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Quality of life issues relating to a specific illness such as ankylosing spondylitis (AS) is typically measured by standardized questionnaires that request information relating to several aspects of the illness, including:

• Symptoms
• Physical mobility and function
• Employment status
• Social interactions including marital, familial, and work-related interactions
• Psychological status
• Financial burden of the illness
• Side-effects of medications

Ankylosing spondylitis is a chronic condition and patients typically experience symptoms throughout the course of the condition over many decades. Although the symptoms of AS vary widely among individuals, back pain and back stiffness are the most common. Because much of the data regarding quality of life for patients with ankylosing spondylitis is derived from questionnaires filled out by patients enrolled in rheumatology clinics, it is possible if not probable, that the information regarding quality of life issues and impact on activities of daily living is skewed towards people who have more significant symptoms. In general, the overall impact of ankylosing spondylitis on quality of life and activities of daily living is less pronounced than for many other chronic rheumatic conditions.

In general, quality of life issues facing patients with ankylosing spondylitis may include:

• Sleep disturbances resulting in moderate to severe fatigue
• Altered postural appearance due to back pain and stiffness
• Increased physical dependency on family and friends which may impact social relationships
• Anxiety
• Reduced ability to care for oneself
• Additional medical expenses for AS-related problems such as doctor visits, medications, and physical therapy
• Discomfort from side-effects of drugs
• Loss or reduction of income due to frequent absence from the workplace

Some patients find the lack of cure for ankylosing spondylitis very frustrating. While NSAIDs and physical therapy are considered the gold standard treatment for ankylosing spondylitis, they are effective only when the patient is taking them but do nothing to slow or change the course of disease progression. The side effects of NSAIDs may minimize their overall benefit and cause some patients to discontinue their use. The second level medications (DMARDs and corticosteroids) are effective temporarily for some people but their overall efficacy has not been clearly proven in clinical trials. In addition, the major benefit of physical therapy for many patients is preservation of spinal flexibility but any relationship to decreasing pain and stiffness is still a topic of debate. Anti- TNF-alpha drugs are promising in terms of their relief from symptoms and altering the inflammatory progression of ankylosing spondylitis, however, these drugs are still under investigation and are not prescribed routinely.

During periods of acute flare-ups or increased inflammation and disease activity, patients report greater negative impact on quality of life and normal activities of daily living. In general, the research regarding lifestyle modification issues for patients afflicted with ankylosing spondylitis can be summarized as follows: