Thymos Health
Your Ankylosing Spondylitis Journey

Still stiff.
Still switching one drug at a time.
Still no real answers.

You're not alone. This is how ankylosing spondylitis is typically managed — and an honest look at what that journey costs, and where it leads, over time.

~0.5% of US adults have ankylosing spondylitis — or 1% if non-radiographic axSpA is included.1
3:1 male-to-female ratio — ankylosing spondylitis is more prevalent in men, though often underdiagnosed in women.2
6–8 years is the average delay from first symptoms to a correct ankylosing spondylitis diagnosis.3
24 is the average age of onset — most patients are diagnosed in the prime of their careers.4

How ankylosing spondylitis is typically treated

Most doctors and insurance plans follow step therapy — starting with NSAIDs and physical therapy before approving any biologic. The problem: every month of uncontrolled inflammation contributes to irreversible spinal fusion. Ankylosing spondylitis onset typically occurs in the 20s and 30s, meaning delayed access to effective therapy maps directly to lost career and quality of life years.

Mark where you are in your journey and we'll show you the full picture.

Step 1: Your doctor starts you on NSAIDs + Physical Therapy
Naproxen, Indomethacin, Celecoxib / Etoricoxib — full anti-inflammatory doses + structured PT
What your doctor says
"NSAIDs are first-line for ankylosing spondylitis. They control pain and inflammation well in many patients and there's even evidence that continuous use may slow spinal radiographic progression. Try two different ones before considering a biologic."
56.9% achieve moderate response on full-dose NSAID5
~40–50% have inadequate symptom control or intolerance5
Insurance requires failure of ≥2 NSAIDs before biologic approval
Annual drug cost (generic NSAID) ~$120–$600
How many NSAIDs have you tried?
How long were you on NSAIDs?
What happened?
Required monitoring: CBC, creatinine, LFTs at baseline and annually; cardiovascular risk assessment before prolonged use
~$300–$700/yr in monitoring labs
~40–50% inadequate NSAID responders escalate to a biologic
Step 2: You escalate to Adalimumab
Humira / biosimilars (Hadlima, Hyrimoz, Cyltezo) — SC injection every 2 weeks (anti-TNF biologic)
What your doctor says
"Adalimumab is a well-established anti-TNF therapy. It significantly reduces inflammation, pain, and disease activity — and most patients see results within 12 weeks."
Moderate response at week 12–16: ~45–58%6
~30% are primary non-responders6
No proven effect on slowing spinal radiographic progression at 2 years7
Annual cost before insurance (AWP) ~$103,000
How long were you on Adalimumab?
What happened?
Your coinsurance for this drug
Your estimated annual out-of-pocket for this drug
$20,600
~30–40% fail or lose response to anti-TNF — move to Step 3
Step 3: After anti-TNF failure, you move to Secukinumab
Cosentyx — SC injection (300 mg or 150 mg, weekly × 5 then monthly; IL-17A inhibitor)
What your doctor says
"Secukinumab targets IL-17A rather than TNF — so it often works when TNF inhibitors haven't. It has shown consistent efficacy across multiple large trials and some data suggest benefits in slowing MRI progression."
Prior anti-TNF therapy has failed or stopped working
Moderate response (40–54%) at week 168
~46–60% still do not achieve Moderate response at 16 weeks8
Annual cost before insurance (AWP — 150 mg maintenance) ~$95,800
How long have you been on Secukinumab?
What happened?
Your coinsurance for this drug
Your estimated annual out-of-pocket for this drug
$19,160
Uncontrolled inflammation leads to progressive spinal fusion
When years of inflammation accumulate into permanent damage: Spinal fusion
Progressive syndesmophyte formation → irreversible vertebral ankylosis — the structural endpoint of uncontrolled ankylosing spondylitis
What Your Doctor says
"We can't reverse the fusion that's already occurred, but we can try to prevent further progression. Your mobility and pain can still be managed, and surgery may help in certain cases."
31% achieve work disability status due to ankylosing spondylitis9
41% productivity loss among employed ankylosing spondylitis patients11
~24% are force-retired early due to ankylosing spondylitis; mean retirement age 36 yrs9
7–10 yr
Typical diagnostic delay — the longest of any rheumatic disease3
35%
Higher cardiovascular mortality risk vs. the general population10
2–3×
Higher prevalence of depression vs. general population12
Structural progression — what accumulates silently
Syndesmophyte formation (bridging bone between vertebrae) Variable; often silent
Sacroiliac joint fusion (irreversible) Occurs in majority over time
Cervical spine fusion (atlantoaxial instability) High fracture risk
Spinal fracture risk (rigid fused spine) ~5–7× elevated vs. general population
Chest expansion loss (intercostal ankylosis) Reduced lung capacity
Hip replacement surgery (ankylosing spondylitis-related joint damage) Required in 5–15%
What changes with advanced ankylosing spondylitis
🦴 No biologic has yet proven it halts spinal radiographic progression. Despite dramatically reducing inflammation and symptoms, neither anti-TNF nor IL-17 inhibitors have demonstrated statistically significant slowing of new syndesmophyte formation in randomized trials at 2 years.7 This means that even well-controlled patients may be accumulating structural damage silently. Early initiation of therapy is considered the best current strategy to minimize damage, but is directly undermined by step therapy delay.
💼 Ankylosing spondylitis begins in the prime working years and devastates careers early. Mean onset is age 24. Mean forced retirement age for work-disabled ankylosing spondylitis patients is 36 years — a full 29 years before standard retirement age.9 Work disability (31%), job modification (44.6%), and sick leave (12–46 days/year) together represent a societal productivity loss that far exceeds the direct drug costs of treatment.9
🫀 Cardiovascular mortality is substantially elevated. A population-based Canadian study of 21,473 ankylosing spondylitis patients found a 35% higher cardiovascular mortality risk and 60% higher cerebrovascular mortality risk vs. age- and sex-matched controls without ankylosing spondylitis.10 Aortitis, cardiac conduction abnormalities, and accelerated atherosclerosis are all documented ankylosing spondylitis comorbidities that are rarely screened for in rheumatology practice.
🧠 Depression and anxiety are underrecognised and underscreened. A US claims-based analysis of ankylosing spondylitis patients found significantly higher rates of depression and anxiety post-diagnosis compared to matched controls.12 Depression rates in ankylosing spondylitis are 2–3× the general population, driven by chronic pain, restricted mobility, sleep disruption from night pain, and the psychosocial burden of disability at a young age.
👁️ Uveitis affects ~25–30% of ankylosing spondylitis patients over their lifetime — causing acute painful eye inflammation that can recur, may cause vision impairment, and requires prompt ophthalmology involvement. It is the most common extra-articular manifestation of ankylosing spondylitis. IBD (Crohn's or UC) occurs in ~5–10%.
⚠ Timing matters: the window before structural damage closes
Structural spinal damage in ankylosing spondylitis begins within 2–5 years of symptom onset. The 6–8 year diagnostic delay means that many patients have already accumulated irreversible fusion by the time they receive a diagnosis, let alone a biologic. Step therapy requirements that mandate NSAID failure before biologic access add further months of uncontrolled inflammation at the exact window where intervention would have the greatest impact.

What ankylosing spondylitis is really costing you

Ankylosing spondylitis strikes in the 20s and 30s — peak career years. The direct drug cost is only a fraction of the economic toll. Work disability, sick leave, and reduced productivity represent the largest share of its total economic burden.

Based on your journey above–adjust the numbers to match your situation.
Sick days missed in the last 12 months
Your hourly wage (for lost income calculation)
Your estimated total annual cost of ankylosing spondylitis $0
Drug out-of-pocket costs$0
Lost income (sick days)$0
Reduced productivity at work (presenteeism)$0
Overall work productivity loss 40.9% in ankylosing spondylitis; sick leave 12–46 days/yr; daily activity impairment ~50%11
The Other Side of the Bill

What your insurer is paying

Ankylosing spondylitis imposes a substantial and rising cost on commercial insurers. Pharmacy costs — driven by biologics — account for the majority of total ankylosing spondylitis healthcare expenditure, dwarfing the cost of NSAID treatment. Yet step therapy requirements continue to delay biologic access.

Annual Payer Perspective — Commercial Insurance
What your health plan spends on your ankylosing spondylitis each year
Based on your ankylosing spondylitis journey above · All figures reflect the payer (insurer) paid portion, not patient out-of-pocket cost.
Estimated annual payer cost for your ankylosing spondylitis care $0
Biologic drug spend (payer portion ~80% of AWP)
Pharmacy costs represent $38,263 (mean) of total $44,783 annual ankylosing spondylitis healthcare costs in real-world US claims data13
$0
Non-drug medical costs (rheumatologist, MRI, labs, PT)
Mean ankylosing spondylitis-related non-pharmacy medical costs: $6,521/yr (hospitalisations $3,459 + outpatient $2,160 + diagnostics)13
~$6,521
Mean total healthcare costs for ankylosing spondylitis patients in US claims data: $44,783/yr, with pharmacy costs ($38,263) representing 85% of total expenditure.13 Every 1.0-unit increase in HAQ-DI (functional impairment score) was significantly associated with higher hospitalisation rates, ED visits, and diagnostic testing — meaning worse disease control directly and measurably inflates payer costs.
⚑ Why early biologic access saves payers money
Step therapy requirements mandate NSAID failure before biologics — adding months of uncontrolled inflammation during the structural damage window. Ankylosing spondylitis work disability (31%) and early forced retirement (mean age 36) impose indirect societal costs that can exceed $1M per patient in lost lifetime earnings. The 6–8 year diagnostic delay alone contributes substantially to downstream medical costs through accumulated joint damage, cardiovascular comorbidity, spinal fracture, and surgical intervention. Indirect costs (productivity loss, disability, caregiver burden) account for the majority of the total economic burden of ankylosing spondylitis — a figure that is never on an insurer's remittance advice.
Understanding Your Risk

What the research shows over time

These are the documented long-term trajectories for ankylosing spondylitis patients. Early, effective disease control is the only modifiable strategy — and the current treatment system is built to delay it.

Based on peer-reviewed clinical data
Long-term outcomes for ankylosing spondylitis patients on standard step therapy
🦴
6–8 yr average diagnostic delay — the longest of any rheumatic disease, during which irreversible structural damage accumulates in the sacroiliac joints and spine before a single biologic is prescribed3
💼
24% of ankylosing spondylitis patients are forced into early retirement due to their disease, at a mean age of 36 years — with a further 44.6% required to change to lighter work; work disability is 15–17% higher than expected in the general population9
🫀
35% higher cardiovascular mortality and 60% higher cerebrovascular mortality in ankylosing spondylitis patients vs. age- and sex-matched controls — driven by aortitis, vascular inflammation, and accelerated atherosclerosis that is rarely screened in a rheumatology visit10
😞
2–3× higher rates of depression and anxiety in ankylosing spondylitis compared to matched controls — driven by chronic pain from night-waking, progressive disability, and restricted mobility at a young age; rarely screened in standard rheumatology follow-up12
✦ A different journey exists

Thymos Health offers another way

Conventional ankylosing spondylitis care focuses on managing symptoms through sequential medications. Thymos goes further – synthesizing diagnostics, medical history, symptoms, and lifestyle to understand what's driving your disease and customizes care based on your individual needs.

✓
Root cause treatment — not just another layer of suppression
✓
Whole system autoimmune specialist quarterbacks your labs, your team, your care plan
✓
24/7 personalized support — not just at your quarterly rheumatology visit
✓
80%+ symptom relief within 3 months across autoimmune conditions
No commitment. Takes 2 minutes.
Sources & Citations▼
[1]Reveille JD et al. "The epidemiology of back pain, axial spondyloarthritis and HLA-B27 in the United States." American Journal of the Medical Sciences, 2012;341(6):607–614. Prevalence of ankylosing spondylitis: 0.52–0.55%; axial SpA (ankylosing spondylitis + non-radiographic): 1.0–1.4% of US adults. Based on NHANES 2009–2010 data. National HLA-B27 prevalence: 6.1%.
DOI: 10.1097/MAJ.0b013e31824f1543  ·  PMID: 23841117
[2]Dougados M, Baeten D. "Spondyloarthritis." The Lancet, 2011;377(9783):2127–2137. Ankylosing spondylitis: male-to-female ratio approximately 2:1 to 3:1; onset in second or third decade of life; HLA-B27 positive in 90–95% of ankylosing spondylitis patients. Women are more likely to have non-radiographic disease and shorter diagnostic delays are less common; gender-based diagnostic bias documented.
DOI: 10.1016/S0140-6736(11)60071-8  ·  PMID: 21708304
[3]Feldtkeller E et al. "Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis." Rheumatology International, 2003;23(2):61–66; reviewed in Sykes MP et al., "Changes in ankylosing spondylitis incidence, prevalence and time to diagnosis over two decades." RMD Open, 2022;8(1):e001990. Mean diagnostic delay across multiple studies: 6–8 years; average onset age 23–27 years; mean age at diagnosis 27–34 years. Diagnostic delay unchanged or minimally improved over 20 years despite advances in MRI and biologic therapy awareness. Delay longer in women and HLA-B27-negative patients.
PMC (Sykes): PMC8663075
[4]Akkoc N, Khan MA. "Looking into the new ASAS classification criteria for axial spondyloarthritis through the other side of the lens." Current Rheumatology Reports, 2015;17(6):47. Mean onset age of ankylosing spondylitis/axSpA: approximately 24 years; peak onset range 20–30 years. Approximately 80% of patients develop symptoms before age 30.
DOI: 10.1007/s11926-015-0524-y
[5]Grigorieva D et al. "Non-steroidal anti-inflammatory drugs as potential disease-modifying medications in axial spondyloarthritis." Frontiers in Medicine, 2020. Open-label naproxen trial in axSpA: 56.9% achieved ASAS40 at 4 weeks; 35.3% achieved ASAS partial remission. In phase 3 biologic trials, 39.4–58.1% of participants on biologics achieved ASAS40 — similar to full-dose NSAID response in early axSpA, but diverges significantly with disease severity. Cochrane systematic review (Kroon et al. 2015/2021): NSAIDs moderately effective; ~40–50% have inadequate symptom control on maximal NSAID doses.
PMC: PMC7113090
[6]van der Heijde D et al. (ATLAS trial). "Efficacy and safety of adalimumab in patients with ankylosing spondylitis: results of a multicenter, randomized, double-blind, placebo-controlled trial." Arthritis & Rheumatism, 2006;54(7):2136–2146. n=315. ASAS20 at week 12: 58.2% adalimumab vs 20.6% placebo (p<0.001). ASAS40 at week 12: 38.2% vs. 8.7% (p<0.001). Primary non-response: ~30% (did not achieve ASAS20 at 12 weeks). At 5-year open-label follow-up, 70% of continuing patients achieved ASAS40.
DOI: 10.1002/art.22102  ·  PMID: 16802350
[7]van der Heijde D et al. "Assessment of radiographic progression in the spines of patients with ankylosing spondylitis treated with adalimumab for up to 2 years." Arthritis Research & Therapy, 2009;11(4):R127. Adalimumab cohort (n=307) vs. anti-TNF-naïve OASIS cohort (n=169). Mean mSASSS change: 0.8 (adalimumab) vs. 0.9 (OASIS); p=0.771 (not significant). Conclusion: Adalimumab did not demonstrate statistically significant slowing of radiographic spinal progression at 2 years. Similar findings across other anti-TNF and IL-17 trials at 2 years. The lack of proven structural modification remains a fundamental limitation of current biologic therapy for ankylosing spondylitis.
PMC: PMC2745811  ·  DOI: 10.1186/ar2793
[8]Baeten D et al. (MEASURE 1 and 2 trials). "Secukinumab, an Interleukin-17A Inhibitor, in Ankylosing Spondylitis." New England Journal of Medicine, 2015;373(26):2534–2548. n=590 (MEASURE 1) and n=219 (MEASURE 2). ASAS20 at week 16: 61–71% for secukinumab 150 mg vs. 28–36% placebo (p<0.001). ASAS40 at week 16: 41% (150 mg, MEASURE 2) to 54% (300 mg IV, MEASURE 3 at week 52). Patients with prior anti-TNF failure showed ~5% lower response rates. ~46–59% do not achieve ASAS40 at 16 weeks across trials.
DOI: 10.1056/NEJMoa1505066  ·  PMID: 26699169
[9]Bozan N et al. "Work disability in ankylosing spondylitis: differences among working and work-disabled patients." Clinical Rheumatology, 2009;28(11):1299–1304. n=121 male ankylosing spondylitis patients. 24% retired (work disabled) due to ankylosing spondylitis; 44.6% changed to lighter job; 31.4% continued without change. Mean retirement age of disabled group: 36 ± 4.2 years. Confirmed by Guillemin F et al. systematic review: work disability in ankylosing spondylitis ranges 3–50% depending on disease duration; sick leave 12–46 days/yr. Boonen A et al. Dutch cohort (n=658): work disability 15.7–16.9% higher than expected vs. general population.
DOI: 10.1007/s10067-009-1249-1  ·  PMID: 19685294
[10]Haroon NN et al. "Patients with Ankylosing Spondylitis Have Increased Cardiovascular and Cerebrovascular Mortality: A Population-Based Study." Annals of Internal Medicine, 2015;163(6):409–416. Population-based Canadian registry; n=21,473 ankylosing spondylitis patients, n=86,606 matched controls. Ankylosing spondylitis was associated with 35% higher cardiovascular mortality (HR 1.35; 95% CI 1.20–1.52) and 60% higher cerebrovascular mortality (HR 1.60; 95% CI 1.23–2.08) vs. matched controls without ankylosing spondylitis. Vascular mortality risk increased by 12% per year of advancing age.
DOI: 10.7326/M15-0614  ·  PMID: 26258757
[11]Doeleman MJH et al. "Work Productivity and Costs Related to Patients with Ankylosing Spondylitis, Rheumatoid Arthritis, and Psoriasis." Value in Health, 2018;21(S1):S39. n=230 ankylosing spondylitis patients. WPAI: overall work productivity loss 40.9%; daily activity impairment approximately 50%. Annual productivity cost per ankylosing spondylitis patient estimated at €2,000 (approximately $2,200 USD). BASDAI and HAQ were the strongest predictors of productivity impairment.
PMID: 29702796
[12]Danve A et al. "Evaluation of the comorbidity burden in patients with ankylosing spondylitis using a large US administrative claims data set." Clinical Rheumatology, 2018;37(7):1869–1878. MarketScan® Commercial and Medicare databases. After ankylosing spondylitis diagnosis, significantly higher proportions of patients developed depression, cardiovascular diseases, osteoporosis, spinal fracture, IBD, psoriasis, and uveitis vs. matched controls. Depression and anxiety prevalence 2–3× higher than general population. Depression was independently associated with higher disease activity (BASDAI) and functional impairment (BASFI).
PMC: PMC6006197  ·  DOI: 10.1007/s10067-018-4086-2
[13]Liang G et al. "Association of health care utilization and costs with patient-reported outcomes in patients with ankylosing spondylitis." Journal of Managed Care & Specialty Pharmacy, 2022;28(9):1008–1019. Real-world US claims (n=patients with confirmed ankylosing spondylitis, physician-confirmed diagnosis subset n=167). Mean total healthcare costs: $44,783/yr (SD $40,595); pharmacy costs: $38,263 (85% of total); ankylosing spondylitis-related medical costs: $6,521 (hospitalisations $3,459, outpatient $2,160, diagnostics). Every 1.0-unit increase in HAQ-DI score significantly associated with higher hospitalisation rates, ED visits, outpatient visits, and diagnostic testing.
DOI: 10.18553/jmcp.2022.28.9.1008