History: Individuals typically complain of a gradual onset of low back pain and associated muscle spasms experienced over several months. The pain is usually described as worse in the morning and improving during the day. It may have followed a gradual ascending pattern from the tailbone (sacrum) to the lower back (lumbar spine) to the chest region (thoracic spine) and finally to the neck (cervical spine). Individuals may also report pain and stiffness of the rib cage and / or pain beginning in the larger peripheral joints (e.g., knees, hips, shoulders). Eye pain may be reported as well as a loss of appetite, weight loss, and fatigue. A family history of ankylosing spondylitis may also be reported on questioning.