What is Ankylosing spondylitis (AS)? Causes, Symptoms, Treatments

January 27, 2024 Bone Health 146 Views

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What is Ankylosing spondylitis (AS) ?

Ankylosing Spondylitis (AS) belongs to a group of conditions known as spondyloarthropathies, which also includes other forms of arthritis like psoriatic arthritis and reactive arthritis.Over time, this inflammation can lead to fusion of the vertebrae, causing the spine to become rigid and inflexible. 

While the exact cause of Ankylosing Spondylitis (AS) is not fully understood, it is believed to involve a combination of genetic and environmental factors.

Common symptoms of AS include:

  • Pain and stiffness: Particularly in the lower back and buttocks, which is often worse in the morning or after periods of inactivity.
  • Reduced flexibility: As the condition progresses, the spine may become increasingly stiff and less flexible.
  • Fatigue: Many people with AS experience fatigue, which can be related to both the inflammation and the challenges of living with chronic pain and stiffness.
  • Pain and stiffness in other joints: AS can also affect other joints such as the hips, shoulders, knees, and ankles.
  • Eye inflammation: Some individuals with AS may experience inflammation in the eyes, known as uveitis or iritis, which can cause eye pain, redness, and sensitivity to light.

Diagnosis of Ankylosing Spondylitis (AS) typically involves a combination of medical history, physical examination, imaging studies (such as X-rays and MRI scans), and blood tests to look for markers of inflammation.

Treatment for Ankylosing Spondylitis (AS) aims to alleviate symptoms, prevent complications, and improve quality of life. This may include medications to reduce inflammation and pain, physical therapy to maintain flexibility and strength, exercise programs, and lifestyle modifications. In some cases, surgery may be necessary to correct severe deformities or joint damage caused by the disease. 

How is Ankylosing spondylitis diagnosed ?

Ankylosing spondylitis (AS) is diagnosed through a combination of medical history, physical examination, imaging studies, and laboratory tests. Here’s a breakdown of the diagnostic process:

  • Medical History: The doctor will ask about your symptoms, including the location, severity, and duration of any pain or stiffness you’re experiencing. They’ll also inquire about any family history of AS or related conditions, as genetics plays a role in the development of the disease.
  • Physical Examination: During the physical exam, the doctor will assess your range of motion, flexibility, and areas of tenderness. They may also look for signs of inflammation, such as swelling or warmth in the joints.
  • Imaging Studies:
    • X-rays: X-rays of the spine and pelvis can reveal changes characteristic of AS, such as fusion of the vertebrae (syndesmophytes) and inflammation of the sacroiliac joints.
    • MRI (Magnetic Resonance Imaging): MRI scans can detect early signs of inflammation in the sacroiliac joints and spine, even before changes are visible on X-rays. MRI is particularly useful for diagnosing AS in its early stages or in individuals with atypical symptoms.
  • Laboratory Tests: While there is no specific blood test for diagnosing AS, certain blood tests can help support the diagnosis and rule out other conditions. These may include:
    • HLA-B27: A genetic marker associated with AS. However, not everyone with AS is HLA-B27 positive, and many people without AS have this marker.
    • C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): These blood tests measure markers of inflammation, which are often elevated in people with AS but can also be elevated in other conditions.
  • Assessment of Symptoms Over Time: Since AS is a chronic condition, the diagnosis may involve monitoring symptoms and their progression over time. This longitudinal assessment helps in distinguishing AS from other conditions that may have similar symptoms initially.

Overall, the diagnosis of Ankylosing Spondylitis (AS) relies on a combination of clinical evaluation, imaging studies, and laboratory tests. ( Know more about- What is Bone Fracture ? )

What are the causes and risk factors for Ankylosing spondylitis ?

Ankylosing spondylitis (AS) is believed to result from a combination of genetic, environmental, and immunological factors. While the exact cause of AS is not fully understood, several factors contribute to its development:

  • Genetics: One of the strongest risk factors for AS is genetic predisposition. The majority of individuals with AS carry a specific genetic marker called HLA-B27. However, having the HLA-B27 gene does not guarantee that a person will develop AS, and many people with AS do not have this gene. It is believed that other genetic factors outside of HLA-B27 also play a role in the development of AS.
  • Immune System Dysfunction: AS is considered an autoimmune disease, where the body’s immune system mistakenly attacks its own tissues, leading to inflammation and tissue damage. In AS, the immune system targets the joints of the spine and pelvis, causing inflammation and eventual fusion of the joints.
  • Environmental Factors: While the exact environmental triggers for AS are not known, certain environmental factors may contribute to the development or exacerbation of the disease in genetically susceptible individuals. These factors could include infections, smoking, and other environmental exposures, although their precise role in AS development is still being investigated.
  • Family History: AS tends to run in families, suggesting a strong genetic component to the disease. Individuals who have a family history of AS or related conditions such as psoriasis or inflammatory bowel disease (IBD) are at higher risk of developing AS themselves.
  • Gender and Age: AS is more common in men than women, with the onset typically occurring in late adolescence or early adulthood. However, women with AS may experience delayed diagnosis due to differences in symptom presentation and lower prevalence compared to men.
  • Ethnicity: AS is more commonly diagnosed in individuals of Northern European descent, although it can affect people of any ethnic background.

Note that while these factors increase the risk of developing Ankylosing Spondylitis (AS), not everyone with these risk factors will develop the condition. Similarly, individuals without these risk factors can still develop AS. 

How can Ankylosing spondylitis be treated ?

Ankylosing spondylitis (AS) is a chronic condition for which there is no cure, but various treatment options are available to help manage symptoms, improve quality of life, and prevent complications. 

Treatment for AS typically involves a combination of medications, physical therapy, exercise, lifestyle modifications, and in some cases, surgery. Here’s an overview of treatment options for AS:

  • Medications:
    • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs such as ibuprofen, naproxen, and diclofenac can help reduce pain and inflammation associated with AS. They are often the first-line treatment for managing symptoms.
    • Disease-Modifying Antirheumatic Drugs (DMARDs): DMARDs such as sulfasalazine may be prescribed to reduce inflammation and slow the progression of AS, particularly in individuals with peripheral joint involvement or inflammatory bowel disease (IBD) associated with AS.
    • Biologic Agents: Biologic medications, such as tumor necrosis factor (TNF) inhibitors (e.g., etanercept, adalimumab, infliximab), interleukin-17 (IL-17) inhibitors (e.g., secukinumab), and other biologics targeting specific pathways involved in inflammation, can help reduce symptoms and slow disease progression in individuals with moderate to severe AS who do not respond adequately to NSAIDs or DMARDs.
  • Physical Therapy: Physical therapy plays a crucial role in the management of AS by helping to maintain flexibility, improve posture, and strengthen muscles around the spine and joints. Physical therapists can provide personalized exercise programs and techniques to improve mobility and reduce pain.
  • Exercise: Regular exercise, including stretching, strengthening, and low-impact aerobic exercises, can help improve flexibility, reduce stiffness, and strengthen muscles. Swimming, walking, cycling, and yoga are often recommended for individuals with AS.
  • Posture and Spinal Mobility: Practicing good posture and performing daily spinal mobility exercises can help prevent stiffness and maintain range of motion in the spine.
  • Pain Management Techniques: Heat therapy, such as using heating pads or taking warm baths, can help alleviate pain and stiffness in affected joints. Cold therapy may also be beneficial during acute flare-ups to reduce inflammation and pain.
  • Lifestyle Modifications: Making healthy lifestyle choices, such as maintaining a balanced diet, quitting smoking (if applicable), managing stress, and getting adequate rest and sleep, can help improve overall well-being and reduce symptoms of AS.
  • Surgery: In severe cases of AS where joint damage or spinal deformities significantly impact function and quality of life, surgical interventions such as joint replacement surgery or spinal fusion may be considered to improve mobility and relieve pain.

Individuals with Ankylosing Spondylitis (AS) to work closely with a multidisciplinary healthcare team, including rheumatologists, physical therapists, and other specialists, to develop a comprehensive treatment plan tailored to their individual needs and goals. Get the best treatments and also book full body health checkup at the best hospitals in India. 

 


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