Ankylosing Spondylitis

September 15, 2023

3 min read

Ankylosing spondylitis (AS) is a chronic form of arthritis that causes inflammation in the bones and joints of the spine. The disease can also affect ankle joints, hips, and knees.

Some people with ankylosing spondylitis may experience back stiffness and pain that comes and goes. For others, the disease can cause severe symptoms resulting in ongoing pain and lack of flexibility in the spine.

With time, the inflammation in the spine may cause bony bridges to form in between the vertebrae in the spine, causing a section of the vertebrae to fuse or grow together.

Fused vertebrae flatten the spine's natural curvature, causing an inflexible hunched posture.

What is ankylosing spondylitis?

Ankylosing spondylitis (AS) is a chronic inflammatory disorder affecting the sacroiliac joint between the base of the spine and the pelvis. The inflammation, also known as sacroiliitis, often spreads to the joints between the vertebrae, a condition called spondylitis.

AS can also affect other joints in the knees, chest, and hips and cause inflammation in the areas where the tendons are attached to the bone

The term “ankylosing” refers to the tendency of the vertebrae to fuse or ankylose.

The term ” Spondylitis” refers to the inflammation of the spine, which causes back stiffness and pain, loss of flexibility, and, in extreme cases, a complete loss of motion in the lower back.

What are the causes of Ankylosing spondylitis?

Genetics and certain unidentifiable environmental triggers play a primary role in developing this condition. More than 90 % of people with ankylosing spondylitis have a genetic marker called HLA-B27. However, many people with the gene do not develop the disease, making the environment's role a critical factor.

What are the symptoms of ankylosing spondylitis?

The most common symptoms of AS are pain and stiffness in the lower back, which may progress to other areas of the back and spine over time. The pain varies in severity and increases after a prolonged period of inactivity.

People feel intense pain while sleeping at night or after prolonged sitting. Usually, movement and exercise can reduce pain and stiffness.

Other symptoms may include:

Pain, inflammation, and stiffness in other joints like the hips, shoulders, knees, and feet
Eye pain because of uveitis, an eye inflammation which can also cause vision changes
Difficulty in taking deep breaths if the joints in the chest get inflamed
Skin rashes, especially psoriasis
Fatigue and abdominal pain

What are the risks of ankylosing spondylitis?

Even though anyone can get the disease, certain factors can increase a person’s risk of ankylosing spondylitis.

Ankylosing spondylitis is common in children, teens, and people below 45 years, with men two to three times more likely to get the disease than women.
People with a family history of the disease are more likely to suffer from it.
People with other conditions like Chron's disease, ulcerative colitis, or psoriasis are more likely to get the condition.

How is ankylosing spondylitis diagnosed?

It is challenging to diagnose ankylosing spondylitis as the primary symptoms of lower back pain and stiffness can be symptoms of many other conditions. Medical providers usually use a combination of physical exams, medical history, and imaging tests to diagnose the condition.

Imaging studies include X-rays; in some cases, a more detailed evaluation is done using CT scans or MRIs.

What is the treatment of ankylosing spondylitis?

Early diagnosis of the disease can ensure quicker and more effective treatments. Treatment of ankylosing spondylitis involves physical therapy and medications to control inflammation and keep the spine functional.

Physical therapy

As ankylosing spondylitis stiffens the spine, causing inflexibility and leading to a hunched back posture, regular physical therapy and home exercise programs can improve the flexibility of the joints, reducing the symptoms.

As the condition can affect the lungs when it causes chest wall inflammation, breathing exercises are essential for patients to maintain exercise tolerance.

Medications

NSAIDS with physical therapy can be a sufficient treatment for people with mild AS symptoms.

Anti-TNF medications like adalimumab and golimumab can significantly improve mobility while reducing pain in people with severe AS symptoms.

FDA has approved JAK inhibitors like tofacitinib and upadicitinib and biologic medications like secukinumab and ixekizumab that block a chemical called IL-17 to treat AS.