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What is Ankylosing Spondylitis: Symptoms, Causes, Diagnosis, and Treatment

Definition and Overview

Ankylosing Spondylitis is an inflammatory disease characterized by the fusion of the spine vertebrae causing limited movement of the patient and severe pain. If the spine fuses with the ribs, the condition can also cause difficulty in breathing.

The disease is considered a form of arthritis because it affects mostly the joints and muscles. However, it can also result in the confusion of the autoimmune system. When this happens, the immune system starts to attack other body parts, such as the eyes, lungs, and even the heart.

Ankylosing Spondylitis often begins at the Sacroiliac joint located just above the pelvis. The disease then spreads up the lumbar spine, through the thoracic spine, and then the cervical spine. In some cases, the symptoms may be so mild that the patient does not even realize the presence of the disease. Unfortunately, the symptoms can also become so severe that the quality of life of the patient can be greatly affected.

To date there is no cure available for Ankylosing Spondylitis. However, treatment options are available for controlling the symptoms of the disease and improving the patient’s quality of life. Treatment for the disease necessitates a variety of drugs and physical therapy sessions. However, surgery may also be required in some cases, especially when the hips or spinal column has been badly affected.

Cause of condition

It is believed that Ankylosing Spondylitis is genetically inherited. Majority of patients with this disease are found to have the gene HLA-B27. However, presence of this gene does not necessarily mean the onset of the disease. In fact, statistics have shown that around 7% of the US population has the HLA-B27 gene, but only 1% has the disease. Therefore, it is believed that heredity factors also come into play. Those who have the gene and have relatives with the disease are at risk of acquiring Ankylosing Spondylitis.

Other than HLA-B27, studies have shown the presence of other genes such as ARTS1 and IL23R play a significant role in influencing the immune system. Once the immune system has been activated due to other diseases or infections, it is unable to turn off even when it has beaten the infection.

Key Symptoms

The Ankylosing Spondylitis disease progresses in stages. In the early stages of the disease, patients are likely to notice stiffness and pain in the lower back, especially in the mornings. However, the pain and stiffness subsides during the day or while performing exercises. The patient will also experience some pain in the sacroiliac joints, the buttocks, or the back of the thighs.

The early symptoms of the disease are similar to common backaches thus it is often mistaken for such. The difference is that the pain and stiffness of the disease will often last for more than 30 minutes in the morning and may return before going to rest at night or while resting.

Pain and stiffness may not just be limited to the lower back. These symptoms may also appear in the neck or shoulders. There have been cases where the patient also experienced pain and swelling in the knees, ankles or joints of the hands.

Asides from the common symptoms, patients have also been reported to notice the following:

  • Tenderness in the heels
  • Chest pains
  • Frequent feelings of fatigue
  • Eye inflammation
  • Bowel inflammation
  • Tenderness of the pelvis

When inflammation is one of the symptoms, the patient will notice that the swelling comes and goes, and the degree of pain varies with every onset. Mild pains often go unnoticed, but when the spine is affected, the pain can be severe and will prevent the patient from performing normal activities.

Who to See and Types of Treatments Available

Once you experience the symptoms, you will likely first need to report the condition to your family doctor. Your doctor will then refer you to a Rheumatologist, a specialist in the diagnosis and treatment of arthritis, osteoporosis, musculoskeletal disorders, and some types of autoimmune diseases. During the treatment of the disease, physical therapists, occupational therapists and other health professionals may also be consulted.

It is important to note that there is no specific test for diagnosing Ankylosing Spondylitis. However, your doctor will be alerted once you mention the symptoms, which is why you need to mention all of the symptoms carefully.

Your doctor will then perform a physical examination followed by an erythrocyte sedimentation rate (ESR) test and a C-reactive protein (CRP) test. Your doctor may also request an x-ray to check the condition of your lower spine and sacroiliac joints, but if the condition is still in its early stages, there may not be changes in these joints or they may not be evident at this point.

Although the disease cannot be cured, it is important to begin the treatment early because the disease will cause inflammation of the spine and joints and it is highly likely that it will create permanent damage. If flexibility of the spine and joints can be maintained, permanent damage can be avoided.

Once Ankylosing Spondylitis has been confirmed, the doctor will begin treatment with several types of medications. These will likely include non-steroidal anti-inflammatory drugs (NSAIDS) to control the pain and reduce inflammation, corticosteroids for quick pain relief, and biologics that are designed to treat arthritis. Biologics are effective in treating Ankylosing Spondylitis, but they need some time to work. In some cases, it can take months before the effects are noticeable.

Medications to control the symptoms of the disease are only a part of the treatment plan. It is likely that physical therapists and occupational therapists will also be enlisted to help you cope with the disease.

Advanced cases of Ankylosing Spondylitis will require surgery to repair badly damaged joints. In some cases, the joint will need to be replaced by an artificial joint. Some patients may require total hip replacement surgery if the hips have been badly damaged due to the disease.

Spine surgery may also be required, but this procedure is very complex and is only performed on patients that have been severely deformed by the condition.

References:

  • About Ankylosing Spondylitis. www.spondylitis.org/
  • National Ankylosing Spondylitis Society