Ankylosing spondylitis is a subtype of arthritis, which is a collection of diseases that are characterized by inflammation and stiffness of joints. Ankylosing spondylitis develops in 0.1-0.5% of adults.
Unlike other types of arthritis, ankylosing spondylitis specifically affects the spine. Hence, the pain and stiffness of joints is felt from the neck and down to the lower back. In fact, the spine’s bones will fuse together in patients with ankylosing spondylitis, leading to a rigid spine. Over time, ankylosing spondylitis can lead to a stooped-over posture. Hence, it is vital to have an early diagnosis so that treatment can be started as quickly as possible to reduce or prevent any significant deformity.
Ankylosing spondylitis is a systemic disease, which means that involves other regions of the body besides the joints.
Epidemiology of ankylosing spondylitis
While ankylosing spondylitis can develop in patients of any age and gender, it is more likely to develop in men that are in their teens or 20s. If it does occur in women, it tends to be milder. Furthermore, while it can occur in any ethnicity, it more commonly develops in Native Americans.
Cause of ankylosing spondylitis
While it is unknown why ankylosing spondylitis develops, studies have shown that there is a strong genetic link. Hence, it is a condition that can occur in families. Sequencing studies have shown that most patients with ankylosing spondylitis have a gene called HLA-B27. Therefore, patients with HLA-B27 are more likely to develop this disease. Interestingly, up to 10% of people that have this gene don’t develop ankylosing spondylitis for unknown reasons.
Symptoms of ankylosing spondylitis
These are the following symptoms that can occur in patients with ankylosing spondylitis:
- Consistent pain and stiffness in the joints of your lower back, butt and hips that goes on for more than three months. Usually, ankylosing spondylitis will start around joints known as the sacroiliac joints, which are located in the lowest major part of the spine.
- Fusion of bones. Patients with ankylosing spondylitis will often develop news growths on bones, which can lead to irregular joining or fusion of these bones. These are called bony fusions. These fusions affect the bones of the neck, back and hips, and can severely impair a patient’s ability to perform everyday activities. Even more dangerously, this fusion of the ribs to the spine can limit a person’s ability to expand their chest when taking a deep breath.
- Ankylosing spondylitis affects ligaments and tendons that are attached to bone, leading to the development of tendonitis (inflammation of tendon). This leads to severe pain and stiffness in the area around the heel.
- Loss of appetite
- Inflammation of the eye, which is characterized by redness and pain.
- Lung and heart problems.
Diagnosis of ankylosing spondylitis
Physicians will diagnose ankylosing spondylitis based on a mixture of things including symptoms, physical evaluation, detailed medical and family history, imaging tests such as X-rays of the back and pelvis, measurement of the chest when the patient is breathing and lab tests.
Treatment of ankylosing spondylitis
Similar to other types of arthritis, there is currently no cure for the disease. However, there are treatments that can help decrease discomfort and improve functioning. These are the following goals that physicians hope to achieve through treatment:
- Reduce pain and stiffness of joints
- Maintain a good posture
- Prevent permanent deformity
- Be able to conduct everyday activities
If patients are identified early on and properly treated, they can lead normal lives. For treatment, it is ideal to have a team of specialists including the rheumatologist (arthritis specialist), physical therapist and occupational therapist.
These are the following treatments that are likely to be prescribed to patients with ankylosing spondylitis:
- Medicines. Physicians can prescribe a range of drugs that can help provide relief from pain and stiffness and allow patients to do normal exercises with little discomfort. Primarily, physicians will prescribe non-steroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen, naproxen and aspirin. In more severe cases, physician may prescribe a type of drug known as disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate which help reduce inflammation, stiffness and pain better than NSAIDs. Another type of drug that you may be prescribed is known TNF inhibitors, which have been approved by the FDA for treatment of ankylosing spondylitis. Steroid injections can be conducted into a joint or tendon, which can be helpful. Finally, the anti-depressant Cymbalta has been shown to help chronic back pain.
- Physical and occupational therapy. You can learn strategies from both physical and occupational therapists that can help you maintain function, minimize deformity and be able to conduct everyday activities with little to no problems.
- Exercise. A regimen of exercise that is recommended by physical therapists can help reduce stiffness, strengthen muscles around joints and help prevent disability. Swimming is a type of exercise that is often recommended to patients with ankylosing spondylitis.
- Deep breathing. Exercises that involve deep breathing can help keep chest cage flexible.
- Surgeries. Artificial joint replacement surgery can be good option for patients with advanced disease that affects hips or knees.