Working with AS: your rights, accommodations, and when to speak up

Twenty-four percent of people with AS are forced to stop working because of the disease. Forty-four percent switch to a lighter job. Only about a third continue without any work changes.

I cite those numbers not to be alarming but because they are real, and because the impact of AS on work is something that almost nobody prepares you for at diagnosis. The conversation is almost always about medication and pain management. The career conversation rarely happens until things are already difficult.

Why AS hits work so hard

The combination of factors that make AS hard to manage in a work context:

Mornings are the worst time. The morning stiffness that defines AS — worse with inactivity, better with movement — means that many people with AS struggle most in the first 2-3 hours of the day. A 9am start, a morning commute, or an early shift lands exactly in the hardest window.

Sitting for long periods is as harmful as heavy lifting. Both cause stiffness and pain. Desk jobs are not automatically 'light work' for AS patients — sitting in a fixed position for hours is a significant physical challenge.

Fatigue is unpredictable and real. Even on a low-pain day, systemic inflammatory fatigue can make sustained concentration and performance difficult.

Flares happen without warning. The unpredictability of bad days — you cannot always tell Tuesday that Wednesday will be terrible — creates planning challenges that most workplaces are not designed for.

Reasonable adjustments / workplace accommodations

In most countries with disability discrimination legislation, an employer has a legal obligation to make 'reasonable adjustments' or 'reasonable accommodations' for an employee with a disability. AS generally qualifies.

Common and impactful adjustments:

A later start time. This is often the single most impactful adjustment. Starting at 10 or 10:30 instead of 9 allows the morning stiffness to pass before the working day begins. It costs the employer almost nothing and changes your daily experience significantly.

Working from home (partially or fully). Removes the commute, allows you to manage position changes, allows you to lie down during a flare if needed, and removes the energy cost of 'looking normal' in a shared office.

A sit-stand desk. Regular position changes are medically relevant for AS, not just an ergonomic preference. A standing desk or height-adjustable desk enables the movement that reduces stiffness.

Permission to take regular movement breaks. Even five minutes per hour of walking or gentle movement makes a real difference to afternoon pain and stiffness levels.

Flexibility for medical appointments. AS requires regular rheumatology appointments, physiotherapy, blood tests, and imaging. Flexibility around these is important.

Flexible hours or compressed working. Allows you to work when you feel best rather than to a fixed schedule that may coincide with your worst times.

When and whether to disclose

Disclosure is your choice. You have no legal obligation to tell your employer about a health condition in most jurisdictions (consult local employment law for specifics). There are circumstances where disclosure serves your interests and circumstances where it does not.

When disclosure makes sense: when you need adjustments that require explanation, when your performance is affected and you want context on record, when you have a supportive manager and a culture where the conversation will be received well.

When to be cautious: in workplaces with poor cultures around disability, when job security is uncertain, or when you are applying for a new position (generally, do not disclose in a job application).

If you do disclose: keep it functional, not medical. You do not need to explain the full biology of AS. 'I have an inflammatory arthritis that affects my spine and my energy levels. The main things I need are...' is usually enough.

The conversation with your manager

The most effective approach I have seen: request a meeting, describe the functional impacts (not symptoms) on your work, name the specific adjustments you are asking for, and ideally bring a letter from your rheumatologist to support the request.

A letter from your rheumatologist confirming your diagnosis, describing the functional impact in general terms, and supporting specific adjustments is not always required but it transforms the conversation. It moves from 'I need this favour' to 'I have a documented medical condition and my specialist supports this approach.'

HR can be your ally or your antagonist depending on the organisation. If you have a good relationship with your line manager, starting there before going to HR often produces better outcomes.

Disability benefits — if and when

If AS prevents you from working or significantly limits your working capacity, disability benefits may be relevant. The specifics vary enormously by country — what qualifies, how to apply, and how long it takes are different in the US, UK, Australia, NZ, and everywhere else.

The key thing: do not wait until crisis point to investigate what is available. Understanding your options before you need them, and keeping documentation of how AS affects your function, puts you in a much better position if you need to make a claim.