Ankylosing Spondylitis

Ankylosing spondylitis, or “AS,” is a form of arthritis that causes pain and stiffness of the spine. The word "ankylosing" means rigid. In AS, the bones of the spine become very rigid and can fuse together. The symptoms usually begin in the lower back and may also affect the hips and the rest of the spine. Other joints are affected less frequently.

Symptoms

The most common symptoms are low back pain and stiffness that are worse after resting and better after exercise or a hot bath or shower. Symptoms usually come and go but get gradually worse over time. In addition to back pain and stiffness, you may have:

  • Pain in the buttocks that shoots down into your thighs
  • Stooped shoulders and trouble taking a deep breath
  • Pain and stiffness in the hips, neck, knees, and feet
  • Fatigue and fever

Causes

The causes of AS are not known but genes may play an important role. Most people with AS have a gene called HLA-B27. But some people with this gene do not get AS and some people with AS do not have the gene. If you have the gene and you have a family member with AS, your chance of having AS is higher. Doctors think that the cause of AS may be a combination of genes and something in your lifetime, such as an infection, that triggers AS to become active.

Diagnosis

If your doctor suspects AS, you will need a good history and physical exam. Your doctor will look for x-ray evidence of inflammation at the area where your spine attaches to your pelvis. This is called the sacroiliac joint. Along with this evidence your doctor will look for at least one of these symptoms:

  • Low back pain for at least three months that gets better with exercise but not with rest
  • Limitation in bending your spine side to side and front to back
  • Limitation of your ability to expand your chest with a deep breath

Your doctor may also do a blood test to see if you have the HLA-B27 genetic marker and other blood tests like C-reactive protein that measures inflammation. You may need to have imaging studies done of your spine.

Risk Factors and Complications

Having a family history of AS and inheriting the HLA-B27 gene are the biggest risk factors. Being a male is another risk factor, since men are diagnosed more frequently with AS than women. Complications include:

  • Gradual stiffening of the spine
  • Gradual stiffening of the chest wall
  • Inflammation of the eyes
  • Inflammatory bowel disease
  • Weakening of bones called osteoporosis
  • Depression

Treatment

There is no cure for AS but several treatments can help. These include:

  • Exercise to stretch the spine and posture exercises to keep the spine straight.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and stiffness.
  • Corticosteroid drugs to fight inflammation when symptoms flare.
  • Disease modifying anti-rheumatic drugs (DMARDs), if NSAIDs are not helping.
  • Tumor necrosis factor inhibitor drugs (TNF-blockers) are new drugs that may be able to slow down the progression of AS.

Other treatments may include surgery to replace or reconstruct a joint, support and counseling, and physical therapy and occupational therapy.

What to Do

There is no way to prevent AS. Learning as much as you can about AS and working closely with your doctor is the best way to maintain a normal posture and reduce pain and stiffness. If you have symptoms of AS, talk to your doctor. If you have been diagnosed with AS, here are some things you should do:

  • Learn how to do your daily spinal and posture exercises.
  • Quit smoking.
  • Avoid slouching at all times.
  • Practice deep breathing to maintain chest expansion.
  • Make sure you have good back and neck support in bed.
  • Make adjustments at work to protect your back.
  • Maintain a healthy weight and a healthy diet.
  • Seek help if you are struggling with depression.

What We Have Learned

Ankylosing spondylitis is a form of arthritis that causes pain and stiffness of the spine.
True or False
The answer is True

Inflammation of the eyes and depression are both symptoms of Ankylosing spondylitis.
True or False
The answer is True

There are no options for the treatment of Ankylosing spondylitis.
True or False
The answer is False. Posture exercises and Corticosteroid drugs are just two of several treatment options.

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