Ankylosing Spondylitis

Ankylosing spondylitis is a kind of rare arthritis. This inflammatory disease causes vertebrae, the small bones in the spine, to fuse which decreases the flexibility of the spine. This is the reason for a hunch-forward posture. The patient may experience difficulty in deep breathing, if their ribs are affected. Men tend to be involved with ankylosing spondylitis more than women. Signs and symptoms of the disease usually begin in people in early adulthood. Any part of the body can also be inflamed, especially the eyes. However, there is no specific treatment for ankylosing spondylitis. The purposes of the treatment are to relieve the symptoms and to decelerate the development of the disease.

Symptoms

Pain and stiffness in the lower back and hips are the early signs and symptoms of ankylosing spondylitis. These symptoms usually occur especially in the morning after being inactive for a while. The patients may also experience neck pain and fatigue which are also the common symptoms of ankylosing spondylitis. These symptoms may worsen or develop over time and may also irregularly discontinue.

Ankylosing spondylitis may occur in any area of the body. However, the areas that are commonly affected may include:

• The joint in the middle of the base of the spine and pelvis
• The vertebrae in the lower back
• The areas in the spine along the back of the heel or other areas where tendons and ligaments attach to bones
• The cartilage between the breastbone and ribs
• The hip joints
• The shoulder joints

When to see the doctor

You are advised to see the doctor if you experience pain in the lower back or buttlock especially in the morning or during the late night. You may raise your awareness of ankylosing spondylitis if the pain gets relieved with exercise and worsens with rest.

Since the inflammation can also affect the eyes, see the doctor immediately if you have painful red eyes, severe sensitivity to light, or blurred vision.

Causes

The specific cause of ankylosing spondylitis is still unknown. However, it is shown that there is a relation between the disease and a gene called HLA-B27 resulting in genetic factors that may be involved with the development of ankylosing spondylitis.

Risk factors

The risk factors of ankylosing spondylitis may include:

• Age The signs and symptoms of ankylosing spondylitis tend to occur in people in late adolescence or early adulthood.
• Gender Men have a higher risk of ankylosing spondylitis than women.
• Genetic factors Ankylosing spondylitis tends to occur in people containing the HLA-B27 gene.

Complications

In severe ankylosing spondylitis, the fusion limits the flexibility of the spine. It also causes the stiffness of the spine as well as other parts of the body including the rib cage. This may restrict the capacity and function of the lung which may lead to difficulty breathing.

Patients with ankylosing spondylitis may be involved with other complications including:

• Compression of fractures The spinal cord and the nerves may be injured by the pressure of vertebral fractures.
• Uveitis or eye inflammation People with ankylosing spondylitis may have rapid-onset eye pain, blurred vision, or severe light sensitivity.
• Heart problems

Diagnosis

The doctor may conduct several physical exams including testing the range of motion in your spine by asking you to bend in different directions and moving your legs into several positions. The doctor may investigate the pain by pressing on specific portions of your pelvis. To check for the function of the lung, the doctor may ask you to take a deep breath.

The doctor may require several additional tests which might include:

• Imaging tests
  •  X-ray. The doctor may use an X-ray to check for changes in the joints and bones.
  • MRI. The doctor may require an MRI to see more detailed images of bones and soft tissues.
  • Lab tests. Lab tests help the doctor to investigate the cause of the inflammation.

Treatment

The purposes of the treatment for ankylosing spondylitis are to relieve the pain and to prevent or decelerate complications and deformity of the spine. Treatment for ankylosing spondylitis is found most successful before the joints are irreversibly damaged.

The treatment for ankylosing spondylitis includes medications, therapy, surgery, change of lifestyle, and home treatment.

• Medications. The doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen and indomethacin to relieve the inflammation, pain, and stiffness. If the patients do not respond to NSAIDs, they may be prescribed a biologic medication such as a tumor necrosis factor blocker or an interleukin-17 as the alternative.
• Therapy. The doctor or the therapist may design some specific exercises including range-of-motion and stretching exercises to relieve the pain and improve and maintain strength and flexibility in the joints. The patients may also be advised to have proper sleeping, walking positions, and back and abdominal exercises to maintain an upright posture.
• Surgery. Generally, surgery is not necessary for ankylosing spondylitis. However, in some severe cases that have acute pain or joint damage, the doctor might suggest surgery to replace the damaged joint.

Lifestyle and home treatment

Apart from the treatments above, symptoms of ankylosing spondylitis may be relieved by a change of lifestyle and home treatment including:

• Practice good posture. The patients may practise healthier posture such as while standing.
• Apply heat and cold compress. Applying stiff joints with a hot compress can help relieve pain and stiffness, while a cold compress can reduce swelling.
• Stay active. Exercise can maintain flexibility and strengthen joints as well as improve posture.
• Quit smoking

Preparing for the appointment

Before your appointment, you may prepare a list that includes:

• Some specific information
  • major stresses
  • recent changes in life
  • medical history of the patients and family that may relate to the symptoms
• The symptoms
  • the beginning of the symptoms
  • the severity of the symptoms
• All of the medications, vitamins, and other supplements
  The information may include doses of the use.

Questions that should ask the doctor

The questions may include information such as:

• What may cause the symptoms
• The tests that may need to be required
• Whether the symptoms tend to be temporary or chronic
• The most effective action
• The management of the recent symptoms and other health conditions
• Restrictions that may be required

During the consulting, the doctor may ask some questions including information such as:

• The area of the pain
• The severity of the pain
• Whether the symptoms are continuous or occasional
• The factors that may worsen or improve the symptoms
• The medications taken