What is Ankylosing Spondylitis?

What is Ankylosing Spondylitis?

Ankylosing Spondylitis (AS) is a chronic inflammatory arthritis primarily affecting the spine and sacroiliac joints (where the spine meets the pelvis). Over time, the inflammation can cause the vertebrae to fuse together, leading to reduced flexibility, a hunched-forward posture, and significant discomfort. AS is a type of axial spondyloarthritis, meaning it primarily involves the spine.

Key Features:

• Chronic Inflammation: Long-term inflammation causes pain and stiffness in the spine and other joints.
• Progressive Condition: Over time, it can lead to spinal fusion, reducing mobility.
• Autoimmune Link: It is considered an autoimmune or autoinflammatory disorder, where the immune system attacks the body’s tissues.

Symptoms:

1. Back Pain and Stiffness:

   • Pain in the lower back and hips, especially in the morning or after prolonged inactivity.
   • Pain improves with exercise and worsens with rest.

2. Reduced Flexibility:

   • Difficulty bending or turning due to stiffness in the spine.

3. Kyphosis:

   • A forward-stooped posture in advanced cases due to spinal fusion.

4. Peripheral Joint Involvement:

   • Pain and swelling in other joints, such as the shoulders, hips, knees, or feet.

5. Enthesitis:

   • Inflammation where tendons and ligaments attach to bones, often in the Achilles tendon or plantar fascia.

6. Fatigue:

   • Chronic inflammation can lead to tiredness and malaise.

7. Eye Inflammation (Uveitis):

• Pain, redness, and blurred vision in one or both eyes.

Causes:

1. Genetic Predisposition:

   • The HLA-B27 gene is strongly associated with AS. Not everyone with this gene develops AS, but its presence increases the risk.

2. Environmental Triggers:

• Infections or other environmental factors may play a role in triggering the condition in genetically predisposed individuals.

Risk Factors:

• Age: AS typically begins in early adulthood, usually between ages 17 and 35.
• Gender: Men are more commonly affected than women.
• Family History: A family history of AS or related conditions increases the risk.

Diagnosis:

1. Medical History and Physical Exam:

   • Assessing symptoms such as back pain, stiffness, and family history.
   • Testing for limited spine mobility and tenderness in affected joints.

2. Imaging Tests:

   • X-rays: Show changes in the sacroiliac joints or spine.
   • MRI: Detects early inflammation before visible changes on X-rays.

3. Blood Tests:

• Testing for HLA-B27 gene (though not diagnostic, as not all carriers develop AS).
• Inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) may be elevated.

Complications:

1. Spinal Fusion:
   • Loss of spinal flexibility due to the fusion of vertebrae.
2. Breathing Difficulties:
   • Fusion of the ribs to the spine can limit chest expansion and lung capacity.
3. Osteoporosis:
   • Increased risk of fractures in the fused spine.
4. Heart Problems:
   • Inflammation may affect the aorta and increase the risk of cardiovascular disease.
5. Uveitis:
• Recurrent inflammation of the eye that can impair vision.

Treatment and Management:

Although there is no cure for AS, treatment focuses on managing symptoms, improving mobility, and preventing complications.

1. Medications:

• Nonsteroidal Anti-inflammatory Drugs (NSAIDs):
  • E.g., ibuprofen, naproxen, or diclofenac to reduce pain and inflammation.
• Biologics:
  • TNF inhibitors (e.g., etanercept, infliximab) or IL-17 inhibitors (e.g., secukinumab) to target specific inflammatory pathways.
• DMARDs:
  • For peripheral joint involvement (e.g., sulfasalazine).
• Corticosteroids:
  • Short-term use for severe inflammation.

2. Physical Therapy:

• Exercises to maintain spinal flexibility, improve posture, and strengthen core muscles.
• Breathing exercises to enhance lung capacity.

3. Lifestyle Changes:

• Regular Exercise:
  • Low-impact activities like swimming, yoga, and walking.
• Good Posture:
  • Avoid slouching to prevent spinal deformity.
• Healthy Diet:
  • Balanced nutrition to support bone and joint health.
• Quit Smoking:
  • Smoking worsens lung function and inflammation.

4. Surgery:

• Rarely required, but joint replacement or corrective surgery may be necessary in severe cases.

Prognosis:

• AS progresses at different rates for different individuals. Early diagnosis and treatment significantly improve the quality of life.
• Regular exercise and medication can help maintain mobility and manage symptoms effectively.