About Ankylosing Spondylitis
Ankylosing spondylitis is a chronic inflammatory condition that primarily affects the joints in the spine and hips. It is a form of arthritis that causes inflammation and damage in the sacroiliac joints between the spine and the pelvis. Over time, the inflamed spinal joints can become fused, leading to limited movement and potential fractures. Common symptoms include chronic back pain, stiffness, and decreased mobility.
Ankylosing spondylitis is relatively rare and it is more common in otherwise healthy young men. While its exact cause is not understood, genetics likely play a role, and individuals with the HLA-B27 gene may have an increased risk of developing this condition.
The exact causes of ankylosing spondylitis (AS) are not fully understood, but it is believed to be a combination of genetic and environmental factors. Changes in spinal joints, cartilage, tendons, and ligaments are also found to be involved in the disease mechanism of AS.
Risk factors of AS include:
- Genetics and family history: AS tends to run in families, suggesting a genetic predisposition. AS is strongly genetically determined, with the HLA-B27 gene being the most well-known risk factor. Other genes, such as ERAP1 and IL-23R, which play important roles in the immune system and inflammation pathways, have also been found to contribute to the genetic risk.
- Race and ethnicity: AS appears to be more common in Indigenous North Americans, Asians, and Europeans.
- Gender: Men are more likely to develop AS than women.
- Preexisting inflammatory conditions: Crohn's disease, ulcerative colitis, and psoriasis have been associated with an increased risk of developing AS.
It's important to note that while these factors may increase the likelihood of developing AS, they do not guarantee its development. If you have concerns about your risk for AS or want to learn more about managing the condition, it's best to consult with your healthcare professional.
The most common early symptoms of Ankylosing Spondylitis (AS) include fatigue, low back pain, and stiffness. As the condition progresses or becomes more severe, other common symptoms may occur. These can include:
- Joint pain in other areas of the body
- Eye irritation
- Chest pain
- Gastrointestinal challenges
- Difficulty breathing
- Curving of the spine (kyphosis)
- General back pain
It's important to note that the severity and progression of symptoms can vary from person to person. Some individuals may experience only occasional mild pain, while others may have more severe and persistent pain. Symptoms can also fluctuate, with periods of worsening symptoms (flares) and times when symptoms improve (remission).
If you experience any of these symptoms or suspect you may have AS, it is important to consult with a healthcare professional for an accurate diagnosis and appropriate management.
To diagnose ankylosing spondylitis, the following examinations, tests, and procedures are commonly performed:
- Physical exam: During the physical exam, the healthcare provider will look for signs of inflammation in the body, such as pain, swelling, and restricted movement. They may focus on areas like the back, chest, pelvic bones, sacroiliac joints near the spine's bottom, and heels.
- X-rays: X-rays are the first-line imaging test for ankylosing spondylitis. They can show if joints are damaged or fused, particularly in the sacroiliac joints.
- Magnetic resonance imaging (MRI): If X-rays come back negative or there is a suspicion of Ankylosing Spondylitis, an MRI may be recommended. MRIs are more sensitive to detecting inflammation and can reveal changes that X-rays may miss.
Additional examinations, tests, and procedures to determine the stage or severity of Ankylosing Spondylitis may include:
- Genetic blood test: A genetic blood test may be recommended to check for the presence of the HLA-B27 gene. This gene is found in about 90 percent of people with ankylosing spondylitis.
It's important to consult with your healthcare provider who can guide you through these examinations, tests, and procedures based on your individual situation.
The goals of treatment for ankylosing spondylitis (AS) are to:
- Ease and reduce pain and inflammation.
- Improve posture, flexibility, and strength
- Slow or halt disease progression
- Repair joint damage
To achieve these treatment goals, the following approaches are recommended:
- Medications: Over the counter NSAIDs or corticosteroid injections into the joints can decrease inflammation and offer immediate pain relief.
- Biologic medications, TNF-a inhibitors, and Janus kinase (JAK) inhibitors can target immune messages and interrupt inflammation signals to slow down the progression of AS.
- Physical therapy: Exercises recommended by physical therapists can relieve pain, strengthen back and neck muscles, improve core strength, maintain good posture, and enhance joint flexibility.
- Health behavior changes: Low-impact activities like swimming and cycling are often suggested to provide a full-body workout without putting excessive strain on the joints.
- Surgery is usually recommended for repairing severe joint damage.
- Other treatments: Breathing exercises can help expand the chest and improve lung function in individuals with AS.
Remember to consult with your healthcare professional for personalized advice for treatments and medication dosing, as this may vary depending on individual circumstances. Other side effects may occur as well, so it's important to discuss this with your healthcare professional or refer to the medication information provided.