What is ankylosing spondylitis?
Ankylosing spondylitis is a form of arthritis or an immune condition that affects the spine and is presented in form of pain and stiffness from the neck to the lower back. Arthritis is an inflammatory condition that causes vertebrae of the spine to fuse together, leading to a rigid spine. These changes could be mild to severe depending on the person and may result in a stooped-over posture.
Ankylosing spondylitis is more common in men than women. Its signs and symptoms typically start during early adulthood, and may also show inflammation in other parts of the body like the eyes.
What are the causes of the disorder?
The specific reason for ankylosing spondylitis is not known, though involvement of genetic factors is postulated. Studies show that the presence of a gene called HLA-B27 greatly increases the risk of developing ankylosing spondylitis, though many people with the gene also never develop the disorder. Ankylosing spondylitis is more likely to develop in men than women, and generally begins towards late adolescence.
What one needs to know about symptoms or signs?
The earliest signs of ankylosing spondylitis include pain and stiffness in the lower back and hips, with increased incidence after periods of inactivity and in the mornings. Symptoms may worsen, improve or stop irregularly. The affected areas in ankylosing spondylitis are:
- Vertebrae in the lower back
- Joint between the base of spine and pelvis
- Areas in spine and back of heel where tendons and ligaments attach to bone
- Cartilage between the breastbone and ribs
- Hips and shoulder joints
Which specialist should be consulted in case of signs and symptoms?
Persons experiencing symptoms of ankylosing spondylitis should consult a rheumatologist, a doctor who specializes in inflammatory disorders.
What are the screening tests and investigations done to confirm or rule out the disorder?
Ankylosing spondylitis is diagnosed through:
- Physical exam - The doctor checks the chest circumference by measuring once with lungs empty and once with lings full of air. The patient is also asked to bend the back in different directions, and stand upright with heels and back of the head against a wall. Specific points of the pelvis are also pressed and legs made to move in particular directions to reproduce the pain.
- X-rays - Images from x-rays allow the doctor to look at changes in the joints and bones. However, early cases of ankylosing spondylitis may not exhibit visible changes.
- Laboratory tests - Though there are no specific lab tests to identify ankylosing spondylitis, certain blood tests can check for markers of inflammation (however, inflammation could be due to various health reasons). Blood can also be tested for the HLA-B27 gene, though many people without the gene also develop ankylosing spondylitis.
What treatment modalities are available for management of the disorder?
Treatment aims to reduce pain and stiffness, and prevent or delay complications like spinal deformity. Early treatment help prevent irreversible damage to joints.
- Medications - (a) Non-steroidal anti-inflammatory drugs (NSAIDs) are most commonly used to treat ankylosing spondylitis. These work by reducing inflammation, pain and stiffness. A side effect of these medicines is gastrointestinal bleeding. (b) In case NSAIDs prove ineffective, the doctor may prescribe tumour necrosis factor (TNF) blocker, which targets the cell protein known as TNF, and helps to reduce pain, stiffness and tender or swollen joints. These medications are injected into the skin or administered intravenously. A side effect includes reactivation of latent tuberculosis and neurological problems.
- Therapy - Physical therapy provides relief from pain, and improves physical strength and flexibility. A therapist designs an exercise programme that includes range-of-motion and stretching exercises to maintain flexibility and posture. Deep breathing exercises help keep the chest cage flexible. Swimming as an exercise is recommended to people with ankylosing spondylitis.
- Surgery - Most patients with ankylosing spondylitis do not require surgery. However, it may be needed if the pain is severe or there is damage to the joint, or if the damage to hip joint is such that it necessitates replacement.
What are the known complications in management of the disorder?
In severe cases, a new bone may form as part of the body's healing mechanism. This bone, however, closes the gap between the vertebrae and eventually fuses together sections of vertebrae, making them inflexible and stiff. This fusion can also stiffen the rib cage, restricting lung capacity and function. Other complications of the disorder include:
- Inflammation of the eye (uveitis) - Rapid onset of eye pain, sensitivity to light and blurred vision.
- Compression fractures - Thinning of bones in early stages of ankylosing spondylitis; vertebral fractures damage spinal cord and the nerves that pass through it.
- Heart issues - Inflammation of aorta can distort the shape of aortic valve in the heart, impairing its function.
What precautions or steps are necessary to stay healthy and happy during the treatment?
- Quitting smoking and tobacco
- Sleeping on a firm mattress while keeping a straight back
- Avoiding propping up legs on pillows and sleeping with large pillows
- Avoiding the risk to sudden impact, like falling or jumping
How can the disorder be prevented from happening or recurring?
The prognosis may change over time, and relapses or remissions can occur throughout the life. However, many people continue to live normally even after diagnosis of the disorder.
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Sources:
"Arthritis and Ankylosing Spondylitis," WebMD.com, https://www.webmd.com/back-pain/guide/ankylosing-spondylitis
"Ankylosing spondylitis," mayoClinic.com, Mayo Clinic Staff, https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/basics/definition/con-20019766
"Ankylosing Spondylitis," MedlinePlus, NLM, NIH, https://www.nlm.nih.gov/medlineplus/ankylosingspondylitis.html
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