Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease that primarily affects the spine and sacroiliac joints, where the spine connects to the pelvis. It is part of a broader group of conditions known as axial spondyloarthritis (axSpA). Inflammation associated with AS can cause persistent back pain and stiffness. Symptoms often begin in adolescence or early adulthood and may be most noticeable in the morning, after rest, or following long periods of inactivity. Unlike many forms of mechanical back pain, symptoms often improve with movement or exercise. Over time, some people develop reduced spinal flexibility or structural changes involving the spine and sacroiliac joints. AS can also affect areas outside the spine, including the eyes, hips, shoulders, heels, and other joints.

Common Symptoms

Diagnosis is based on a combination of medical history, physical examination, imaging such as X-ray or MRI, and laboratory testing when appropriate. Testing for HLA-B27 may support the diagnostic evaluation, but the presence or absence of HLA-B27 alone does not confirm or exclude AS.

Ankylosing spondylitis requires ongoing medical management. Established treatment focuses on controlling inflammation, reducing pain and stiffness, maintaining mobility, and preserving function.

Standard Treatment Categories

• Exercise and physical therapy: Regular exercise, stretching, posture work, and supervised physical therapy can help preserve mobility, strength, and function.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs are commonly used as first-line medication for pain and stiffness when medically appropriate.
• Biologic medications: Tumor necrosis factor inhibitors (TNF inhibitors) and interleukin-17 inhibitors (IL-17 inhibitors) may be considered for persistent active disease.
• Targeted medications: Janus kinase (JAK) inhibitors are another treatment option for selected patients with active axial spondyloarthritis.
• Supportive care: Smoking cessation, maintaining physical activity, appropriate sleep, and management of related health conditions can support overall health.
• Surgery: Joint replacement or other surgical treatment may occasionally be needed for severe hip damage, spinal complications, or selected advanced cases.

Long-term systemic corticosteroid treatment is generally not recommended for purely axial disease, although localized corticosteroid injections may sometimes be considered for specific areas of inflammation. Modern biologic and targeted medications act on important inflammatory pathways involved in AS. Even with these advances, some patients continue to experience active disease, incomplete response, treatment intolerance, or recurring symptoms. This has contributed to interest in additional approaches, including regenerative medicine and cell-based research.

Stem cell therapy for autoimmune conditions is being investigated because mesenchymal stromal cells (MSCs) can interact with immune and inflammatory signaling pathways. For ankylosing spondylitis, researchers have studied MSCs from several sources, including bone marrow and umbilical cord tissue. Laboratory, translational, and early clinical research has examined whether these cells may influence the abnormal inflammatory activity involved in axial spondyloarthritis. Stem cell therapy for ankylosing spondylitis remains an investigational approach.

What Researchers Are Studying

• Influence inflammatory and immune-system signaling involved in AS
• Affect disease-activity and functional measures
• Reduce selected markers of inflammation
• Be administered safely and feasibly to people with active disease
• Influence inflammatory findings seen on MRI
• Help determine which cell sources, doses, treatment schedules, and delivery approaches warrant further study

Researchers are also investigating MSC-derived extracellular vesicles (EVs). These small particles carry proteins, RNA, and other signaling molecules released by cells and are being studied for their potential effects on immune regulation and tissue signaling. Studies of AS remain limited and vary substantially in design, cell source, dose, follow-up period, comparison treatment, and patient population. Results from one MSC product or treatment protocol should therefore not be assumed to apply to another.

Note: Stem cell and MSC-derived therapies for ankylosing spondylitis are not FDA-approved and remain investigational. Early studies have reported changes in disease activity, inflammatory measures, function, and imaging findings, but substantially more controlled clinical research is needed to establish effectiveness, appropriate treatment protocols, and long-term safety.

How Stem Cell Therapy for AS Is Being Studied

Research on stem cell therapy for ankylosing spondylitis has focused primarily on intravenous MSC administration, clinical safety, disease activity, functional outcomes, inflammatory markers, and possible effects on immune regulation. Early human studies have included patients whose disease remained active despite treatment with NSAIDs, as well as small studies involving umbilical-cord-derived MSCs. Researchers have reported improvements in some measures of symptoms and disease activity, although effects have varied over time and the available studies remain relatively small. At present, stem cell treatment for ankylosing spondylitis should be considered product-specific, protocol-specific, and investigational.

2025: Review Highlighted Growing MSC Research in Ankylosing Spondylitis

Breaking Boundaries in Ankylosing Spondylitis: How Innovative Cell Therapies Reshape Immunity, Drive Cutting-Edge Advances, and Face Future Challenges — Read Review

This 2025 review examined the immune mechanisms involved in ankylosing spondylitis and summarized emerging research on MSC-based and other cell therapies. The authors reviewed early human MSC studies, including research involving intravenous allogeneic MSCs and umbilical-cord-derived MSCs. Clinical reports described improvements in selected disease-activity, functional, inflammatory, and imaging measures, while several additional clinical trials have been registered to investigate MSC therapy in AS.

2025: Systematic Review Identified a Positive Signal in the Available Randomized AS Research

Efficacy and Safety of Mesenchymal Stromal Cell Transplantation in the Treatment of Autoimmune and Rheumatic Immune Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials — Read Study

This systematic review evaluated 42 randomized controlled trials involving 2,183 participants across several autoimmune, rheumatic, and inflammatory conditions. For ankylosing spondylitis, the reviewers identified one randomized controlled study evaluating MSC treatment. At six months, the study reported a potential improvement in overall clinical effectiveness compared with the non-MSC comparison treatment. Because only one randomized AS study was available, the authors emphasized that additional controlled trials are needed.

2023: Review Examined MSC-Derived Extracellular Vesicles in Axial Spondyloarthritis

Biology and Therapeutic Potential of Mesenchymal Stem Cell Extracellular Vesicles in Axial Spondyloarthritis — Read Review

This review examined the biology of MSCs and MSC-derived extracellular vesicles (EVs) in axial spondyloarthritis. Extracellular vesicles carry biologically active proteins, microRNAs, and other signaling molecules that can influence immune regulation, cellular communication, tissue remodeling, and cellular homeostasis. The article was a review of biological and therapeutic research rather than a clinical trial of EV treatment in AS patients, and important questions remain regarding manufacturing, characterization, dosing, and clinical effectiveness.

2014: Intravenous MSC Study Reported Improvements in Active Ankylosing Spondylitis

Effects and Safety of Allogenic Mesenchymal Stem Cell Intravenous Infusion in Active Ankylosing Spondylitis Patients Who Failed NSAIDs: A 20-Week Clinical Trial — Read Study

This open-label clinical study included 31 people with active ankylosing spondylitis who had an inadequate response to NSAIDs or could not tolerate their side effects. Participants received four intravenous infusions of allogeneic MSCs over three weeks. At week four, 77.4% achieved an ASAS20 response, and the mean ASDAS-CRP disease-activity score decreased from 3.6 at baseline to 2.4 at week four. The clinical response diminished over time, with the mean ASDAS-CRP increasing to 3.2 by week 20; however, MRI evaluation showed a statistically significant reduction in the study’s measure of inflammatory extent at week 20, with no major treatment-related safety concerns reported.