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Though symptoms of ankylosing spondylitis (AS) differ among individuals, some of the more common symptoms include:

• Frequent pain and stiffness in the area of the lower back (lumbar spine) and buttocks (sacroiliac joint). The pain comes on gradually over weeks or months.
• Pain may present on one side of the spine, bilateral (both sides), or alternate between sides
• Pain is usually dull and diffuse, and is worse at night.
• Stiffness is typically worse in the morning and can last for a few hours. It abates after a warm shower or bath and exercise, and recurs following periods of inactivity.
• Early in the process there may be fever, night sweats, loss of appetite, weight loss, and/or general discomfort.
• Pain has typically persisted for 3 months or longer.
• Patients may complain of increased fatigue.

For some patients (especially women) the pain may start in other joints such as the hip, ankle, elbow, knees, or shoulder. The symptoms for ankylosing spondylitis may initially appear in a different form in women and in adolescents which makes the diagnosis even more difficult to determine. In juveniles, the initial presentation of pain and inflammation in the peripheral joints is more common.

Ankylosing spondylitis tends to appear differently in women than in men. Some of the more common differences found in women include:

• Later age of onset
• Milder disease
• More extra-spinal (outside the spine) involvement such as chest wall, shoulders, feet, knees, wrists, and/or ankles. Men with AS typically have more involvement of the spine and pelvis.
• Ophthalmic complications are not as severe
• Longer asymptomatic periods between flares
• Significantly lower leukocyte (white blood cell) levels
• Women typically remain more functional than men
• Lower incidence of "bamboo spine"

There are also a number of differences between symptoms of juvenile-onset AS and adult-onset AS, including:

• More frequent involvement of peripheral joints in juvenile-onset AS
• Higher prevalence of hip involvement
• Significantly higher frequency of eventual hip replacement