Ankylosing Spondylitis

Ankylosing spondylitis, sometimes called axial spondyloarthritis, is a condition where the body's immune system mistakenly attacks and inflames the joints, particularly in the spine. Over time, this inflammation can cause the bones in the spine (vertebrae) to grow together, or fuse. This fusion makes the spine stiffer and less flexible, which can lead to a stooped or hunched posture. If the inflammation affects the ribs, breathing deeply can become challenging.

Ankylosing spondylitis often starts with pain and stiffness in the lower back and hips. This discomfort is typically worse first thing in the morning or after resting. You might also feel neck pain and tiredness. These symptoms can come and go, sometimes getting better, sometimes getting worse, and sometimes disappearing for a while.

The parts of the body most frequently affected by this condition include:

• The sacroiliac joint: This is the joint where the base of your spine connects to your pelvis.
• The lower back vertebrae: These are the bones in your lower spine.
• Areas where tendons and ligaments connect to bones: This commonly happens in the spine, but sometimes affects the back of the heel. Tendons and ligaments connect muscles to bones.
• The cartilage between the breastbone and ribs: This cartilage acts as a cushion between these bones.
• The hip and shoulder joints: These joints can also be affected.

This means the inflammation can spread to various parts of the body where these structures are located, causing pain and stiffness.

If your lower back or buttocks hurt gradually, get worse in the morning or wake you up in the second half of the night, see a doctor. This is especially important if the pain feels better after you move around and worse when you rest.

If you suddenly have a painful, red eye, very sensitive eyes to light, or blurry vision, go to an eye doctor right away.

Ankylosing spondylitis, a type of arthritis, doesn't have a single, known cause. Scientists think genes play a role. One important gene, called HLA-B27, is strongly linked to an increased chance of getting ankylosing spondylitis. However, having this gene doesn't automatically mean you'll get the disease. Many people with the HLA-B27 gene never develop ankylosing spondylitis. Other factors, besides genetics, likely contribute to the development of the condition.

Ankylosing spondylitis usually starts in late teenage years or early adulthood. A common link is the HLA-B27 gene. However, having this gene doesn't automatically mean a person will get ankylosing spondylitis. Many people with the HLA-B27 gene never develop the condition.

Ankylosing spondylitis is a condition where the body tries to heal by forming new bone. This new bone grows between the bones of the spine (vertebrae), eventually joining them together. This fusion makes the spine stiff and inflexible. It can also stiffen the rib cage, making it harder to breathe deeply.

This condition can lead to several other problems:

• Eye inflammation (uveitis): This is a common problem. Uveitis can cause sudden eye pain, light sensitivity, and blurry vision. If you notice any of these symptoms, see a doctor immediately. Uveitis can seriously affect your eyesight if not treated promptly.

• Broken spine bones (compression fractures): In some people with ankylosing spondylitis, the bones of the spine can weaken. This weakening makes the spine bones more likely to break, especially in the early stages of the disease. These broken bones can lead to more severe bending of the back. Broken vertebrae can also put pressure on the spinal cord and nerves, causing damage.

• Heart problems: Ankylosing spondylitis can affect the aorta, the main blood vessel in the body. Inflammation in the aorta can cause it to swell and change the shape of the heart valve. This can disrupt the heart's ability to pump blood effectively. The inflammation also increases the risk of other heart problems overall.

It's important to remember that these complications aren't inevitable. Early diagnosis and treatment can help manage the disease and reduce the risk of these problems. Always discuss any concerns you have with your doctor.

During a physical exam, your doctor might ask you to bend to check how well your spine moves. They might press on your pelvis or move your legs to see if that triggers your pain. They might also ask you to take a deep breath to see if you have trouble expanding your chest.

Doctors use X-rays to look for changes in your bones and joints. These changes are sometimes a sign of a condition called ankylosing spondylitis (also known as axial spondyloarthritis). However, X-rays might not show these problems early on in the disease.

An MRI (magnetic resonance imaging) uses magnets and radio waves to create detailed pictures of bones and soft tissues. MRIs can sometimes show signs of ankylosing spondylitis earlier than X-rays, but they're more expensive.

There aren't any specific blood tests to diagnose ankylosing spondylitis. Some blood tests can check for inflammation, but inflammation can be caused by many different things. For example, other health problems can also cause inflammation.

Doctors can test your blood for the HLA-B27 gene. Having this gene doesn't automatically mean you have ankylosing spondylitis, and you can have the disease even without it. So the HLA-B27 test isn't definitive.

Ankylosing Spondylitis Treatment: Managing Pain and Preventing Problems

Ankylosing spondylitis is a type of arthritis that affects the spine and surrounding joints. The goal of treatment is to reduce pain and stiffness, and to stop or slow the progression of the disease, preventing problems like a curved spine. Treating ankylosing spondylitis is most effective when it's caught early, before the condition causes permanent damage.

Medications:

Pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, are often the first line of treatment for ankylosing spondylitis. These medications help reduce swelling, pain, and stiffness. However, NSAIDs can sometimes cause stomach problems, like bleeding.

If NSAIDs aren't enough, doctors might prescribe other medications that target different parts of the immune system. These include:

• TNF blockers: These medications, injected under the skin or into a vein, block a protein that plays a role in inflammation. Examples include Adalimumab (Humira), Certolizumab pegol (Cimzia), Etanercept (Enbrel), Golimumab (Simponi), and Infliximab (Remicade).

• IL-17 inhibitors: These medications, like secukinumab (Cosentyx) and ixekizumab (Taltz), also target inflammation. They're injected.

• JAK inhibitors: These medications, taken by mouth, like tofacitinib (Xeljanz) and upadacitinib (Rinvoq), are another option. However, these medications can increase the risk of infections, including reactivating hidden tuberculosis.

Physical Therapy:

Physical therapy is a vital part of managing ankylosing spondylitis. A physical therapist can create a personalized exercise plan to help:

• Reduce pain: Exercises can target the specific areas causing discomfort.
• Improve strength: Strengthening exercises for the abdomen and back can help support the spine.
• Increase flexibility: Stretching exercises will help maintain range of motion.
• Improve posture: Learning proper posture, including how to sit, stand, and sleep, can help prevent further problems.

Surgery:

Surgery is usually not needed for ankylosing spondylitis. It might be considered in very severe cases where pain is extreme, or if a hip joint is badly damaged and needs replacement.

Important Note: It's essential to work closely with your doctor to find the best treatment plan for your specific situation. They can assess your individual needs and adjust the treatment as necessary.