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Ankylosing spondylitis (AS) typically carries a generally favorable prognosis, with little to no effect on mortality unless patients have long standing disease and significant complications. In general, most people who are diagnosed with ankylosing spondylitis do not develop severe functional disabilities and can expect to lead normal, productive lives. Pain and inflammation in most patients can be adequately controlled with medications and exercise therapy. Compliance with treatment programs is an important aspect of maintaining maximum mobility and comfort in ankylosing spondylitis.

Some patients may require long term anti-inflammatory therapy during "flares" which may occur intermittently. The symptoms of ankylosing spondylitis may come and go over many years and without treatment, the spinal column of some patients becomes progressively more painful and stiff due to excess bony growth and painful. Many patients with ankylosing spondylitis also complain of fatigue.

The severity of disease is very individual and only a limited number of patients suffer long-term significant disability. Because ankylosing spondylitis is a chronic disease, however, it is difficult to predict the long-term prognosis (outcome) of the natural disease progression for individual patients.

Studies that have evaluated the natural progression of ankylosing spondylitis over a long time interval have provided some useful information about disease progression and prognosis:

• Approximately 75% of patients with ankylosing spondylitis with mild spinal restriction who have had the disease for at least 10 years do not develop more severe spinal involvement. Patients with severe spinal involvement will usually experience most loss of function and mobility within the first 10 years of the start of the disease.

• Patients who develop arthritis of the hip early (within the first 2 years) during the course of ankylosing spondylitis tend to have a worse long-term prognosis than patients who develop hip arthritis 2 years or longer after developing AS.

In addition, studies have indicated that other markers for progression to severe disease include:

• No response or limited pain relief from nonsteroidal anti-inflammatory medications (NSAIDs)
• Sausage-like finger or toe
• Oligoarthritis (inflammation of up to 3 joints)
• Onset of AS before the age of 16
• Grade IV structural damage of the spine as visualized on x-ray images
• Significant functional impairment
• Ocular involvement
• Need to undergo surgery

Conversely, the absence of these factors is predictive of mild disease progression and a more favorable prognosis. Young age onset of ankylosing spondylitis without hip involvement does not appear to predict severe outcome.