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Ankylosing Spondylitis

Ankylosing spondylitis is a form of arthritis that mainly affects the spine between the intervertebral discs. In some people, joints in the shoulders, ribs, hands, and feet are also affected due to inflammation.

This form of back pain condition usually begins in adolescence or young adulthood, with onset usually occurring between ages 20 and 40. About 80 percent of patients develop symptoms before age 30, and males are more likely to be affected than females.

While a concrete cause of ankylosing spondylitis, sometimes known as ankylosis spondylitis, has not yet been identified, evidence suggests that both genes and environmental factors may play a role in its development.

Symptoms of Ankylosing Spondylitis

Ankylosing spondylitis symptoms usually begin with intermittent low back pain. A patient may experience stiffness, as well as increased pain first thing in the morning or after periods of inactivity. Pain may be severe enough to interrupt sleep.

While pain often begins in the sacroiliac joint, which is located between the pelvis and lower spine, it may spread to include the entire spine. Patients may lose mobility in the lower spine, or experience inflammation between the ribs, leading to an inability to fully expand the chest. Eventually, the inflammation may cause the spinal joints to fuse.

Additional symptoms of ankylosing spondylitis may include:

  • Fatigue
  • Eye inflammation and pain
  • Pain in the heel
  • Stiffness or swelling in the shoulders, knees, ankles, or hips
  • Loss of appetite, abdominal pain, and/or diarrhea
  • Weight loss
  • Mild fever
  • Lower back pain and stiffness
  • Difficulty breathing
  • Fatigue
  • Skin rash

How Is Ankylosing Spondylitis Diagnosed?

Diagnosing ankylosing spondylitis begins with the patient’s medical history and physical examination. Lab and imaging tests will help to confirm the diagnosis, although tests alone typically do not make the final determination.

During a physical exam, a physician will look for signs and symptoms consistent with ankylosis spondylitis, including pain and stiffness in the heels, joints, spine, and pelvis. The physician may then direct the patient to move and bend the body in multiple ways to evaluate the flexibility of the spine. By having the patient breathe deeply, the physician can check for problems with chest expansion. Difficulty expanding the chest may indicate inflammation of the joints between the ribs and spine.

Besides a physical exam, a doctor may order X-rays or an MRI. X-rays may show changes in the joints that indicate ankylosing spondylitis. However, damage to the joints or joint fusion with inflammation may not always be visible or it may be too early in the process. An MRI or CT scan may be better to detect damage to soft tissue and joint ankylosis (fusion) and therefore can detect joint damage earlier than X-rays may. These studies can be rechecked over time to monitor the disease’s progress as well.

The most common blood test used in diagnosing spondylitis is for the gene HLA-B27. This gene is commonly present in a large majority of those diagnosed with this disease, however, this test is not 100% definitive. The gene can also be found in some people who do not suffer from the disease. The presence of HLA-B27 supports a diagnosis of spondylitis only in people with symptoms or imaging that is consistent with the disease.

Treatment for Ankylosing Spondylitis

Ankylosing spondylitis is a condition for which no cure currently exists. However, there are treatments available that can relieve symptoms and slow the progression of the condition. These treatments may include medications, a healthy diet, and exercise.

Medications used to treat ankylosing spondylitis include non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDS), and biological agents. NSAIDs are available both over-the-counter and by prescription, and they work by blocking chemicals called prostaglandins that cause pain and inflammation. DMARDS are second-line medications that can reduce inflammation, and they include drugs such as corticosteroids and methotrexate. Biologic agents are newer drugs that are genetically engineered to suppress a protein involved in the body’s inflammatory response, leading to reduced inflammation.

A diet that is rich in omega-3 fatty acids, such as salmon, can help to reduce joint inflammation. Maintaining a healthy weight is also important in reducing stress on the joints. Exercise and stretching can help to reduce stiffness in the joints, increase flexibility, and strengthen the muscles that support the joints.

In cases where there is severe damage to the joints, joint replacement surgery may be recommended. Spinal straightening surgery is a very rare option for treatment.

The progression of ankylosing spondylitis can vary greatly from person to person. Some individuals may experience mild, intermittent episodes of back pain, while others may experience severe, chronic pain. Most sufferers will experience painful episodes followed by periods of reduced pain known as remissions. It is important for those diagnosed with ankylosing spondylitis to attend regular appointments with their physician and to follow the prescribed treatment plan in order to manage their condition effectively.