Ankylosing Spondylitis

Inflexible spine with a hunched posture.

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There are two types of axial spondyloarthritis: ankylosing spondylitis, which is visible on X-rays, and nonradiographic axial spondyloarthritis, which is diagnosed based on symptoms, blood tests, and other imaging tests when it cannot be seen on X-ray. Symptoms usually start in early adulthood and can affect other parts of the body, such as the eyes.

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Unfortunately, there is no cure for ankylosing spondylitis, but treatments are available to reduce symptoms and possibly delay disease progression.

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Symptoms

If you're experiencing early symptoms of ankylosing spondylitis, you may notice back pain and stiffness in your lower back and hips, particularly in the morning and after staying inactive for a while. You might also experience neck pain and fatigue which are common symptoms. As time goes by, these symptoms may worsen, improve, or fluctuate in intensity at irregular intervals

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The areas most commonly affected are:

• The joint between the base of the spine and the pelvis.

• The vertebrae in the lower back.

• The places where tendons and ligaments attach to bones, mainly in the spine, but sometimes along the back of the heel.

• The cartilage between the breastbone and the ribs.

• The hip and shoulder joints.

 

When to see a doctor

If you are experiencing low back or buttock pain that crept up on you and has worsened over time, especially if it's worse in the morning or if it's waking you up in the second half of the night, it's important to seek medical attention. Pay attention to whether the pain improves with exercise and worsens with rest, as this can provide valuable information to your healthcare provider. Additionally, if you notice a painful red eye, severe light sensitivity, or blurred vision, it's crucial to see an eye specialist right away to get proper treatment.

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Causes

Ankylosing spondylitis is a chronic inflammatory disorder that primarily affects the spine and sacroiliac joints. While the specific cause of this disorder is unknown, research suggests that genetic factors play a significant role. In particular, individuals who possess a specific gene called HLA-B27 are at a much greater risk of developing ankylosing spondylitis. However, it is important to note that not all people who possess this gene will necessarily develop the condition

 

Risk factors

Ankylosing spondylitis is a debilitating condition that can lead to the formation of new bone in an attempt to repair damage. This process can cause the gradual bridging of gaps between vertebrae, leading to the eventual fusion of sections of vertebrae. As a result, the spine becomes stiff and inflexible, limiting one's range of motion. Moreover, fusion can also stiffen the rib cage, which can lead to reduced lung capacity and function.

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Other complications might include:

• Eye inflammation, called uveitis. One of the most common complications of ankylosing spondylitis, uveitis can cause rapid-onset eye pain, sensitivity to light and blurred vision. See your health care provider right away if you develop these symptoms.

• Compression fractures. Some people's bones weaken during the early stages of ankylosing spondylitis. Weakened vertebrae can crumple, increasing the severity of a stooped posture. Vertebral fractures can put pressure on and possibly injure the spinal cord and the nerves that pass through the spine.

• Heart problems. Ankylosing spondylitis can cause problems with the aorta, the largest artery in the body. The inflamed aorta can enlarge to the point that it distorts the shape of the aortic valve in the heart, which impairs its function. The inflammation associated with ankylosing spondylitis increases the risk of heart disease in general.

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Diagnosis

During a physical exam, your healthcare provider may ask you to bend in different directions to test the range of motion in your spine. They may also try to reproduce your pain by pressing on specific areas of your pelvis or by moving your legs into a certain position. You may also be asked to take a deep breath to see if you have difficulty expanding your chest.

 

Imaging Tests

Imaging tests, such as X-rays, can help doctors check for any changes in joints and bones, which might be indicative of radiographic axial spondyloarthritis, although the visible signs of ankylosing spondylitis, also known as axial spondyloarthritis, may not be evident in the early stages of the disease. Magnetic resonance imaging (MRI) scans use radio waves and a strong magnetic field to provide more detailed images of bones and soft tissues. MRI scans can reveal evidence of nonradiographic axial spondyloarthritis earlier in the disease process, but they are much more expensive.

 

Lab Tests

Although there are no specific lab tests to identify ankylosing spondylitis, certain blood tests can check for markers of inflammation. However, it's important to note that many different health problems can cause inflammation. Blood tests can also be done to check for the HLA-B27 gene, but many people who have the gene don't have ankylosing spondylitis, and some people can have the disease without having the HLA-B27 gene.

 

Treatment

The primary objective of treating ankylosing spondylitis is to alleviate pain and stiffness, as well as to prevent or delay spinal deformity and complications.

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Medications

Axial spondyloarthritis and nonradiographic axial spondyloarthritis are commonly treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aleve and Advil. These drugs can help alleviate inflammation, pain and stiffness, but they may also cause gastrointestinal bleeding.

 

If NSAIDs are not effective, your doctor may suggest a TNF blocker or an IL-17 inhibitor, which are injected under the skin or through an intravenous line. Another option is to take a JAK inhibitor by mouth. However, it's important to note that JAK inhibitors can reactivate untreated tuberculosis and increase your risk of infections.

 

Examples of tumor necrosis factor (TNF) blockers include:

• Adalimumab (Humira).

• Certolizumab pegol (Cimzia).

• Etanercept (Enbrel).

• Golimumab (Simponi).

• Infliximab (Remicade).

interleukin-17 (IL-17) inhibitors used to treat ankylosing spondylitis include secukinumab (Cosentyx) and ixekizumab (Taltz). JAK inhibitors available to treat ankylosing spondylitis include tofacitinib (Xeljanz) and upadacitinib (Rinvoq).

 

Therapy

Physical therapy is an important part of treatment and can provide a number of benefits, from pain relief to improved strength and flexibility. A physical therapist can design specific exercises for your needs. To help preserve good posture, you may be taught:

• Range-of-motion and stretching exercises.

• Strengthening exercises for abdominal and back muscles.

• Proper sleeping and walking positions.

Surgery

Most people with ankylosing spondylitis or nonradiographic axial spondyloarthritis don't need surgery. Surgery may be recommended if you have severe pain or if a hip joint is so damaged that it needs to be replaced.

 

Self care

Lifestyle choices also can help manage ankylosing spondylitis.

• Stay active. Exercise can help ease pain, maintain flexibility and improve your posture.

• Don't smoke. If you smoke, quit. Smoking is generally bad for your health, but it creates additional problems for people with ankylosing spondylitis, including further hampering breathing.

• Practice good posture. Practicing standing straight in front of a mirror can help you avoid some of the problems associated with ankylosing spondylitis.

 

Coping and support

The course of your condition can change over time, and you might have painful episodes and periods of less pain throughout your life. But most people are able to live productive lives despite a diagnosis of ankylosing spondylitis.

 

You might want to join an online or in-person support group of people with this condition, to share experiences and support.

 

 

 

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