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Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disease that may begin in the spine’s sacroiliac joints at the back of the pelvis. The sacroiliac joints are on either side of the spine. The hallmark symptoms include pain and progressive stiffness that may spread to other levels of the spine such as the neck and chest. Other symptoms include hip and shoulder stiffness, eye inflammation, and fatigue.

AS is more common in men and onset, in either sex may begin between the ages of 15 and 45.
 
A type of inflammatory arthritis
AS is an inflammatory arthritis and part of a group of rheumatic diseases that have the human antigen HLA-B27 in common. Because ankylosing spondylitis develops gradually, its degenerative effects to the spine may not be apparent on early x-ray studies. In addition to considering the patient’s symptoms, the doctor relies on results of a physical and neurological exam and imaging studies. A special blood test may be ordered to determine if the antigen HLA-B27 is present in the patient’s blood. Most AS patients have this blood antigen. 
 
Progressive
Pain and joint stiffness can progress. The disease’s inflammatory process triggers formation of new bone (ossification) on the spine. Bony formations can cause the spine lose flexibility, stiffen, and fuse itself into a fixed position. Ankylosing spondylitis may lead to a stooped forward posture (abnormal kyphosis), swayback (abnormal lordosis), or lead to spinal deformity.
 
AS can initially present as low back pain that spreads (radiates) into the buttocks and upper legs. Gradually, lumbar motion can be limited. The patient may notice, over time, that discomfort and symptoms move up the spine. Difficulty expanding the chest (thoracic spine) can develop.
 
Ossification leads to thickening and hardening of tissues, such as the discs, vertebral endplates, and ligaments. Eventually vertebrae may fuse together and increase the risk for spinal fracture. Ossification can affect the spine’s ligaments and contribute to development of spinal stenosis and neurological symptoms such as numbness, tingling, and weakness.
 
Treatment
Surgery is seldom necessary and most patients lead productive lives. Your treatment options depend on your symptoms, their severity, and disease progression. Although over-the-counter anti-inflammatory non-steroidal drugs (NSAIDs) and analgesics may adequately control symptoms, they do not attempt to control disease progression. A rheumatologist or spine specialist may offer you more effective treatments.
  • Disease-modifying anti-rheumatic drugs (DMARDs); a type of prescription medication that may help symptoms
  • Biologic medications that affect the tumor necrosis factor levels (TNF); these are tied into your immune system’s inflammatory process
  • Before getting out of bed, gently stretch.
  • A warm shower or bath can help relieve stiffness.
  • Physical therapy can teach you how to improve your body’s flexibility and build strength by performing certain exercises. Your physical therapist can give you tips on how to improve posture and biomechanics at rest and during activity.
  • Aquatic exercise, swimming
 Living with ankylosing spondylitis
Although ankylosing spondylitis is not curable, most patients are only mildly affected. Pain and stiffness may be episodic and most patients lead productive and active lives.

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