Axial Spondyloarthritis and Body Image

Learn to keep a positive self-image if your posture and physical abilities change.

By Emily Delzell

The inflammation at the root of axial spondyloarthritis (axSpA) — including ankylosing spondylitis (AS) — can, over time, cause the spine to fuse in a forward-flexed position. This stooped posture is one reason poor body image may affect people with AS.

Body image is our emotional view of our bodies and physical abilities. A negative body image can involve more than not liking what you see in the mirror. You might feel incapable, full of self-doubt or anxious about your physical function or sexuality. Feeling bad about your body is common among healthy people and even more prevalent in people living with a long-lasting disease. Many studies find that chronic pain strongly predicts a negative body image.

One such study was conducted in Austria and published in Clinical and Experimental Rheumatology. The researchers found that people with axSpA judged their bodies more negatively, worried more about them, and felt less attractive and self-confident than healthy peers.

How AxSpA Affects Body Image

Axial spondyloarthritis usually develops in early adulthood. People with axSpA often experience low back pain and stiffness for years, says Christopher J. DeWald, MD, director of the Section of Spinal Deformity at Rush University Medical Center in Chicago.

“Patients with spinal fusion have difficulty looking forward because their neck can fuse into a flexed position,” explains Dr. DeWald. “They cannot look others in the eye and have difficulty with walking and activities of daily living like shaving and driving.”

However, people with axSpA can have a poor body image even when the disease hasn’t changed their posture. The Austrian study found that those with mild disease (mostly women) had more body worries than those whose spinal movement was severely limited.

One reason for this may be that axSpA is harder to diagnose in women than men. Women often have less X-ray evidence of the disease. They may live for years with pain and loss of function that doctors attribute to non-physical causes, like depression.

Getting diagnosed and treated as early as possible can help limit negative self-perceptions stemming from axSpA, says Dr. DeWald.

Boosting Body Positivity

Nurture your body image and self-esteem.

  • Exercise to keep flexible and strong and to gain confidence.
  • Accept that your feelings are valid; denying them means you’re denying yourself.
  • Foster self-compassion with self-talk like “What would you say to a friend in this situation?” Greater self-compassion is associated with a more positive body image and a healthier mental state.
  • Connect with people and activities that give you pleasure. 
  • Treat your body well. Eat healthfully, practice good sleep habits and get regular physical activity.
  • Spend time with friends and family who support, respect and encourage you.
  • See a mental health counselor if you become distressed, anxious or depressed. 



Deodhar A, et al. Ankylosing spondylitis diagnosis in US patients with back pain: identifying providers involved and factors associated with rheumatology referral delay.
Guenther V, et al. Body image in patients with ankylosing spondylitis.
Levenig CG, et al. Body image is more negative in patients with chronic low back pain than in patients with subacute low back pain and healthy controls.
Neff K. Self-Compassion Guided Meditations and Exercises.
Seekis V, et al. The effectiveness of self-compassion and self-esteem writing tasks in reducing body image concerns.
Senkowski D, Heinz A. Chronic pain and distorted body image: Implications for multisensory feedback interventions.
Sirois FM, Hirsch JK. Self-Compassion and Adherence in Five Medical Samples: the Role of Stress.

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