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Ankylosing Spondylitis Flares


Use objective ways to assess disease activity and functional ability

  • BASDAI [Bath Ankylosing Spondylitis Disease Activity Index]

  • Total score 4 or greater -suboptimal control of disease


  • BASFI [Bath Ankylosing Spondylitis functional Index]

  • No cutting point, higher the score, higher functional impaired

Ankylosing Spondylitis Flares

Reach out to your healthcare team if your flare: 

  • Doesn't improve with your developed strategies after 7 days

  • When symptom is more intense or different than normal. (For example, it causes particularly strong back pain.)

  • If you have Fever with chills, sweats, or weight loss:

  • Could be a signal an underlying infection, patients taking biologics are at increased risk of infection and should seek medical attention immediately 

What is a flare?1

A flare can be defined as the acute worsening of symptoms.

Axial inflammation in Spondyloarthritis

  • Chronic lower back, pelvic, and hip pain that comes and goes Stiffness

  • Flare:  feel significantly more intense and debilitating may be like stabbing in nature or feel like muscle cramps

Localized flares2:

  • Symptoms affect one primary area, causing pain, immobility, and fatigue.

  • Gentle exercise, stress management, listening to your body and the right medication treatment plan, you can get through these periods of flare-up.

Generalized flares2:

  • Symptoms are more severe and may affect multiple parts of the body.

  • In addition, may have flu-like illness (fever, sweating); hot, burning joints; muscle spasms; and more sensitivity. 

  • Emotional upset/taxing

  • Episodes may last from a few days to a few weeks

What causes a flare?1

  • Some flares are due to treatment interruption or discontinuation

  • Delaying doses or extending the time between doses, or

  • Loss of efficacy of the drug

  • Result of “random” fluctuations in disease activity

  • Patients linked flares to situations of increased emotional stress or an episode of “overdoing it.”

  • Infections are another potential trigger.

  • Inability to follow established exercise routines during the COVID-19 pandemic has been a recent problem

Try Do-It- Yourself first(DIY) in AS flare3

Use objective ways to assess disease activity and functional ability BASDAI [Bath Ankylosing Spondylitis Disease Activity Index]

Flares might be lasting from days to weeks

  • Many patients may have found their own ways of dealing with the situation

Coping strategies such as:

  1. Changes in the exercise routine -> gentle exercise e,g Tai-Chi, deep breathing exercises

  2. Long hot baths or showers and other nonpharmacological interventions

  3. Walking, range-of -motion exercises, even just stretching or deep breathing. swimming and hydrotherapy are also well-tolerated

  4. Find a balance between rest and gentle exercise to keep your joints moving

  5. Heat or cold therapy

  6. Try employing mind/body techniques such as meditation

  7. You might feel completely wiped out. “With the fatigue it brings about, take nap a couple of times a day

Ankylosing Spondylitis Flares

What does fatigue feel like?

In Ankylosing spondylitis, fatigue from inflammation, can feel like you have the flu, body ache all over

(uncontrolled systemic inflammation is the factor that predicts fatigue in AS)1

Try Do-It- Yourself first(DIY) for fatigue3

Apply many fatigue - fighting measures are under your control, such as :

  • Keep moving

  • Regular exercise helps reduce pain and inflammation –sleep better helps ease fatigue

  • Try the exercise/ physiotherapy recommendation

  • Fight fatigue, feed your body a healthy diet of lean proteins, healthy fats, fruit, vegetables and whole grains

  • Don’t skip meals, start every day with a good breakfast.

  • Set the right mood for sleep, try stick to a sleep schedule and soothing bedtime routine. Try warm bath, some gentle stretching

  • Ask for help! If fatigue, poor sleep, or depression are taking a toll. Suggest you may need referral for managing stress and mental health


  1. What is a Flare? [Online] at: Accessed on 18th Oct 2021

  2. Ankylosing Spondylitis Flares [Online] at: Accessed on 18th Oct 2021

  3. Try Do-It- Yourself first(DIY) in AS flare [Online] at: Accessed on 18th Oct 2021

Disclaimer: This material is not meant to replace professional advice from HCPs. Please consult your doctors/physiotherapist if you have any questions or before undertaking any physical activities.