Ankylosing spondylitis is a type of arthritis called spondyloarthritis, and typically affects the spine. However, it can also affect the peripheral joints in the body such as the hips, knees, ankles and feet. Patients may experience problems with walking, getting out of bed, bending forward and other daily activities.
Ankylosing spondylitis tends to begin between the ages of 20 to 40 and both males and females can be affected.
Clinical manifestations begin in late adolescence or early adulthood, and rarely after the age of 40 years old. Why this age group is most affected is still unknown but it may be due to the inheritance of the HLA-B27 gene.
Despite many studies, it is still unclear how the gene predisposes patients to disease, but it may be due to its effect on how immune cells interact with one another.
There is no way to prevent it but one can lessen the seriousness of the disorder by actively participating in physical activity and avoiding smoking. An active lifestyle helps to maintain mobility of the spine and neck, which prevents them from getting stiff in a bent position.
Smoking has been shown to result in greater spinal fusion, a complication of ankylosing spondylitis. Furthermore, patients with ankylosing spondylitis can have greater difficulty breathing due to reduced movements of their rib cage, and smoking can compound this problem by causing further lung injury.
Patients often have back pain due to immobility, and this can be especially bad at night. Mattresses that provide enough support for sleeping will greatly reduce this discomfort. Also, patients often experience heel pain due to their disease and use of gel-heel cushions in their shoes will reduce discomfort when walking and exercising.
Acupuncture can be helpful to relieve the pain. There are no food restrictions and one should have a healthy and well-balanced diet.
Ankylosing spondylitis is diagnosed by taking a careful history, reviewing the family history and careful examination of the spine. There is no direct test for ankylosing spondylitis and it may take several visits to the doctor and accurate reporting of symptoms, over a period of time before a definitive diagnosis is made. Very often, in active disease, infl ammatory markers like the ESR and CRP are raised. In majority of AS patients the gene HLA-B27 is present. X-rays of the spine and MRI are often helpful in confirming the diagnosis.
Treatment often includes physical therapy by the physiotherapists, which includes stretching exercises to maintain range of motion, posture control, muscle strengthening, increasing lung capacity, improving balance and cardiovascular fitness.
Medical therapy includes anti-inflammatory drugs such as non-steroidal anti-inflammatory drugs (NSAIDs). Other medications include disease-modifying anti-rheumatic drugs (DMARDs), such as sulfasalazine, and biological therapies, such as tumour necrosis factor inhibitors and interleukin-17 inhibitors. These medications reduce damage to the joints, reduce inflammation and control pain.