What is ankylosing spondylitis?

Ankylosing spondylitis (AS) is a chronic spine inflammation disease (spondylitis) that affects spine bones and can cause fusion. The fusing of the bones decreases spine flexibility and results in a hunched posture. Besides affecting the joints AS can also damage the eyes, heart, kidneys, and lungs. AS develops mainly in early adulthood (20-30 years old), and men are affected by AS approximately two times more often than women are.

Risk Factors:

The etiology of the disease is unknown. The only accepted risk factor for developing AS is genetic predisposition. More than 90% of the patients have a gene known as human leukocyte antigen B27 (HLA-B27). However, having HLA-B27 doesn't mean that you must have AS.

Signs and Symptoms:

Ankylosing spondylitis (AS) symptoms normally appear gradually over months or years. Over time, the symptoms may come and go, increase or decrease at irregular intervals. Pain and stiffness in the lower back and hips are the most common symptoms of AS. Moreover, the symptoms get worse in the morning and at night and it gets better with exercise.

Other common symptoms include:

• Inflammation in the joints (arthritis) and inflammation where a tendon connects a bone (enthesitis) - this inflammation causes pain and swelling in various places of the body
• Extreme fatigue
• Weight loss

Diagnosis:

People who experience the symptoms of AS should see their GP. In case of AS suspicion GP will do a physical examination and order blood tests to check for signs of inflammation. Physical examination is an important part of diagnosing AS to test the range of motion in the spine. The next destination for an AS suspected patient is the rheumatologist who should run further additional tests. Imaging tests like X-rays and MRI can be used to check for changes in joints and bones, as well as a genetic blood test may sometimes be carried out to see if the patient carries the HLA-B27 gene. To be diagnosed with AS, a patient must have a complex of symptoms including AS-specific changes in imaging examinations and AS typical pain and/or stiffness.

Treatment:

Although there is no cure for ankylosing spondylitis (AS), medication is available to aid with symptoms. The goal of treatment is to reduce pain and stiffness while preventing or delaying consequences such as spinal deformity.

The treatment of AS consists of a mix of:

• Exercise
• Physiotherapy
• Medicine

Physical therapy is a crucial part of treatment that can help with pain alleviation and increase strength and flexibility. The exercises should be tailored to patients' individual needs. If a joint has been significantly damaged, joint replacement surgery may be advised to alleviate pain and improve the movement in the affected joint. AS patients need to regularly visit their rheumatologist so that the doctor can ensure that the treatment is effective and examine how the patient's condition is advancing.

Complications:

The following complications may arise through the development of AS:

• Eye inflammation (uveitis)
• Osteoporosis and compression fractures
• Heart problems
• Amyloidosis
• Cauda equina syndrome