Ankylosing Spondylitis

Overview

Ankylosing Spondylitis (AS) is a type of arthritis that primarily targets the spine but can also affect other joints. The term 'ankylosing' means stiff or rigid, 'spondyl' refers to the spine, and 'itis' indicates inflammation. AS leads to inflammation in the spine and large joints, causing stiffness and pain. It can also impact the joint between the spine and the hipbone, potentially resulting in additional symptoms such as digestive issues, rashes, and weight loss.

What is Ankylosing Spondylitis?

Ankylosing Spondylitis, also known as axial spondyloarthritis, is an inflammatory disease causes some of the bones in the spine to fuse over time. This fusing not only makes the spine less flexible but can also cause issues while breathing. AS, is a form of arthritis that majorly affects the spine, and other joints. It causes inflammation of the spinal joints i.e. vertebrae that can lead to chronic pain and stiffness leading to discomfort.

Symptoms of Ankylosing Spondylitis

People with Ankylosing Spondylitis often experience unique combination of symptoms with the pain spreading or radiating from the hip, buttocks, neck and abdomen or stomach. Early indications of AS usually start to appear during early adulthood. John Hopkins Medicine states that symptoms of ankylosing spondylitis tend to come and go over time and varies greatly from person to person. The symptoms may include:

- Severe back pain, typically worse at night during rest
- Stiffness in the early morning
- Stooped posture due to back pain (bending forward often relieves the discomfort)
- Rigid and straight spine
- Difficulty taking deep breaths if the rib-spine joints are affected
- Loss of appetite
- Weight loss
- Fatigue
- Fever
- Anemia
- Joint pain
- Mild eye inflammation
- Potential damage to organs like the heart, lungs, and eyes
- Skin rashes
- Digestive issues, such as Crohn's disease or ulcerative colitis

In severe cases, the body tries to heal itself by forming new bones in the spine. Over time, this new bone can fuse the vertebrae (the bones in your spine), making your spine stiff and inflexible. This stiffness can also spread to your ribs, making it harder to breathe deeply. Complications to be aware of include eye inflammation, which can cause sudden pain, light sensitivity, and blurry vision.

Another complication is bone fractures, as some people's bones may weaken and break in the spine early in the disease, worsening a hunched posture and putting pressure on the spinal cord and nerves. Finally, ankylosing spondylitis can increase your risk of heart problems, as inflammation can affect the aorta, the main artery in your body, and potentially even the heart valve itself.

The inflammation caused by AS can lead to varying levels of fatigue. Mild to moderate anemia, which can also result from the inflammation, may contribute to an overall sense of tiredness.

Causes of Ankylosing Spondylitis

Ankylosing Spondylitis is an autoimmune disease, which occurs when your immune system mistakenly attacks your own body instead of protecting it. While doctors don't know exactly what causes AS, there seems to be a connection to a person's genes. People with a gene called HLA-B27 are much more likely to develop it, but not everyone with this gene will have the condition.

Spondylitis Association of America states, "It is important to note, however, that one does not have to be HLA-B27 positive to have AS. Also, a majority of people with this marker never develop ankylosing spondylitis."

Tests, Management and Treatment for Ankylosing Spondylitis

Recent studies indicate that newer biologic medications can potentially slow disease progression in some individuals. However, responses vary, and finding the most effective treatment may take time. Treatment depends on symptoms, age, general health, and the severity of the condition. The goal is to ease pain and stiffness, prevent deformities, and maintain a normal lifestyle.

Common treatments for ankylosing spondylitis include:

- Regular physical activity to reduce stiffness and prevent worsening of AS.
- Over-the-counter NSAIDs like ibuprofen and naproxen for pain and inflammation.
- Biologic DMARDs to reduce inflammation and pain, potentially halting disease progression.
- Corticosteroids as prescription anti-inflammatory medications.
- Surgery, rarely suggested, for severe symptoms unresponsive to other treatments.

Your healthcare provider will conduct a physical exam to evaluate your spinal movement and pain levels, pressing on different parts of your back and legs to check for pain triggers. They may also ask you to take a deep breath to see if it’s difficult. X-rays can be used to look for changes in your bones and joints, but they might not reveal anything early on. MRIs, being more detailed, can sometimes detect signs of the disease earlier but are more expensive. There is no single blood test for ankylosing spondylitis, but doctors might perform blood tests to check for inflammation, which can occur with many conditions. They might also test for the HLA-B27 gene, but having this gene doesn’t guarantee you have the disease, and some people with the disease do not have the gene.

Prevention for Ankylosing Spondylitis

While there is no surefire way to prevent AS, managing the condition can be achieved through several strategies. So creating a plan with your healthcare provider is essential. Lifestyle changes can improve your quality of life. Here are some steps to reduce inflammation and stress on your joints:

- Exercise regularly to ease pain, increase flexibility, and improve posture.
- Smoking worsens AS, especially for breathing, so quitting is crucial.
- Adopt a balanced diet and limit alcohol consumption.
- Standing tall can prevent some AS-related problems.

A physiotherapist can help design an exercise plan and maintain good posture.