Understanding Ankylosing Spondylitis: Symptoms, Causes, Treatment, and Living with AS

Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints but can extend to other areas of the body. While many people are unfamiliar with this condition, AS affects thousands of individuals worldwide, leading to pain, stiffness, and, in severe cases, a significant reduction in spinal mobility. This blog will dive into AS’s symptoms, causes, diagnosis, treatment options, and lifestyle recommendations for those managing this condition.

What is Ankylosing Spondylitis?

Ankylosing spondylitis is classified as a type of spondyloarthritis, a group of inflammatory diseases affecting the spine and joints. In AS, chronic inflammation can cause the vertebrae of the spine to fuse over time. This fusion limits flexibility and can lead to a hunched posture or, in advanced cases, a rigid spine. AS is generally considered an autoimmune disease, where the immune system mistakenly attacks the body’s own tissues, specifically in the spine and surrounding ligaments.

AS typically begins in late adolescence or early adulthood and is more common in men than women. Because of its tendency to onset early in life, AS can impact a person’s ability to work and perform daily activities if not managed effectively.

Ankylosing Spondylitis symptoms

Symptoms of ankylosing spondylitis often start subtly and may be dismissed as regular back pain or discomfort. However, as the disease progresses, the symptoms can become more persistent and disruptive. Here’s what to look for:

Initial Symptoms

1. Chronic Lower Back Pain: Persistent pain in the lower back and buttocks is often one of the earliest signs of AS. This pain is typically worse in the morning or after periods of inactivity and may improve with physical activity.
2. Morning Stiffness: Those with AS often experience stiffness upon waking, which gradually decreases as they move around.

Progressive Symptoms

• Joint Pain and Stiffness: As AS progresses, pain may spread to other areas, such as the shoulders, hips, and even rib cage, which can affect breathing.
• Eye Inflammation (Uveitis): In some cases, AS can cause inflammation in the eyes, known as uveitis, which leads to redness, pain, and sensitivity to light.
• Fatigue: Systemic inflammation often causes fatigue and a general feeling of malaise, which can make daily tasks more difficult.

These symptoms can vary in intensity and duration, with some people experiencing flare-ups followed by periods of reduced symptoms.

Causes and Risk Factors

The exact cause of ankylosing spondylitis is not fully understood, but a combination of genetic and environmental factors is believed to contribute to its development.

Genetic Factors

A significant genetic factor in AS is the presence of the HLA-B27 gene. This gene is found in a large percentage of AS patients and may increase the risk of developing the disease. However, not all people with the HLA-B27 gene develop AS, indicating that additional factors are involved.

Environmental Factors

While researchers are still investigating environmental triggers, some theories suggest bacterial infections or other external triggers may play a role in activating AS in genetically predisposed individuals.

Lifestyle Factors

Smoking has been shown to worsen AS symptoms and accelerate disease progression, especially in those who already have mild symptoms.

Diagnosing Ankylosing Spondylitis

Ankylosing spondylitis can be challenging to diagnose because its symptoms overlap with other forms of arthritis and chronic back pain conditions. Here’s what to expect in a diagnostic process:

Physical Exams and Patient History

A doctor will likely begin by discussing symptoms, family history, and performing physical exams to check for areas of pain, limited mobility, and any signs of stiffness. A common assessment, the Schober test, is used to measure the flexibility of the lower back.

Imaging Tests

1. X-rays: These can reveal changes in the sacroiliac joints and spine that indicate AS.
2. MRI and CT Scans: These advanced imaging techniques are particularly helpful in detecting early signs of sacroiliitis (inflammation of the sacroiliac joints).

Laboratory Tests

• Inflammation Markers: Blood tests for markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can indicate inflammation.
• Genetic Testing: Testing for the HLA-B27 gene may support a diagnosis, though it is not definitive on its own.

Stages of Ankylosing Spondylitis

Understanding the stages of AS helps in tracking progression and tailoring treatments.

1. Early Stage: Characterized by occasional back pain and stiffness, mainly in the lower back and hips.
2. Intermediate Stage: Pain and stiffness become more widespread, possibly affecting the rib cage, neck, and other joints.
3. Advanced Stage: Chronic inflammation may lead to the fusion of the vertebrae (ankylosis), creating a “bamboo spine” appearance on X-rays and leading to a severe reduction in flexibility.

Ankylosing Spondylitis treatment

While there is no cure for AS, various treatments can manage symptoms, reduce inflammation, and improve quality of life.

Medications

1. NSAIDs: Nonsteroidal anti-inflammatory drugs are often the first line of treatment to manage pain and inflammation.
2. DMARDs and Biologics: Disease-modifying anti-rheumatic drugs (DMARDs) and biologics, like TNF inhibitors, target specific parts of the immune response to slow the disease’s progression.
3. Steroids: In cases of severe inflammation, corticosteroid injections may be used to manage pain during flare-ups.

Physical Therapy

Physical therapy is essential in managing AS. A physical therapist may design exercises to improve flexibility, posture, and strength. Low-impact activities like swimming and stretching exercises are especially beneficial for maintaining mobility and core strength.

Lifestyle and Home Remedies

1. Regular Exercise: Regular, low-impact exercise helps maintain flexibility and reduce stiffness.
2. Diet and Weight Management: Although specific foods are not directly linked to AS, an anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids may help manage symptoms.
3. Sleep and Posture Support: Using a firm mattress and supporting proper sleeping positions can reduce morning stiffness. Practicing good posture daily can help prevent further spinal curvature.

Surgical Intervention

Surgery is typically considered only in advanced cases or if other treatments have not been effective. Joint replacement, particularly in the hips, may be necessary if damage is severe.

Living with Ankylosing Spondylitis

Living with AS can be challenging, but the right lifestyle adjustments and support systems can make a difference.

1. Daily Management Tips: Establishing a routine that includes gentle stretches and exercises can help reduce stiffness. Rest and relaxation are equally important during flare-ups.
2. Mental Health Considerations: The chronic pain associated with AS can affect mental health, leading to stress or depression. Counseling, mindfulness techniques, and even joining support groups can provide emotional support.
3. Support and Community: There are many online communities and local support groups for people with AS. Connecting with others who have similar experiences can be empowering and provide helpful coping strategies.

Recent Advances and Future Outlook

Research into ankylosing spondylitis is ongoing, with advancements being made in biologics and other treatments. Precision medicine—using genetic information to tailor treatments—is an exciting area of research that could lead to more personalized AS treatment options in the future.

Ankylosing spondylitis is a lifelong condition that requires ongoing management and support. With a multidisciplinary approach that includes medication, physical therapy, lifestyle modifications, and a supportive community, individuals with AS can lead fulfilling lives. The future holds promise, as new treatments and research continue to enhance the quality of life for those affected by this condition.

Remember, if you or someone you know is experiencing symptoms of AS, early diagnosis and proactive management are key to maintaining mobility and reducing the impact of this disease.

To consult a Rheumatologist at Sparsh Diagnostic Centre, call our helpline number 9830117733.

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Disclaimer:

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Additional Reading:

• https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/diagnosis-treatment/drc-20354813
• https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/imaging