Ankylosing spondylitis (AS) is a chronic immune-mediated inflammatory disease, it is a form of arthritis characterized by an autoimmune and genetic etiology, included in the group of chronic inflammatory, autoimmune, and diseases.

One of the most frequent reasons for the long delay in diagnosis is represented by the AS main symptoms such as: chronic low back pain, very common in this kind of patients, followed by a diagnosis of degenerative disc pathologies, rheumatoid arthritis, and tuberculosis of the spine. Another reason is the quite late appearance of the radiographic signs in the sacroiliac region.

The pain symptomatology manifesting itself from the onset of the pathology is the cause of an antalgic response. In this sense an early diagnosis is essential to avoid the establishment of deformities at the level of the spine and of the articular and peri-articular structures. Pharmacological treatment as well as a rehabilitation program are very important and effective in the early phase of the disease.

In the most advanced phases, the spine presents an increasing stiffening, with dorsal hyperkyphosis and the abolition of the lumbar lordosis determining the typical postural alterations characteristic of the disease. Early diagnosis and timely delivery to rehabilitation and physiotherapy can significantly reduce disability and complications. The international guidelines and recommendations suggest the pharmacological treatment as well as the rehabilitation and physiotherapy program during the different stages of the disease. In the 2016 update of the ASAS-EULAR recommendations for axial AS, multidisciplinary, non-pharmacological (along with pharmacological) treatment is required to ensure optimal management of the disease.

US-based recommendations also suggest the relevance of nonpharmacological therapies, along with recommended patient education, active physiotherapy and regular physical activity.