What is ankylosing spondylitis?
Ankylosing spondylitis is an inflammatory disease that can cause some of the small bones in your spine (vertebrae) to fuse over time. This fusion makes the spine less flexible and can lead to a hunched forward posture. Moreover, if the ribs are affected by this disease, taking deep breaths can be difficult.
It is noted that ankylosing spondylitis affects men more than women. Signs and symptoms usually begin in early puberty. The inflammation may occur in other parts of your body, the most common being your eyes.
There is no cure for ankylosing spondylitis, but treatments may relieve your symptoms and slow the progression of the disease.
What are the symptoms of ankylosing spondylitis?
Early signs and symptoms of ankylosing spondylitis may include pain and stiffness in the lower back and hips, especially in the morning and after periods of inactivity and movement. Also, neck pain and fatigue are common symptoms. Over time, your symptoms can worsen, improve, or even stop intermittently.
The most affected areas are:
- The joint between the base of your spine and your pelvis
- Vertebrae in your lower back
- The places where your tendons meet and attach you to your bones, especially in your spine, but sometimes along the back of your heel
- The cartilage between the breastbone and the ribs
- Your hip and shoulders joints
What are the causes of ankylosing spondylitis?
There is no known specific cause of ankylosing spondylitis, although it appears that genetic factors may be involved. In particular, people with a gene called HLA-B27 are more likely to develop ankylosing spondylitis. However, only some carriers of this gene will develop the disease.
What are the complications of ankylosing spondylitis?
In severe ankylosing spondylitis, a new bone forms as part of the body’s attempt to heal. This new bone gradually bridges the gap between the vertebrae, and eventually fuses the sections of the vertebrae. These parts of the spine become stiff and inflexible. Spinal fusion can harden the rib cage, restricting the efficiency and function of your lung.
Other complications may include:
- Eye inflammation (uveitis). One of the most common complications of ankylosing spondylitis is causing eye pain, sensitivity to light, and blurred vision. Go to your doctor immediately if you develop these symptoms.
- Pressure fractures. Some people experience raised bones during the early stages of ankylosing spondylitis. Weakened vertebrae may fracture and thus increase the severity of your posture curve. A vertebral fracture can increase pressure and potentially injure the spinal cord and the nerves that pass through the spine.
- Heart problems. Ankylosing spondylitis can cause problems with the aorta, which is the largest artery in the body. The inflamed aorta can enlarge until it distorts the shape of the aortic valve in the heart, which may impair its ability to function.
How is ankylosing spondylitis diagnosed?
During the physical exam, your doctor may ask you to bend in different directions to test the range of motion of your spine. He or she may try to relieve the pain by pressing certain areas of the pelvis or by moving your legs to a certain position. Your doctor may ask you to take a deep breath to see if you are having difficulty expanding your lungs.
- An X-ray allows your doctor to check for changes in the joints and bones, although clear signs of ankylosing spondylitis may not be apparent at the start of the disease.
- An MRI uses radio waves and a strong magnetic field to provide more-detailed images of bones and soft tissues. MRI scans are used to reveal evidence of ankylosing spondylitis early in the disease, but they are more expensive.
- There are no specific laboratory tests to identify ankylosing spondylitis. Certain blood tests can check for signs of inflammation, but inflammation can be caused by many different health problems.
- Your blood can be tested for the HLA-B27 gene. But most people who do have this gene do not have ankylosing spondylitis and it is possible to develop the disease without this gene.
How is ankylosing spondylitis treated?
The goal of treatment is to reduce pain and stiffness and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage to the joints.
- Nonsteroidal Anti-Inflammatory Drugs like Brufen or Voltaren are the most common drugs that doctors use for ankylosing spondylitis. They can reduce inflammation, pain and stiffness. However, these drugs can cause gastrointestinal bleeding.
- If NSAIDs are not of help, your doctor might suggest starting a course of antibiotics, such as tumor necrosis factor (TNF) blockers or interleukin 17 (IL-17) inhibitors.
- TNF blockers help reduce pain, joint stiffness, sensitivity, and swelling. It is given as an injection under the skin or into an intravenous catheter.
- Physical therapy is an important part of treatment and can offer a number of benefits, from pain relief to improved strength and flexibility. Our physical therapist can tailor exercises to meet your individual needs.
- Range of motion exercises and stretches can help keep your joints flexible and maintain good posture. Proper sleeping and walking positions, stomach and back exercises can help you maintain an upright posture.
Your doctor may recommend surgery if you have severe pain or joint damage, or if the hip joint is very damaged and needs to be replaced.