Ankylosing Spondylitis in Women: Frequently Misdiagnosed
Rheumatic ConditionsAnkylosing Spondylitis
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Why Ankylosing Spondylitis Is Often Misdiagnosed in Women

Why Ankylosing Spondylitis Is Often Misdiagnosed in Women
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Updated on April 17, 2025
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While it was previously believed that ankylosing spondylitis (AS) was more prevalent in men than in women, recent research has found that, in fact, AS affects both genders equally.

However, it still takes longer for women to receive an AS diagnosis compared with men, which may be because some clinicians still lack awareness of what AS looks like in women. The result is that women are sometimes misdiagnosed with other conditions, such as fibromyalgia or osteoporosis.

Why Doctors Often Misdiagnose Women With Ankylosing Spondylitis

The misdiagnosis of AS in women might be in part due to how under-recognized the condition still is.

Research published in 2023 noted that it took approximately five years for a man to receive an AS diagnosis and around 11 years for a woman to get one.

This may be due to a number of factors, such as:

Lack of Female Participants in Research Studies

Historically, more men have participated in research studies, often because women were overtly excluded. As a result, data on how a particular disease manifests in women may simply not exist, making it challenging for a physician to make a proper diagnosis.

Differences in X-Rays and Blood Tests in Men vs. Women

With AS, men tend to have damage to their spines that can be seen clearly on X-rays; women with AS have less visible spine damage.

“X-rays of the sacroiliac joints — the joints that connect the pelvis to the lower spine — are often the first step in evaluating for AS,” says David Chetrit, MD, rheumatologist at Carolina Health Specialists in Myrtle Beach, South Carolina. “However, studies suggest that women may experience slower progression of changes detectable on X-rays, making early diagnosis more challenging.”

Women also tend to have AS symptoms in their arm and leg joints, which is less common in men.

Blood tests used to diagnose AS may also yield different results in men and women.

According to Dr. Chetrit, “AS is driven by certain immune-related genes and pathways, particularly the Th17 pathway. Research has shown that males with AS tend to have higher levels of IL-17 and TNF, proteins involved in immune regulation. As a result, inflammatory markers [in the blood] like ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) can be higher in males than in females.”

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How Are AS Symptoms Different in Women Than Men?

William Kemp, MD, a spinal neurosurgeon at VSI (formerly Virginia Spine Institute) in Reston, Virginia, says, “AS in women isn’t always obvious. It might look like fatigue, digestive issues, or joint pain that moves around, rather than just lower back stiffness.”

Women with AS are also more likely to develop inflammatory bowel disease (IBD) than men.

 A study published in 2024 found that around 3 percent of people with IBD also have AS.

Additionally, AS seems to be more severe in women, with reported higher disease activity, poorer quality of life, and greater functional impairment. However, women are less likely than men to develop ankylosis of the spine, a condition in which the vertebrae fuse together.

Some symptoms of AS, particularly low back pain, are also seen in other conditions, making it hard for a doctor to pinpoint their cause.

Treatment for AS in Women

Treatments for AS are typically the same for both men and women. Treatments can include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Tumor necrosis factor inhibitors (TNFi), which help reduce inflammation
  • Physical therapy
  • Surgery

The delay in treatment for women with AS might mean they only receive treatment once their disease has progressed, which may lead to worse outcomes.

“Some [women] also respond more slowly to treatment or have a harder time finding the right medication,” says Dr. Kemp.

How to Make Sure You Get an Accurate AS Diagnosis

“The most important step is finding a specialist who listens closely and takes persistent symptoms seriously — especially in women, whose AS symptoms often don’t match the classic ‘textbook’ version seen in men,” says Kemp.

Kemp recommends you “do your research and look for providers experienced in inflammatory spine conditions, particularly those familiar with female patterns of AS.”

You may also find it useful to keep track of your symptoms, as this can help a specialist make a more accurate diagnosis, Kemp says. “I encourage women to advocate for themselves: Bring a detailed symptom history, note any family history of autoimmune disease, and don’t hesitate to request imaging or a referral. If you’re dealing with chronic back pain and keep getting told it’s stress, aging, or something vague, don’t give up.”

The Takeaway

  • AS occurs in women just as frequently as it occurs in men.
  • Disparities in AS diagnosis between men and women may be due to several factors, most notably the differences in presentation of AS between these two genders.
  • If you’re a woman with AS symptoms, you should look for a specialist who understands how inflammatory spine conditions can present in women.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Marzo-Ortega H et al. The impact of gender and sex on diagnosis, treatment outcomes and health-related quality of life in patients with axial spondyloarthritis. Clinical Rheumatology. June 2022.
  2. Spondyloarthritis in Women. Spondylitis Association of America.
  3. Magrey M et al. The International Map of Axial Spondyloarthritis Survey: A US Patient Perspective on Diagnosis and Burden of Disease. ACR Open Rheumatology. May 2023.
  4. Merone L et al. Sex Inequalities in Medical Research: A Systematic Scoping Review of the Literature. Women's Health Reports. January 2022.
  5. Rusman T et al. Sex and gender differences in axial spondyloarthritis: myths and truths. Rheumatology. October 2020.
  6. Wright GC et al. Understanding differences between men and women with axial spondyloarthritis. Seminars in Arthritis and Rheumatism. August 2020.
  7. Ding Y et al. Inflammatory bowel disease activity threatens ankylosing spondylitis: implications from Mendelian randomization combined with transcriptome analysis. Frontiers in Immunology. February 2024.
  8. Can Ankylosing Spondylitis Be Misdiagnosed? The Clinic by Cleveland Clinic.
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Samir Dalvi, MD

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Samir Dalvi, MD, is a board-certified rheumatologist. He has over 14 years of experience in caring for patients with rheumatologic diseases, including osteoarthritis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, lupus, and gout.

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