The pain and stiffness may be especially pronounced in the morning when waking up and after resting, and may be relieved by activity, and may be aggravated by coughing, sneezing or sudden twisting of the lower back. It may be accompanied by fatigue, weight loss, loss of appetite, and low-grade fever. The pain and stiffness in the lower back and hips fluctuate and progress as the disease tension progresses. The pain and stiffness may spread to other joints such as the upper back, shoulders, chest, hips, knees and ankles. Inflammation can also affect the eyes, manifesting as eye pain, redness, photophobia, and tearing. Inflammation can also affect the heart and blood vessels, and even the lungs. Patients with long-term uncontrolled disease may permanently lose joint function due to inflammation that leads to joint ossification. Stiffness of the spine that prevents bending, hunchback deformity, difficulty walking or standing, and difficulty breathing may occur.