Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a progressive inflammatory rheumatoid arthritis that affects the small joints in the spine and pelvis (sacroiliac joints), eventually causing them to fuse, making the spine become stiff, inflexible, and hunched over. As the disease progresses, it can also affect the ribs, eyes (acute iritis), and cause fractured spinal vertebrae. There are two subtypes of ankylosing spondylitis: 1) non-radiographic ankylosing spondylitis (nr-axSpA), which means that the joint damage cannot be seen on X-ray, and 2) ankylosing spondylitis (AS), when the joint damage can be seen on X-ray. Ankylosing spondylitis affects more men than women, and usually begins in adolescence or early adulthood.

There are several alternative names for ankylosing spondylitis, including AS, Bechterew disease, Marie-Struempell disease, spondylarthritis ankylopoietica, spondylitis ankylopoietica, spondylitis, ankylosing arthritis, and spondyloarthrtis ankylopoietica.

Ankylosing spondylitis is an autoimmune disorder, meaning that the body’s immune system attacks the normal cells in the joints of the spine, ribs, and pelvic bones, usually after being triggered by a bacterial or viral infection. Researchers further believe that ankylosing spondylitis may have a genetic cause, as individuals with the disease are often carriers of the HLA B27 genetic marker as well as have variations in other genes; however, ankylosing spondylitis is not entirely a genetic disease, as individuals without the genetic variations can also develop the disease. Additional environmental and other factors that can contribute to developing ankylosing spondylitis include exposure to smoking and infections, and having psoriasis or inflammatory bowel diseases (Crohn’s disease and ulcerative colitis).

The primary symptom of ankylosing spondylitis is neck, hip, and lower back pain and stiffness due to inflammation of the joints of the spine (especially in the morning) that began in adolescence or early adulthood, is worse at night, improves with exercise, and worsens with rest. The symptoms may come and go and affect other joints. As the ankylosing spondylitis progresses and the ribs become affected, it may become difficult to breathe deeply. Other symptoms may include eye pain and sensitivity to light (photophobia), skin rashes, and loose bowel movements. In rare cases, ankylosing spondylitis may affect the heart and lungs.

Treatments for ankylosing spondylitis focus on relieving pain and stiffness and decreasing joint swelling and inflammation, preserving flexibility in the spine, and prevention of spinal deformity (hunching over) and include medications, physical and occupational therapy, lifestyle modifications, and, in severe cases, surgery. Medications – Medications for ankylosing spondylitis include non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen, ibuprofen, meloxicam, or indomethacin (Indocin, Tivorbex), to reduce pain and swelling; biologics, such as TNF alpha blockers, which include infliximab (Remicade), entanercept (Enbrel), adalimumab (Humira), certolizumab (Cimzia), golimumab (Simponi), and IL-17 blockers, such as secukinumab (Cosentyx) and izekizumab (Taltz); the Janus kinase inhibitor, tofacitinib (Xeljanz); disease-modifying antirheumatic drugs (DMARDs; sulfasalazine ) to relieve symptoms and prevent joint damage, and corticosteroids to reduce inflammation. Physical therapy and regular exercise– Physical therapy and regular exercise are recommended for patients with ankylosing spondylitis to help improve extension of the spine and mobility, to preserve range of motion, to strengthen the neck and back, to maintain flexibility, and for improving posture. Swimming is a recommended exercise due to its low impact on joints. Lifestyle adjustments – Individuals with axial spondylarthritis can benefit from lifestyle modifications, such as always maintaining good posture, sleeping on their back on a firm mattress, stopping smoking, using assistive devices as recommended by an occupational therapist for workplace accommodations, avoiding lifting or sitting too long, taking frequent breaks, eating a healthy diet, applying hot and cold treatments as needed, massage and relaxation techniques, acupuncture, and focusing on emotional wellness when dealing with a chronic disease.

There are several online, local, national, and international support groups for ankylosing spondylitis, including the following: Arthritis Foundation - https://www.arthritis.org/diseases/spondyloarthritis Arthritis Society - https://arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/ankylosing-spondylitis Spondyloarthritis Association of America - https://spondylitis.org/

While the outcomes (prognosis) for ankylosing spondylitis can depend on the individual, the disease is progressive, and many patients will experience fatigue and spinal joint pain and stiffness that can be steady or come and go. As the disease progresses, some individuals’ joints or spine may become fused, leading to a lack of flexibility and reduced mobility or hunched-over posture. Due to newer treatments, most patients with ankylosing spondylitis are able to maintain a productive life with a normal lifespan.

Complications of ankylosing spondylitis may include fusing of the bone between the spinal vertebrae and spinal joints, stiffening of the rib cage, restriction of breathing, compression fractures, and, in rare cases, inflammation of aortic heart valve, scarring in the lungs, or inflammation of the large intestine (colitis). Other complications of ankylosing spondylitis may include urinary and bowel incontinence and loss of normal ankle reflexes.

If you experience low back or buttock pain that developed slowly over a period of weeks or months and is worse in the morning, or when at rest, and/or develop a painful red eye, sensitivity to light, or blurred vision, make an appointment with your doctor as soon as possible.

There is no way of preventing axial spondyoarthritis; however, the disease can be managed with treatments to help prevent as much joint damage and spinal fusion as possible. Quitting smoking can help reduce the rate of progression of spinal fusion in axial spondyloathritis.