Ankylosing spondylitis (SA) is a type of chronic inflammation of the sacroiliac joints and the spine. Chronic inflammation in those areas can result in stiffness in and around the spine including the middle and lower back, the neck, and the buttocks.
Over time, spondylitis (chronic inflammation of the spine) can result in fusion of the vertebrae. This fusion is referred to as ankylosis. In some cases, ankylosis may lead to spine mobility loss. Ankylosing spondylitis is a systemic disease. In other words, it not only affects the spine but also other tissues throughout the body.
The condition shares several features with other arthritic conditions like reactive and psoriatic arthritis. The condition is more common among men than in women. It also affects all age groups, even children. In children, the condition is referred to as juvenile ankylosing spondylitis. The condition is also known as Bechterew’s disease.
What are the Causes?
Ankylosing spondylitis is believed to be genetically inherited. Nearly 90 per cent of SA patients are born with the HLA-B27 gene. Studies indicate that the gene can increase one’s risk of developing the condition. Other genes like ARTS1 and IL23R have also been linked to the development of ankylosing spondylitis. Both genes are believed to influence immune system function.
What are the Symptoms?
Symptoms of SA are often associated with inflammation of the joints, spine, and other body parts. Spine inflammation results in stiffness and pain in the neck, lower back, upper buttock area, and the remainder of the spine. Fatigue is also a prevalent symptom that comes with active inflammation.
The onset of stiffness and pain is often gradual and worsens with loss of motion. Pain and stiffness also become more noticeable after hours of inactivity and in the mornings. Since ankylosing spondylitis is common among adolescents, the onset of low back pain is sometimes incorrectly attributed to athletic injuries.
Patients with chronic and severe spine inflammation can develop ankylosis (complete bony fusion of the spine). When this happens, spine pain disappears but the patient will experience a complete loss of spine mobility. The fused spines are often brittle and are more prone to breakage or fracture. Among patients, sudden onset of pain in the spinal area often signals bone breakage. Ankylosing spondylitis patients can also have arthritis in other joints aside from the spine.
In some cases, patients will experience stiffness, swelling, redness, and pain in the joints found in the knees, hips, and ankles. Occasionally, small joints of the toes can also swell and become “sausage” shaped. In addition, the condition can also cause scarring and inflammation of the lungs and can result in shortness of breath and coughing. Therefore, breathing difficulty can be a complication for those who are suffering from the condition.
How is the diagnosis confirmed?
Diagnosis of ankylosing spondylitis is done through physical examination and evaluating symptoms, blood tests, and X-ray findings (radiographs). Pain, stiffness, and decreased motion range of the spine are some of the most prevalent symptoms of ankylosing spondylitis.
However, early symptoms of the condition can be deceptive as stiffness and pain in the lower back can also be seen in several other conditions. Physical examination of patients with SA will often show signs of joint inflammation and decreased motion range, particularly in the spine. Low back and neck flexibility will also decrease.
Additional clues that can help with the diagnosis can be apparent by X-ray abnormalities of the spine and the presence of HLA-B27 genetic marker in the blood.
What is the Treatment?
Treatment intervention for SA typically involves the use of medications to minimize inflammation, suppressing immunity to keep the disease from progressing, exercise, and physical therapy. Medications can reduce inflammation in the spine and other joints and organs. Exercise and physical therapy can also help improve spine mobility, lung capacity, and posture. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed to decrease stiffness and pain in the spine and other joints.
In some patients, inflammation of joints aside from the spine (i.e. knees, hips, ankles, etc.) can be a concern since inflammation in those areas may not respond to NSAIDs alone. In line with this, additional medications that will suppress the body’s immune system may be introduced.
Injectable or oral corticosteroids (cortisone) are powerful anti-inflammatory agents and may be given to effectively control spondylitis and other body inflammations. Unfortunately, it can only be used for short periods as long-term use can have serious side effects.
Physical therapy for patients with SA will involve instruction and exercises to maintain proper posture. It also includes stretching exercises and deep breathing (for lung expansion) to enhance joint and spine mobility. Since spine ankylosis may cause kyphosis (forward curvature), patients are advised to do back-extension exercises and maintain proper posture as often as possible. Physical therapists will also design tailored exercise programs for each individual.
Swimming is often recommended as it helps avoid any jarring impact on the spine. Aerobic exercises are also encouraged as it helps open the lung’s airways and promote the total expansion of the breathing muscles.
In cases where the severe disease of the spine and the hip joint has occurred or trauma has happened, orthopaedic surgery may be needed. Newer treatment techniques enable a good quality of life for patients to be achieved.