Ankylosing Spondylitis
Ankylosing spondylitis (AS) is a chronic, inflammatory disease that primarily affects the spine and sacroiliac joints, leading to pain and stiffness. Over time, it can cause the vertebrae to fuse, resulting in reduced flexibility and a hunched-forward posture. Ankylosing spondylitis is a type of spondyloarthritis, a group of inflammatory rheumatic diseases that can affect the spine and other joints.
Key Features and Symptoms
Back Pain and Stiffness:
- The most common symptom of AS is chronic pain and stiffness in the lower back and hips, particularly in the morning or after periods of inactivity. The pain usually improves with movement and exercise.
Inflammation of Sacroiliac Joints:
- AS often begins in the sacroiliac joints, which are located where the lower spine connects to the pelvis. Inflammation in these joints is a hallmark of the disease.
Reduced Spine Flexibility:
- As the disease progresses, inflammation can lead to the formation of new bone, causing sections of the spine to fuse. This can result in a loss of flexibility and, in severe cases, a hunched posture (kyphosis).
Pain in Other Joints:
- While the spine is most commonly affected, AS can also cause pain and swelling in other joints, such as the shoulders, hips, knees, and ankles.
Enthesitis:
- Inflammation of the entheses, where tendons and ligaments attach to bone, is common in AS. This can cause pain in areas like the heels or the back of the pelvis.
Fatigue:
- Chronic inflammation often leads to significant fatigue in people with AS.
Extra-Spinal Symptoms:
- AS can also affect other organs and systems, leading to conditions such as uveitis (inflammation of the eye), heart problems, and, less commonly, lung involvement.
Causes
- Genetics: A strong genetic component is associated with AS. The HLA-B27 gene is present in many individuals with AS, though not everyone with this gene will develop the disease.
- Gender: AS is more common in men than in women.
- Age: Symptoms typically begin in early adulthood, usually between the ages of 17 and 45.
Treatment
There is no cure for ankylosing spondylitis, but treatment focuses on managing symptoms, preventing deformity, and maintaining function.
Medications:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These are often the first line of treatment to reduce pain and inflammation.
- Biologic Agents (TNF Inhibitors and IL-17 Inhibitors): These drugs target specific pathways in the immune system and are used in more severe cases or when NSAIDs are ineffective.
- Disease-Modifying Antirheumatic Drugs (DMARDs): These are less commonly used but may be prescribed if peripheral joints (e.g., knees, hips) are affected.
Physical Therapy and Exercise:
- Regular exercise and physical therapy are crucial to maintaining flexibility, posture, and overall function. Exercises that focus on strengthening the back and core muscles and improving spinal flexibility are particularly beneficial.
Surgery:
- In severe cases, surgery may be necessary to correct significant deformities or replace damaged joints, particularly in the hips.
Lifestyle Modifications:
- Good posture, stretching, and activities like swimming or yoga can help manage symptoms and maintain spinal mobility.
- Smoking cessation is important, as smoking can exacerbate symptoms and increase the risk of complications.
If you would like to have additional information contact Dr. Vipul Shet, serving communities and people from all walks of live.
