As an FCA-authorised expert with over 750,000 policies issued, WeCovr provides this guide to ankylosing spondylitis. This article explains the condition, its treatments, and the role of private medical insurance in the UK, helping you make informed decisions about your health and financial protection.
Understand AS, treatments, and how PMI supports ongoing management
Ankylosing Spondylitis, or AS, is a condition that often begins as a nagging, persistent back pain, particularly in younger adults. But it's far more than a simple backache. It's a long-term (chronic) inflammatory disease that can have a significant impact on daily life.
In this guide, we will explore every facet of AS, from the first signs and symptoms to the latest treatments. Crucially, we will clarify the role of private medical insurance (PMI) in the UK, explaining what it can and cannot cover, and how it can be a vital tool for diagnosis and managing your overall health.
What is Ankylosing Spondylitis (AS)?
Ankylosing Spondylitis is a type of arthritis that primarily affects the spine. The name itself gives us clues:
- Ankylosing: Means fusing or stiffening.
- Spondylitis: Means inflammation of the vertebrae (the bones in your spine).
Essentially, AS causes inflammation in the joints of your spine. In response to this inflammation, your body can produce extra calcium, leading to the growth of new bone. Over time, this can cause sections of the spine to fuse together, making it less flexible and resulting in a hunched posture.
This inflammation isn't just limited to the spine. It can also affect other parts of the body, including the sacroiliac joints (where the base of your spine meets your pelvis), hips, shoulders, ribs, and even your eyes, bowels, and heart.
AS belongs to a group of conditions called axial spondyloarthritis (axSpA). It's a progressive condition, meaning it can worsen over time, but the severity and progression vary hugely from person to person.
Who is Affected by Ankylosing Spondylitis in the UK?
While AS can affect anyone, it follows certain patterns. Understanding these can help in recognising the potential for the condition.
- Age of Onset: It typically starts in late teens and early adulthood, with most people developing symptoms before the age of 45. It's uncommon for it to start in older adults.
- Gender: AS was once thought to be far more common in men, but recent understanding shows it affects men and women more equally than previously believed. However, men may be more likely to experience the classic spinal fusion.
- Genetics: There is a strong genetic link. About 95% of people in the UK with AS carry a specific gene called HLA-B27. However, it's important to know that most people with this gene (around 8% of the UK population) do not develop AS. It's a risk factor, not a cause.
According to the National Axial Spondyloarthritis Society (NASS), it's estimated that around 1 in 200 adults in the UK live with axial spondyloarthritis. The condition often takes a long time to be correctly identified—on average, around 8.5 years from the onset of symptoms to a formal diagnosis. This diagnostic delay is a key area where private medical insurance can make a profound difference.
What are the Key Symptoms of Ankylosing Spondylitis?
The symptoms of AS can be subtle at first and are often mistaken for general back pain or sports injuries. Recognising the specific pattern of symptoms is crucial for seeking timely medical advice.
Core Symptoms:
- Gradual Onset Back Pain and Stiffness: The pain is usually dull and located in the lower back and buttocks. It develops slowly over weeks or months.
- Morning Stiffness: Stiffness and pain are typically worse in the morning and after periods of inactivity, lasting for at least 30 minutes.
- Improvement with Exercise: Unlike mechanical back pain, the pain and stiffness of AS often improve with movement and exercise.
- Pain at Night: Many people find the pain wakes them up in the second half of the night.
Other Common Symptoms:
- Pain in Other Joints: Inflammation can cause pain and swelling in the hips, shoulders, knees, or ankles.
- Enthesitis: This is inflammation where tendons and ligaments attach to bone. A common example is Achilles tendonitis (pain at the back of the heel) or plantar fasciitis (pain in the sole of the foot).
- Fatigue: A persistent and overwhelming sense of tiredness that isn't relieved by rest is a very common and debilitating symptom.
- Uveitis (Iritis): Around 40% of people with AS experience eye inflammation at some point. Symptoms include a painful, red, and watery eye with sensitivity to light. This is a medical emergency that requires immediate attention.
- Bowel Inflammation: Some people with AS may also have inflammatory bowel disease (IBD), such as Crohn's disease or ulcerative colitis.
If you are experiencing persistent back pain, especially if you are under 45 and it improves with exercise but is worse at night, it's vital to speak to your GP.
The Diagnostic Journey: How AS is Identified
Getting a diagnosis for AS can be a long road on the NHS due to waiting lists and the need for specialist assessment. This is where private health cover can significantly speed things up.
The NHS Diagnostic Pathway
- GP Visit: You'll first discuss your symptoms with your GP. They may perform a physical examination and ask about your family history.
- Blood Tests: The GP may order blood tests to look for markers of inflammation (ESR and CRP) and to check for the HLA-B27 gene.
- Referral to a Specialist: If AS is suspected, you'll be referred to a rheumatologist—a doctor who specialises in conditions affecting joints, bones, and muscles. NHS waiting times for a rheumatology appointment can be many months.
- Imaging: The rheumatologist will likely order imaging tests:
- X-rays: To look for changes in the sacroiliac joints and spine. These changes may not be visible in the early stages.
- MRI Scan: This is much more sensitive and can detect inflammation in the joints and bones long before changes are visible on an X-ray.
- Diagnosis: A diagnosis is made based on your symptoms, physical exam, blood tests, and imaging results.
The Private Medical Insurance (PMI) Pathway
For those with private health cover, the journey can be much faster.
- GP Referral: You still need a GP referral. Many PMI policies now include access to a digital GP service, allowing you to get a referral in hours or days.
- Specialist Appointment: With an open referral, you can choose a rheumatologist from your insurer's approved list and often be seen within a week or two.
- Rapid Diagnostics: The specialist can authorise blood tests and, crucially, an MRI scan almost immediately, without the long waits common in the public system.
- Quick Diagnosis & Treatment Plan: A faster diagnosis means a treatment plan can be put in place much sooner, which is vital for managing inflammation and preventing long-term damage.
NHS vs. Private Diagnosis: A Comparison
Stage | Typical NHS Pathway | Typical Private Pathway with PMI |
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GP Referral | Standard appointment wait times. | Fast access via digital GP services often included. |
Specialist Wait | Can be several months (latest NHS data shows long waits for rheumatology). | Usually within 1-2 weeks. |
MRI Scan Wait | Can be many weeks or months after the specialist appointment. | Often arranged within days of the consultation. |
Time to Diagnosis | Can take months from the initial GP visit. | Can be completed within a few weeks. |
This speed is the primary benefit of private medical insurance for investigating conditions like AS.
The Critical Rule: How Private Medical Insurance Handles Chronic Conditions
This is the most important section for anyone considering PMI in relation to Ankylosing Spondylitis.
Standard private medical insurance in the UK is designed to cover acute conditions.
- An acute condition is a disease or illness that is likely to respond quickly to treatment and lead to a full recovery (e.g., a cataract, a hernia, a joint injury).
- A chronic condition is a disease or illness that is long-term and cannot be cured, only managed (e.g., diabetes, asthma, and Ankylosing Spondylitis).
Once you have been formally diagnosed with Ankylosing Spondylitis, it is classified as a chronic condition. Therefore, standard UK PMI policies will not cover the ongoing treatment and management of AS itself. This is a fundamental principle of how the market works.
Similarly, if you have symptoms of AS or are undergoing tests for it before you take out a PMI policy, it will be considered a pre-existing condition. All pre-existing conditions are excluded from new policies, either for a set period or permanently.
So, How Can Private Medical Insurance Still Help?
Even with the chronic condition exclusion, a PMI policy can be incredibly valuable in several ways for someone concerned about or living with AS.
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Securing a Fast Diagnosis: As detailed above, if you have symptoms but no diagnosis, PMI is your fastest route to seeing a specialist and getting the necessary scans. This initial diagnostic phase is typically covered by outpatient benefits in a policy. Getting a diagnosis quickly allows you to start an effective management plan (usually on the NHS) years earlier than you might otherwise.
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Cover for New, Unrelated Acute Conditions: Having AS does not make you immune to other health problems. If you need a hip replacement, knee surgery, cancer treatment, or a hernia repair for a condition that arises after you take out your policy, your PMI will cover it. This provides immense peace of mind, ensuring you can bypass NHS waiting lists for other serious health concerns.
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Access to Therapies and Wellness Benefits: This is a significant, often overlooked benefit. Many comprehensive PMI policies include cover for:
- Physiotherapy: Essential for managing AS. While the policy won't cover it specifically for AS, you may be able to access a set number of sessions per year to help with general musculoskeletal fitness and pain, subject to policy terms.
- Mental Health Support: Living with a chronic condition can take a toll on mental wellbeing. Most top-tier policies now include excellent cover for talking therapies, counselling, and psychiatric support.
- Wellness Tools: Insurers are increasingly providing resources to help members stay healthy. For instance, at WeCovr, our clients not only get expert advice on the best PMI provider but also receive complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero. This can be a fantastic tool for managing an anti-inflammatory diet.
In summary, you don't buy PMI to treat your diagnosed AS. You buy it to get diagnosed fast, to cover other acute health issues, and to access valuable benefits that support your overall wellbeing while you manage AS through the NHS.
Managing Ankylosing Spondylitis: A Holistic Approach
A diagnosis of AS is life-changing, but effective management can allow you to live a full and active life. The treatment plan is a partnership between you and your healthcare team and typically involves a combination of medication, exercise, and lifestyle adjustments.
1. Medication
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These are usually the first line of treatment. Drugs like naproxen or ibuprofen help to reduce pain and inflammation. They are often taken long-term under a doctor's supervision.
- Biologic Therapies (Anti-TNF): For those who don't respond well to NSAIDs, biologic drugs are a major breakthrough. These powerful drugs target a specific protein (TNF) that causes inflammation. They are administered by injection or infusion and can dramatically reduce symptoms and potentially slow the progression of the disease. They are prescribed by a rheumatologist and are available on the NHS if you meet specific criteria.
- JAK Inhibitors: A newer class of medication that also targets specific parts of the immune system to reduce inflammation. They are taken as tablets.
2. Physiotherapy and Exercise
This is a cornerstone of managing AS. A physiotherapist can design a personalised exercise programme to:
- Improve spinal flexibility and posture.
- Reduce stiffness and pain.
- Strengthen the muscles supporting your spine.
Good exercises for AS include:
- Stretching: Daily stretching of the back, neck, and hips is vital.
- Low-Impact Aerobics: Swimming is often called the perfect exercise for AS as it supports the whole body while strengthening it.
- Strength Training: Using light weights or resistance bands to build muscle.
- Posture Awareness: Consciously thinking about and correcting your posture throughout the day.
3. Lifestyle Management
Small daily changes can have a huge cumulative effect on how you feel.
Lifestyle Area | Recommendations for Managing AS |
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Diet | Focus on an anti-inflammatory diet: rich in fruits, vegetables, oily fish (salmon, mackerel), nuts, and seeds. Limit processed foods, sugar, and red meat, which can promote inflammation. |
Sleep | Aim for a supportive mattress that is firm but not hard. Sleep on your back or stomach to help maintain a straight spine. Use a thin pillow or no pillow to avoid neck strain. |
Work | Ensure your workstation is ergonomically sound. Take regular breaks to stand up, stretch, and walk around. Discuss potential adjustments with your employer if needed. |
Driving & Travel | Adjust your car seat for maximum support. On long journeys, plan for frequent stops to get out and stretch. When flying, book an aisle seat so you can move around more easily. |
Mental Health | Connect with others through support groups like NASS. Practice mindfulness or meditation to manage pain and stress. Don't hesitate to seek professional mental health support. |
Choosing the Right Private Medical Insurance UK Policy
If you are considering private health cover, either before any symptoms appear or for the wider benefits it offers, it's essential to choose the right policy. A specialist PMI broker like WeCovr can be invaluable here. We can help you navigate the market at no extra cost to you.
Here are key features to look for:
- Comprehensive Outpatient Cover: To ensure any diagnostic tests and specialist consultations are fully covered, look for a policy with a high or unlimited outpatient limit.
- Therapy Cover: Check the limits for physiotherapy. Some policies offer a set number of sessions, while others have a financial limit. This is crucial for musculoskeletal health.
- Mental Health Cover: Review the provision for mental health. This is an increasingly important part of modern policies.
- Digital GP Access: This provides incredible convenience for getting quick medical advice and referrals.
- Underwriting Options:
- Moratorium Underwriting: This is the most common type. It automatically excludes conditions you've had in the last 5 years. The exclusion may be lifted if you remain symptom and treatment-free for a continuous 2-year period after your policy starts.
- Full Medical Underwriting: You declare your entire medical history upfront. The insurer then tells you exactly what is and isn't covered from day one. This provides clarity but can be more complex.
An expert broker can explain these options and help you find the best PMI provider for your individual circumstances and budget. Furthermore, clients who purchase PMI or Life Insurance through WeCovr often receive discounts on other types of cover, adding extra value.
Frequently Asked Questions (FAQ)
If I get diagnosed with AS after buying private health cover, will my treatment be covered?
Generally, no. Once diagnosed, Ankylosing Spondylitis is classified as a chronic condition. Standard UK private medical insurance policies are designed to cover acute conditions that are curable, not the long-term management of chronic illnesses. However, the policy would have been invaluable in providing the fast diagnosis and will continue to cover you for any new, unrelated acute conditions that may arise.
Do I need to declare back pain when applying for PMI?
Yes, absolutely. You must be completely honest when applying for insurance. If you have sought medical advice, treatment, or medication for back pain in the last 5 years, you must declare it. Failing to do so could invalidate your policy. The insurer will likely place an exclusion on your spine or back for a period of time. An expert PMI broker can help you understand the implications of any pre-existing conditions.
Can I get PMI if a close family member has Ankylosing Spondylitis?
Yes, you can. Having a family history of AS does not prevent you from getting private medical insurance. Insurers do not typically ask about genetic predispositions for conditions like AS during the application process. In fact, knowing you have a higher genetic risk is a very strong reason to secure a comprehensive policy while you are fit and well, to ensure you are covered for the diagnostic process or any other future health issues.
Ankylosing Spondylitis is a serious and complex condition, but with early diagnosis, modern treatments, and proactive self-management, it is possible to control the symptoms and lead a fulfilling life.
While private medical insurance cannot cover the ongoing management of a chronic condition like AS, its role in providing rapid diagnosis, covering other acute health issues, and offering valuable wellness benefits is undeniable. It provides a safety net, ensuring that when new health challenges arise, you have the choice and control to access the best care quickly.
Navigating the complexities of the private medical insurance UK market can be daunting. At WeCovr, our team of independent experts is here to provide clear, tailored advice. We compare policies from leading insurers to find the right fit for your needs and budget, ensuring you understand exactly what is and isn't covered.
Take the first step towards peace of mind. Contact WeCovr today for a free, no-obligation quote and let us help you secure your health's future.