open communication allows your doctor to adjust your treatment plan, recommend supportive measures, or switch to alternative therapies if needed. For a detailed overview of biologic side effects and safety, see the Arthritis Foundation’s guide to biologics.

24. Vitamin D Deficiency

Vitamin D plays a crucial role in maintaining bone health and supporting proper immune function. For people with ankylosing spondylitis, a deficiency in this essential nutrient has been linked to increased disease activity and worse outcomes. Vitamin D helps regulate calcium absorption, which is vital for bone strength, and also modulates the immune response, potentially reducing inflammation.
Several studies have found that individuals with AS are more likely to have low vitamin D levels compared to the general population. Research published in the Journal of Clinical Rheumatology shows a clear association between vitamin D deficiency and higher disease activity, including increased pain, stiffness, and risk of osteoporosis. This deficiency may also impair the body’s ability to repair bone and joint tissue.
Routine testing of vitamin D levels is recommended for people with AS, especially if symptoms worsen or if there are risk factors for low levels, such as limited sun exposure or malabsorption issues. Supplementation under medical supervision can help restore healthy levels. For further information on vitamin D and arthritis, the Arthritis Foundation’s vitamin D resource offers practical guidance.

25. Unmanaged Comorbidities

Managing ankylosing spondylitis becomes significantly more challenging when other chronic health conditions—such as diabetes, heart disease, or hypertension—are present. These comorbidities can complicate treatment strategies, increase inflammation, and contribute to higher levels of pain and fatigue. For instance, uncontrolled diabetes can lead to poor wound healing and increase the risk of infections, both of which may exacerbate AS symptoms.
Overlapping care plans are often required, with patients needing to coordinate between rheumatologists, primary care providers, and specialists. Medication interactions and conflicting dietary or activity recommendations can further complicate management. People with heart disease, for example, may need to modify their exercise routines, while those with hypertension must be cautious about certain pain medications.
Regular medical checkups and open communication between healthcare providers are essential for optimal care. Monitoring and managing comorbidities can help reduce the overall burden of disease and prevent complications. For more on the impact of comorbid conditions in arthritis care, visit the CDC’s arthritis and comorbidities resource.

26. Overcrowded Living Conditions

Overcrowded living conditions present unique challenges for people with ankylosing spondylitis. High-density environments—often found in urban apartments or shared housing—can increase stress levels due to noise, lack of personal space, and disrupted routines. Chronic stress is a well-known trigger for inflammation and pain flares in AS, making such living situations particularly problematic.
In addition, crowded spaces often carry a higher risk of infection transmission, from the common cold to seasonal flu. This is especially concerning for those with compromised immune systems or who are taking immunosuppressive medications, as infections can quickly lead to AS flare-ups or complications. In contrast, rural or less crowded homes typically provide more opportunities for rest, privacy, and reduced exposure to infectious agents.
Maintaining cleanliness, proper ventilation, and personal hygiene is crucial in shared living environments. Regular handwashing, routine cleaning of high-touch surfaces, and minimizing exposure to sick individuals can help reduce risk. For more information on infection control in crowded settings, see the CDC’s guidelines for environmental infection control.

27. Air Pollution

Air pollution is an increasingly recognized factor in worsening systemic inflammation, particularly for people with ankylosing spondylitis. Exposure to pollutants like particulate matter, ozone, and nitrogen dioxide—prevalent in many major cities—can aggravate the immune system and trigger pain flares. Studies have shown that individuals living in areas with poor air quality are more likely to report increased joint pain and fatigue, as well as higher rates of respiratory illness.
For example, research conducted in metropolitan centers such as Los Angeles and Beijing has linked spikes in air pollution to more frequent hospital visits for inflammatory diseases. Pollutants can enter the body through the lungs and circulate in the bloodstream, amplifying inflammation not only in the lungs but also in joints and other tissues.
To minimize exposure, experts recommend using indoor air purifiers, keeping windows closed on high-pollution days, and monitoring local air quality reports. Wearing masks outdoors and avoiding heavy traffic areas can also help reduce risk. For further insight into how air pollution affects arthritis, visit the Arthritis Foundation’s environmental factors resource.

28. Lack of Sunlight

Limited exposure to sunlight can be a subtle but powerful trigger for worsening ankylosing spondylitis symptoms. Sunlight is essential not only for mood regulation and maintaining healthy circadian rhythms, but also for the natural production of vitamin D—a nutrient vital for bone health and immune function. During winter months, or for those who spend most of their time indoors, decreased sunlight can lead to vitamin D deficiency and disrupted sleep cycles.
Scenarios such as long stretches of gray, overcast weather, working night shifts, or living in higher latitudes can all reduce natural sun exposure. This may result in increased fatigue, joint stiffness, and pain, as well as a heightened risk of flare-ups. The lack of sunlight can also contribute to seasonal affective disorder (SAD), which is common among people with chronic illnesses.
Practicing safe sun habits—such as spending short periods outdoors during midday, wearing sunscreen, and exposing arms or legs for a few minutes at a time—can help maintain healthy vitamin D levels. Supplementation may be recommended by healthcare providers in cases of persistent deficiency. For more information, visit the Arthritis Foundation’s guidance on sunlight, vitamin D, and arthritis.

29. Unresolved Trauma

Both physical and emotional trauma can act as significant triggers for ankylosing spondylitis flares. Physical injuries—such as falls, car accidents, or sports-related strains—can inflame already sensitive joints and tissues, often leading to prolonged pain or even the onset of new symptoms. The stress of post-injury recovery can further disrupt sleep, mood, and activity levels, compounding the impact on overall health.
Emotional trauma, including events like bereavement, relationship upheaval, or major life transitions, can also set off a cascade of stress hormones that fuel inflammation. Research suggests that chronic emotional distress may worsen immune system dysfunction and increase the likelihood of flare-ups in autoimmune diseases like AS.
Addressing trauma is essential for both physical and emotional healing. Comprehensive recovery may involve physical therapy, pain management, and gradual return to activity after injury. Equally important is seeking psychological support—such as counseling or support groups—to process emotional trauma and develop healthy coping strategies. For more information on the interplay between trauma, stress, and arthritis, the Arthritis Foundation’s guide on trauma and arthritis offers additional insight.

30. Overuse of Assistive Devices

While canes, braces, and other assistive devices can be invaluable in managing ankylosing spondylitis, overreliance without professional guidance may inadvertently worsen stiffness and limit mobility. Using assistive devices too frequently, or without the input of a physical therapist, can cause muscles to weaken and joints to lose their natural range of motion. This, in turn, may speed up the progression of joint rigidity and pain.
Proper use of assistive devices is key. When prescribed and fitted by a specialist, these tools can reduce pain, prevent falls, and support independence. However, improper or unsupervised use—such as wearing a brace all day without stretching or relying on a cane for every step—may create new problems. For example, a poorly fitted brace might cause skin irritation or alter gait, while unbalanced cane use can strain the opposite side of the body.
Periodic reassessment by a physical or occupational therapist ensures that devices are being used appropriately and that the underlying causes of pain or instability are addressed. Incorporating tailored exercises and regularly reviewing equipment needs can help maintain function and prevent secondary complications. For more advice, see the Arthritis Foundation’s guide to assistive devices.

31. Overcrowded Social Calendar

An overly packed social calendar can be a hidden trigger for ankylosing spondylitis flares. Overcommitment—especially during busy times like the holiday season—often leads to increased stress, fatigue, and disrupted routines. Social obligations may include family gatherings, parties, travel, and work events, all of which can make it difficult to prioritize rest and self-care.
During these periods, people with AS may find themselves pushing through pain or skipping essential routines such as medication, stretching, or relaxation techniques. The pressure to “keep up” with social expectations can also cause emotional stress, which, as research suggests, has a direct impact on inflammation and pain levels. Even enjoyable events can become overwhelming when they pile up without adequate downtime.
Setting boundaries is a key strategy for protecting health and well-being. This might involve saying no to certain invitations, scheduling rest periods between events, or communicating your needs to friends and family. Thoughtful planning can help ensure a balance between social connection and self-care. For more practical tips on managing social commitments with arthritis, see the Arthritis Foundation’s guide to managing your social life.

32. Unstable Relationships

The emotional stress that stems from unstable or conflicted relationships can be a powerful trigger for ankylosing spondylitis flares. Frequent arguments, lack of support, or ongoing tension with partners, family, or friends may elevate stress hormones and increase systemic inflammation, which can translate directly into more pain and fatigue. The psychological burden of navigating turbulent relationships often leaves little energy for essential self-care and symptom management.
Conversely, strong social support has been linked with improved coping and fewer pain episodes in people with chronic illnesses. Support groups, whether in-person or online, offer a safe space to share experiences, learn coping strategies, and feel understood. These connections can help buffer the negative effects of conflict and isolation, reducing overall stress.
Open communication—expressing needs, setting boundaries, and seeking mutual understanding—is an important skill for maintaining healthy relationships while managing AS. In some cases, professional counseling or relationship therapy may be beneficial. For more guidance on the importance of social support and relationship health, visit the Arthritis Foundation’s support groups resource.

33. Financial Stress

Financial worries can be a relentless source of psychological stress for people with ankylosing spondylitis, often leading to increases in pain and disease activity. Concerns over medical bills, insurance coverage, medication costs, or job security can raise stress hormones such as cortisol, which in turn fuel inflammation and discomfort. The daily strain of balancing treatment costs with other living expenses may also disrupt sleep and make it difficult to maintain a healthy routine.
Comparative studies have shown that individuals with comprehensive health insurance or access to disability resources report lower stress and better disease outcomes than those without adequate coverage. Navigating insurance denials, high deductibles, or gaps in employment can add to the emotional and physical burden, making it harder to stay adherent to treatment plans or afford essential therapies.
Seeking financial counseling or connecting with hospital social workers can help individuals and families access resources, understand their insurance options, and develop a plan to manage costs. Many organizations, including the Arthritis Foundation, offer guidance and support for managing the financial aspects of chronic illness.

34. Poor Dental Health

There’s a growing body of evidence linking poor dental health to increased inflammation and systemic disease activity, including ankylosing spondylitis. Oral infections and gum disease (periodontitis) are not just local problems; they can release inflammatory mediators into the bloodstream, worsening overall immune system dysfunction. Studies referenced by the CDC show that gum disease is associated with higher risks of chronic illnesses such as heart disease, diabetes, and rheumatoid arthritis.
For people with AS, persistent oral inflammation can potentially trigger or amplify flares, as the immune system is already on high alert. Symptoms like bleeding gums, tooth pain, or persistent bad breath should not be ignored, as these may indicate underlying infection. Research suggests that treating gum disease can help reduce systemic inflammation and may even lead to improvements in arthritis symptoms.
Regular dental checkups, daily brushing and flossing, and prompt attention to dental concerns are essential components of overall disease management. Collaboration between dental and medical providers can ensure early intervention and minimize the risk of oral health contributing to AS flares. For more on the connection between oral and systemic health, explore the CDC’s overview on periodontal disease.

35. Untreated Sleep Apnea

Untreated sleep apnea can significantly worsen the experience of ankylosing spondylitis by disrupting restorative sleep and increasing daytime fatigue. Sleep apnea causes repeated pauses in breathing during the night, leading to fragmented sleep, lower oxygen levels, and persistent tiredness. For people with AS, this can mean heightened pain sensitivity, more frequent flares, and reduced ability to cope with daily activities.
Research has shown that sleep apnea is common among individuals with chronic inflammatory diseases, and addressing it can yield meaningful improvements in both sleep quality and arthritis symptoms. Continuous positive airway pressure (CPAP) therapy is a standard treatment that keeps airways open and helps restore normal sleep patterns. Many patients report less pain, more energy, and better mood after starting CPAP.
Screening for sleep apnea is especially important for those who snore loudly, experience morning headaches, or feel excessively sleepy during the day. Sleep studies, which can be performed at home or in a clinic, are used to diagnose this condition. For more information about sleep apnea and its impact on chronic disease, visit the Sleep Foundation’s overview on sleep apnea.

36. Exposure to Chemicals

Exposure to certain chemicals in the workplace or home environment can trigger or worsen ankylosing spondylitis symptoms. Industrial workers, cleaners, or those in agriculture may be exposed to substances such as solvents, pesticides, heavy metals, or fumes that can provoke immune reactions or increase systemic inflammation. These chemical agents may enter the body through inhalation, skin contact, or accidental ingestion, potentially triggering pain flares or aggravating existing joint inflammation.
Studies have linked prolonged exposure to some industrial chemicals with a heightened risk of developing autoimmune conditions or experiencing more severe symptoms. For instance, workers in manufacturing or construction may report increased joint pain and fatigue after regular contact with solvents or dust. Even household products, like strong cleaning agents or paints, can contribute to issues if proper precautions aren’t taken.
To minimize risks, experts recommend using safety gear such as gloves, masks, or ventilation systems whenever working with potentially harmful substances. Employers are required to provide information and training on chemical safety, but individuals should also take personal responsibility for reducing exposure. For more on workplace chemical hazards and autoimmune risk, see the OSHA’s guide to chemical hazards.

37. High Altitude

Traveling to high altitudes can present unique challenges for individuals with ankylosing spondylitis. The lower oxygen levels found at altitude can increase fatigue, reduce exercise tolerance, and potentially aggravate inflammation throughout the body. This is because the body has to work harder to deliver oxygen to tissues, which may amplify feelings of weakness, soreness, or joint stiffness.
People who travel to mountainous regions—whether for vacation, work, or outdoor activities—often report an increase in pain and tiredness, especially if they ascend rapidly without allowing for proper adjustment. The stress of acclimatization can also disrupt sleep patterns and hydration, both of which are vital for managing AS symptoms.
To minimize problems, gradual acclimatization is recommended. This means ascending slowly, staying well-hydrated, and taking breaks to allow the body to adjust. If possible, build in rest days during travel and avoid strenuous activity during the first few days at altitude. For more on how altitude affects chronic health, see the CDC’s high altitude travel resource.

38. Unhealthy Coping Mechanisms

When faced with the chronic pain and stress of ankylosing spondylitis, some individuals may turn to unhealthy coping mechanisms such as substance abuse, emotional eating, or avoidance behaviors. While these strategies might provide temporary relief or distraction, they often lead to worsened physical and emotional symptoms in the long run. Alcohol or drug misuse can disrupt sleep, interfere with medications, and heighten inflammation, while avoidance of activity can lead to deconditioning and increased stiffness.
Research has shown that reliance on these coping strategies may also increase the risk of depression, anxiety, and social isolation. Instead, healthy alternatives such as mindfulness meditation, exercise, creative outlets, or connecting with a support group can help build true resilience and improve quality of life. Many organizations offer resources for those struggling, including the SAMHSA National Helpline for substance use and mental health support.
Seeking help is a sign of strength, not weakness. Engaging with a counselor, joining a peer support group, or exploring therapeutic activities can help replace harmful patterns with sustainable, positive routines. For more on healthy coping strategies, consult the Arthritis Foundation’s coping strategies page.

39. Overuse of Technology

Excessive use of digital devices can have a significant impact on ankylosing spondylitis symptoms. Prolonged screen time, whether for work or leisure, often leads to poor posture—such as slumping over a laptop or craning the neck to look at a phone—which puts additional strain on the spine and joints. Over time, this can worsen pain, stiffness, and even accelerate spinal changes.
Remote workers are particularly at risk, as home offices may lack ergonomic setups and the boundaries between work and rest can become blurred. Many people find themselves glued to screens for hours at a stretch, skipping breaks, and sacrificing sleep. The blue light emitted by screens can also disrupt circadian rhythms, making it harder to fall or stay asleep, which in turn increases pain sensitivity.
To counter these effects, experts recommend taking regular digital breaks—standing up, stretching, and moving every 30 to 60 minutes. Setting up workstations with good ergonomics and limiting screen time before bed are also helpful strategies. For more advice on healthy tech use and posture, visit the Arthritis Foundation’s desk ergonomics resource.

40. Not Following Physical Therapy

Physical therapy is a cornerstone of ankylosing spondylitis management, offering tailored exercises that help preserve flexibility, posture, and overall function. Skipping or inconsistently following PT recommendations can lead to increased stiffness, reduced mobility, and more frequent pain flares. The carefully designed stretches and strengthening routines target the specific areas most affected by AS, supporting the spine and surrounding muscles.
Many patients who stick to their prescribed physical therapy plans report greater ease in daily activities and less progression of spinal rigidity. On the other hand, those who abandon regular sessions often notice setbacks—such as trouble bending, rising from a chair, or maintaining good posture. Stories from AS support groups highlight that, even when symptoms improve, continued commitment to PT is essential for maintaining gains.
Regular sessions with a licensed physical therapist ensure that exercises remain effective and are adjusted as needs change. Therapists can also provide motivation, monitor progress, and address any difficulties or pain that arise. For more on the benefits of physical therapy and how to get started, explore the Spondylitis Association of America’s PT guide.

41. Ignoring Early Symptoms

One of the most significant pitfalls in ankylosing spondylitis management is dismissing new or worsening pain as “just a minor ache.” Early symptoms—such as persistent back pain, stiffness that improves with movement, or unexplained fatigue—are often overlooked or attributed to everyday stress or aging. This can lead to dangerous delays in diagnosis and treatment, allowing the disease to progress unchecked.
Many people with AS report experiencing symptoms for years before seeking medical attention, only to discover that irreversible changes—such as spinal fusion or joint damage—have already occurred. Early intervention is crucial, as prompt diagnosis enables timely initiation of medication, physical therapy, and lifestyle adjustments that can slow disease progression and improve long-term outcomes.
Paying attention to your body and seeking medical advice for any unexplained or persistent pain is essential. Don’t hesitate to advocate for yourself if symptoms are dismissed or misunderstood by others. For more information on recognizing the signs and the importance of early diagnosis, see the CDC’s ankylosing spondylitis resource.

42. Lack of Support Network

Social isolation is more than just an emotional challenge for people with ankylosing spondylitis—it can also worsen the perception and experience of pain. Research shows that individuals with chronic illnesses who lack a strong support network often report higher pain levels, more frequent flares, and lower overall quality of life. Without the encouragement and understanding from friends, family, or peers, it’s easy to feel overwhelmed or alone in managing daily symptoms.
Studies on chronic pain have revealed that social support acts as a buffer, helping people cope with stress, adhere to treatment, and maintain a positive outlook. Support groups—whether online or in person—offer a safe space to share experiences, learn new coping strategies, and gain reassurance from others facing similar challenges.
If you feel isolated, consider reaching out to local arthritis organizations, joining online communities, or talking to a counselor about building social connections. The Arthritis Foundation’s support group resource is a valuable starting point for finding connection and understanding. Remember, a strong support network can make a world of difference in living well with AS.

43. Food Sensitivities

Food sensitivities can be a hidden trigger for increased inflammation and pain in people with ankylosing spondylitis. Certain foods—such as gluten, dairy, or highly processed items—may provoke immune reactions in susceptible individuals, leading to digestive discomfort and even joint pain. While not everyone with AS will react to the same foods, growing research suggests that dietary triggers can play a role in disease activity for some.
Many patients experiment with elimination diets, removing suspected trigger foods for several weeks and then gradually reintroducing them to observe any changes in symptoms. Keeping a detailed food diary is an effective way to track what you eat and correlate it with pain or flare patterns. For example, someone may notice that symptoms worsen after consuming bread or cheese, prompting further investigation with their healthcare provider.
If you suspect food sensitivities are impacting your AS, consult a registered dietitian or rheumatologist before making major dietary changes. They can help guide safe and balanced elimination diets, ensuring nutritional needs are met. For more information on diet and arthritis, visit the Arthritis Foundation’s guide to elimination diets.

44. Unmanaged Anxiety or Depression

Anxiety and depression are common among people living with ankylosing spondylitis, and when left unmanaged, they can significantly worsen the experience of pain and disease activity. Mood disorders are known to heighten pain perception and reduce motivation for self-care, creating a vicious cycle where physical symptoms and emotional distress feed into each other. According to mental health prevalence data, individuals with chronic illnesses like AS are at greater risk for developing depression or anxiety than the general population.
This interplay is supported by research showing that inflammation can impact neurotransmitter levels and brain chemistry, while persistent pain and mobility challenges can erode emotional well-being. Regular mental health check-ins—with a counselor, psychologist, or support group—are crucial for early identification and treatment of mood disorders. Recognizing symptoms such as persistent sadness, loss of interest, or excessive worry is the first step toward recovery.
Managing mental health is as important as managing physical symptoms. Many find relief through therapy, medication, mindfulness practices, or peer support. For more about the relationship between arthritis and mental health, visit the Arthritis Foundation’s mental health and arthritis resource.

45. Excessive Heat Exposure

High temperatures can be particularly challenging for people with ankylosing spondylitis, as excessive heat often leads to dehydration, fatigue, and a noticeable increase in pain and stiffness. Outdoor summer events such as festivals, barbecues, or long days at the beach can easily result in overheating, especially if physical activity is involved. The body works harder to regulate temperature, which can sap energy and worsen inflammation.
Sweating from heat exposure accelerates fluid loss, making dehydration more likely. This reduces the lubrication in joints and tissues, intensifying discomfort and limiting mobility. In addition, being in direct sunlight for extended periods can disrupt sleep patterns and further tax the immune system, increasing the risk of symptom flares.
To minimize the impact, it’s important to stay hydrated by drinking water regularly, seek shade or air conditioning, and wear breathable, light-colored clothing on hot days. Planning ahead for summer outings—such as bringing a water bottle and taking frequent breaks—can make a significant difference. For more advice on managing arthritis in extreme temperatures, visit the Arthritis Foundation’s weather and arthritis resource.

46. Irregular Meal Times

Irregular meal times can disrupt more than just hunger cues—they can throw off metabolism, energy levels, and the effectiveness of medications for ankylosing spondylitis. When eating patterns are inconsistent, the body’s ability to regulate blood sugar and process nutrients efficiently may be impaired, leading to fatigue and increased inflammation. For people whose medications are best taken with food, skipping or delaying meals can also affect absorption and efficacy.
Shift workers, in particular, often struggle to maintain regular eating schedules due to rotating hours or overnight shifts. This erratic routine can exacerbate digestive issues, interfere with sleep quality, and make it difficult to adhere to medication regimens. Over time, irregular meal patterns may contribute to weight fluctuations or nutrient deficiencies, which can further worsen joint pain and fatigue.
Meal planning is a powerful strategy for maintaining consistency. Preparing simple meals in advance, carrying healthy snacks, and setting reminders for medication can help stabilize routines and support better disease management. For more on nutrition and arthritis, visit the Arthritis Foundation’s arthritis diet resource.

47. Unaddressed Sexual Health Issues

Sexual health is an important yet often overlooked aspect of life with ankylosing spondylitis. Pain, stiffness, and fatigue can all affect intimacy, making sexual activity uncomfortable or emotionally stressful. Concerns about body image, performance, or the unpredictability of symptoms may also inhibit communication between partners, leading to frustration or avoidance.
Open and honest communication is essential for maintaining intimacy and emotional connection. Discussing fears, preferences, and comfort levels can help couples find creative ways to adapt, such as experimenting with different positions, using pillows for support, or choosing times of day when symptoms are less severe. It’s also important for individuals to feel empowered to bring up sexual health concerns with their healthcare providers.
Doctors and physical therapists can offer guidance on pain management, recommend stretches to enhance flexibility, or address underlying issues such as medication side effects or hormonal imbalances. Addressing sexual health is an integral part of holistic AS care. For more resources on intimacy and arthritis, see the Arthritis Foundation’s sex and arthritis page. Prioritizing these conversations leads to better quality of life and stronger relationships.

48. Exposure to Loud Noise

Chronic exposure to loud or persistent noise can be a surprising contributor to increased pain and stress in people with ankylosing spondylitis. Prolonged noise—such as traffic, construction, sirens, or noisy neighbors—raises cortisol levels and activates the body’s stress response, which can heighten pain perception and trigger inflammation. Urban living, in particular, often subjects residents to a near-constant barrage of sound, leaving little opportunity for true rest or relaxation.
Research has shown that chronic noise stress can disrupt sleep, worsen mood, and lead to increased sensitivity to pain. Even if the noise is not consciously bothersome, the body may still react by staying in a heightened state of alertness, making it harder to recover from daily stressors or manage chronic pain.
Implementing noise reduction strategies can help create a more peaceful environment. These may include using earplugs, white noise machines, or heavy curtains, as well as arranging furniture to minimize sound transmission. For those in urban environments, soundproofing windows or choosing quieter rooms for rest can also make a difference. For more on noise and health, visit the CDC’s guide to noise and health.

49. Changes in Medication Brand or Formula

A clear pharmacy bottle filled with medication tablets sits on the counter, ready to help someone feel better. | Generated by Google Gemini

A seemingly minor change in medication brand or formula can sometimes have a significant impact on ankylosing spondylitis management. Switching from a brand-name drug to a generic, or from one generic to another, can alter the effectiveness or side effect profile, even if the active ingredient remains the same. Differences in fillers, binding agents, or release mechanisms may influence how a medication is absorbed or tolerated.
Patients occasionally report noticeable changes in symptom control after a pharmacy substitution, such as increased pain, new side effects, or reduced efficacy. This can be frustrating, especially when the switch is made without prior discussion or when insurance coverage dictates the change.
It’s important to monitor for any changes in how you feel after receiving a new brand or formula and to report these differences to your healthcare provider promptly. They can help determine whether a medication adjustment, appeal to your insurance, or a return to the previous brand is warranted. For more information on medication switching and what to watch for, see the FDA’s guide to generic drugs.

50. Delayed Medical Follow-Up

Missing routine checkups or necessary imaging appointments can have serious consequences for people with ankylosing spondylitis. Regular follow-up visits allow healthcare professionals to monitor disease progression, adjust medications, and catch complications early—such as spinal fusion, osteoporosis, or cardiovascular issues. When appointments are missed, subtle but important changes can go unnoticed, leading to delayed intervention and potentially irreversible joint or organ damage.
There are many reasons why people skip follow-ups: busy schedules, feeling better temporarily, or anxiety about test results. However, even if symptoms seem stable, ankylosing spondylitis can progress silently. Imaging studies, like X-rays or MRIs, are crucial for detecting changes that may not yet cause symptoms but require prompt treatment.
Examples abound of patients who missed appointments only to discover advanced disease at their next visit. To avoid these risks, it’s essential to prioritize regular checkups and communicate openly with your care team about any barriers to attendance. For more advice on the importance of follow-up care in chronic diseases, visit the CDC’s arthritis care resource.

Conclusion

Recognizing and proactively managing the many triggers that can send ankylosing spondylitis pain into overdrive is vital for long-term health and well-being. Early action—whether through symptom tracking, regular medical checkups, or adjusting daily routines—can help prevent serious complications and preserve quality of life. Staying vigilant about changes in symptoms, maintaining open dialogue with healthcare providers, and making informed lifestyle choices are essential steps.
Remember, every person’s experience with AS is unique, and what triggers a flare in one may not affect another. By taking a personalized, proactive approach and seeking support when needed, you can better navigate the challenges of AS. For more information and ongoing support, visit the Spondylitis Association of America.

Triggers That Can Send Ankylosing Spondylitis Pain Into Overdrive