Ankylosing Spondylitis – Symptoms, causes, types, and treatment

Ankylosing spondylitis (AS) is a type of arthritis that primarily affects the spine, though it can also affect other joints. It causes inflammation of the vertebrae, which can lead to severe, chronic pain and discomfort. In more advanced cases, this inflammation can lead to ankylosis, or new bone formation in the spine, causing sections of the spine to fuse in a fixed, immobile position.

Symptoms of Ankylosing Spondylitis

The symptoms of ankylosing spondylitis can vary greatly from person to person, but they typically develop slowly over time. Common symptoms include:

1. Back Pain and Stiffness: Persistent pain and stiffness in the lower back and buttocks, especially in the morning and after periods of inactivity.
2. Pain in Other Joints: AS can also affect other joints, including the hips, shoulders, and rib cage.
3. Fatigue: Chronic inflammation can lead to a general feeling of fatigue and tiredness.
4. Neck Pain: Pain and stiffness can extend up the spine to the neck.
5. Loss of Flexibility: Reduced flexibility and range of motion in the spine.
6. Eye Inflammation: Uveitis, or inflammation of the eyes, can cause pain, sensitivity to light, and blurred vision.
7. Enthesitis: Inflammation where tendons and ligaments attach to bone, particularly in the heels and bottom of the feet.

Causes of Ankylosing Spondylitis

The exact cause of ankylosing spondylitis is not known, but it is believed to be a combination of genetic and environmental factors.

1. Genetics: The most significant risk factor is a gene called HLA-B27. Over 90% of people with ankylosing spondylitis have this gene, although not everyone with HLA-B27 will develop the disease.
2. Immune System: AS is an autoimmune disease, meaning the immune system mistakenly attacks healthy tissue in the body.
3. Environmental Factors: While the precise environmental triggers are unknown, infections and other environmental factors may play a role in the onset of the disease.

Types of Ankylosing Spondylitis

Ankylosing spondylitis can be classified into different types based on the severity and areas of the body affected:

1. Axial Spondyloarthritis: This is the most common form and primarily affects the spine and sacroiliac joints.
2. Peripheral Spondyloarthritis: This type involves peripheral joints like the hips, shoulders, and sometimes the knees and ankles.
3. Non-radiographic Axial Spondyloarthritis: Early-stage AS where the inflammation is present, but there is no visible damage on X-rays.
4. Radiographic Axial Spondyloarthritis: Advanced stage where visible damage, such as bone fusion, can be seen on X-rays.

Diagnosis of Ankylosing Spondylitis

Diagnosis can be challenging due to the slow progression of the disease and the similarity of its symptoms to other conditions. The following methods are commonly used for diagnosis:

1. Medical History and Physical Exam: Reviewing symptoms and medical history, followed by a physical examination to assess pain and flexibility.
2. Imaging Tests: X-rays, MRI, and CT scans can show inflammation and changes in the spine and joints.
3. Blood Tests: Testing for the HLA-B27 gene and checking levels of inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).

Treatment of Ankylosing Spondylitis

While there is no cure for ankylosing spondylitis, treatments can help manage symptoms and improve quality of life. Treatment options include:

1. Medications:
   • NSAIDs: Nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen are often the first line of treatment to reduce pain and inflammation.
   • DMARDs: Disease-modifying antirheumatic drugs such as sulfasalazine may be used to manage peripheral arthritis.
   • Biologics: TNF inhibitors (e.g., infliximab, etanercept) and IL-17 inhibitors (e.g., secukinumab) are used for more severe cases to reduce inflammation and prevent joint damage.
   • Corticosteroids: Short-term use of corticosteroids can reduce inflammation during severe flare-ups.
2. Physical Therapy:
   • Exercise: Regular exercise, including stretching and strengthening exercises, is crucial for maintaining flexibility and reducing pain.
   • Posture Training: Learning and maintaining proper posture can help reduce stress on the spine.
3. Lifestyle Changes:
   • Healthy Diet: A balanced diet can help manage weight and reduce stress on joints.
   • Quit Smoking: Smoking can exacerbate symptoms and complicate treatment.
4. Surgery:
   • In severe cases where joints are severely damaged, surgical options like joint replacement or corrective surgery may be considered.

Living with Ankylosing Spondylitis

Living with ankylosing spondylitis can be challenging, but with proper management, many people can lead active and fulfilling lives. Here are some tips for managing daily life with AS:

1. Stay Active: Engage in regular physical activity tailored to your abilities and limitations.
2. Educate Yourself: Learn about your condition and treatment options to make informed decisions about your care.
3. Join Support Groups: Connecting with others who have AS can provide emotional support and practical advice.
4. Work with Healthcare Providers: Regular check-ups with rheumatologists and other healthcare providers can help monitor the condition and adjust treatments as necessary.

Conclusion

Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine but can impact other joints and organs. Early diagnosis and a comprehensive treatment plan involving medications, physical therapy, lifestyle changes, and possibly surgery can help manage symptoms and improve quality of life. By staying informed and proactive in managing their condition, individuals with ankylosing spondylitis can lead active, fulfilling lives.

Also read: Asbestosis – Symptoms, causes, types, and treatment