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What is ankylosing spondylitis
ICD-10 code: M45
Ankylosing spondylitis (Bechterew’s disease) is a chronic systemic inflammatory disease from the spondyloarthritis group. It primarily affects the sacroiliac joints, then inflammation spreads to the spine. Without treatment, ankylosis — ossification of ligaments and loss of spinal mobility — is possible. In 30–40% of patients, peripheral joints are also affected: hips, knees, shoulders.
The disease usually begins between ages 20–40. The foundation of treatment is medication: NSAIDs and biologic agents (TNF-α inhibitors, IL-17). Regenerative methods do not replace base therapy but may be used as an adjunct for peripheral joint involvement.
Symptoms and diagnosis
Key symptoms
Persistent pain in the lower back and sacrum, worsening in the second half of the night. Morning stiffness lasting over 30 minutes, improving with movement. Gradual restriction of spinal mobility. With peripheral arthritis — joint pain and swelling.
Laboratory diagnosis
ESR and CRP are elevated in 50–70% of patients. HLA-B27 is positive in 90–95% (but its presence alone does not confirm the diagnosis). Inflammatory activity is monitored by CRP levels.
Imaging
MRI of the sacroiliac joints detects sacroiliitis at an early stage — bone marrow edema and inflammation. X-rays show changes later: erosions, sclerosis, ankylosis. MRI of peripheral joints assesses cartilage before regenerative treatment.
Ankylosing spondylitis: treatment options and what is known about them
The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.
| Option | What to expect | How well studied |
|---|---|---|
| Treatment by a rheumatologist | Disease-modifying or specific drug therapy — the basis of treatment | Well studied, recommended |
| Exercise therapy and physiotherapy | Reduces pain, strengthens muscles, improves function; the basis of treatment | Well studied, recommended |
| Painkillers and NSAIDs | Ease pain during flare-ups; long-term use is limited by side effects | Well studied, recommended |
| Corticosteroid injection | Quickly reduces inflammation and pain, the effect is often temporary; frequent injections are undesirable | Limited or conflicting evidence |
| PRP / CGF | Concentrate from your own blood; may reduce pain, growth of new tissue has not been shown | Little data |
We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.
Regenerative methods: realistic expectations
In inflammatory joint diseases the key is treating the cause with a rheumatologist: disease-modifying drugs for rheumatoid arthritis and ankylosing spondylitis, lowering uric acid for gout. An intra-articular corticosteroid injection helps with a flare in a single joint. Regenerative injections do not affect the inflammatory process and have hardly been studied for these diagnoses.
When surgery is discussed. Surgery (synovectomy, joint replacement) is discussed for joint destruction or persistent synovitis despite drug treatment.
If an injection helps, the effect usually builds up over 6–12 weeks, and the result is assessed after 2–3 months. No clinic can guarantee a result.
Free case assessment
Describe your situation and attach your test results. We will forward your case to clinics where rheumatologists work together with regenerative medicine specialists.
Submit request +49 160 5736643Good to know: diagnosis, self-help, outlook
How to recognise ankylosing spondylitis
Ankylosing spondylitis (axial spondyloarthritis) usually starts before age 40–45 with inflammatory back pain: it develops gradually, worsens at night and towards morning, comes with stiffness of more than 30 minutes and improves with movement rather than rest. The buttocks and heels may hurt, and the eyes may become inflamed (uveitis). A rheumatologist makes the diagnosis based on sacroiliac joint MRI, blood tests (CRP, HLA-B27) and examination.
What you can do yourself
Daily exercise for spinal and chest mobility, swimming and breathing exercises are the basis for maintaining mobility. Stopping smoking is important, as it worsens the course of the disease. If the condition is suspected, do not delay seeing a rheumatologist.
Outlook and timelines
Modern treatment — NSAIDs and, if insufficient, biological therapy — controls inflammation well in most patients and slows fusion of the vertebrae. Orthopaedic injections and surgery are used only for specific complications, such as destruction of the hip joint.
Recovery and timelines
After an outpatient injection procedure, most patients return to normal activity within 1–3 days. Sport and heavy loads are resumed according to the physician’s plan, usually after 2–6 weeks, alongside therapeutic exercise. The effect is assessed after 6–12 weeks. After surgery, rehabilitation takes longer and depends on the operation.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- Urgent surgery, not injections, is needed if there is progressive leg weakness, numbness in the groin area or bladder dysfunction.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
- Injections into the intervertebral disc carry a rare risk of disc inflammation (discitis).
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Tuakli-Wosornu YA et al. Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study. PM R, 2016.
- Lurie JD et al. Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the Spine Patient Outcomes Research Trial. Spine, 2014.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised
FAQ: ankylosing spondylitis
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.
The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.