Initial Stages (0-10 years):

• In the early stages, AS may present with intermittent lower back pain and stiffness, especially in the morning or after periods of inactivity.
• As inflammation persists, the sacroiliac joints can be affected, causing pain and discomfort in the buttocks and lower back.
• Without intervention, inflammation may progress, leading to spinal fusion as the bones attempt to heal, resulting in reduced flexibility.

2nd and 3rd Decades (10-30 years):

• Chronic inflammation may extend to other joints, including hips, shoulders, and knees, leading to pain, swelling, and decreased range of motion.
• The fusion process intensifies, affecting the entire spine, potentially causing a stooped posture and limiting the ability to perform daily activities.
• Fatigue and stiffness become more pronounced, impacting overall quality of life.

4th Decade (30-40 years):

• Continuing inflammation may contribute to the formation of bone spurs, leading to further joint damage and increased pain.
• Lung involvement can occur, affecting breathing and potentially leading to complications like restrictive lung disease.
• Persistent inflammation may also affect the eyes, leading to uveitis, an inflammatory eye condition.

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Functional Limitations and Quality of Life:

• As the spine fuses, mobility becomes severely restricted, impacting the ability to perform simple tasks and reducing overall quality of life.
• Chronic pain and fatigue may contribute to mental health challenges, including depression and anxiety.
• Reduced lung function and other systemic complications may further compromise health.

Preventive Measures and Treatment:

• While the natural progression of untreated AS can be debilitating, timely intervention with medications, physical therapy, and lifestyle modifications can slow disease progression.
• Regular exercise is crucial to maintaining flexibility and preventing severe joint deformities.
• Biologic medications, nonsteroidal anti-inflammatory drugs (NSAIDs), and disease-modifying antirheumatic drugs (DMARDs) are commonly used to manage inflammation and symptoms.

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Late-stage Complications:

• Severe cases may lead to complications such as spinal fractures, neurological issues, and significant disability.
• Surgical intervention, such as joint replacement or spinal correction surgery, may be considered in advanced stages to improve function.