Ankylosing spondylitis

Description

Ankylosing spondylitis, also known as axial spondyloarthritis is an inflammatory disease that, over time, can cause some of the bones in the spine, called vertebrae to fuse. This fusing makes the spine less flexible and can result in a stooped posture. If ribs are affected, it can be difficult to breathe deeply.

Axial spondyloarthritis has two types. When the condition is found in X-rays, called ankylosing spondylitis, also known as axial spondyloarthritis. When the condition can't be seen on X-ray, but is based on symptoms, blood tests and other imaging tests, it is called nonradiographic axial spondyloarthritis.

The symptoms usually begin in early adulthood. Inflammation also can occur in other parts of the body, most frequently the eyes.

There is No cure for ankylosing spondylitis, but treatments can relieve symptoms and possibly slow the progression of the disease.

Symptoms

The first symptoms of ankylosing spondylitis may include back pain and stiffness in the low back and hips, especially in the morning and after periods of inactivity. Neck pain and fatigue also are common. Over time, the symptoms might worsen, improve or stop at irregular intervals.

The most commonly affected areas are:

  • The joint between the base of the spine and the pelvis.
  • The vertebrae in the lower back.
  • The places where tendons and ligaments attach to your bones, mainly in the spine, but sometimes along the back of the heel.
  • The cartilage between the sternum and the ribs.
  • The hip and shoulder joints.

When to see a doctor

Seek medical attention if you have lower back or pain in the buttock that came slowly, it is worse in the morning or wake up from their slumber in the second half of the night — particularly if the pain improves with exercise and worsens with rest. See an eye specialist immediately if you develop a painful red eye, severe light sensitivity or blurred vision.

Causes

Ankylosing spondylitis has no known specific cause, although genetic factors seem to be involved. In particular, people who have a gene called HLA-B27 are at a higher risk of developing ankylosing spondylitis. However, only some people with the gene develop the condition.

Risk factors

The onset usually occurs in adolescence or early adulthood. Most of the people who have ankylosing spondylitis have the HLA-B27 gene. But many people who have this gene never develop ankylosing spondylitis.

Complications

In the severe form of ankylosing spondylitis, the new bone forms as part of the body's attempt to heal. This new bone gradually closes the gap between the vertebrae and, finally, the fuses of the sections of the vertebrae. Parts of the spine become stiff and inflexible. The fusion can also lead to stiffness of the rib cage, restricting lung capacity and function.

Other complications may include:

  • Inflammation of the eye, called uveitis. One of the most common complications of ankylosing spondylitis, uveitis can cause a rapid onset of pain in the eyes, sensitivity to light and blurred vision. Consult your health-care provider immediately if you experience these symptoms.
  • Compression fractures. Some people that the bones are weakened during the early stages of ankylosing spondylitis. Weakened vertebrae of deformation, the increase in the severity of a stooped posture. Vertebral fractures can put pressure on and possibly injure the spinal cord and the nerves that pass through the spinal column.
  • The problems of the heart. Ankylosing spondylitis can cause problems with the aorta, the largest artery in the body. Inflammation of the aorta may enlarge to the point that it distorts the shape of the aortic valve in the heart, which impairs its function. The inflammation associated with ankylosing spondylitis increases the risk of heart disease in general.

Ankylosing spondylitis

Diagnosis

During the physical exam, your doctor might ask you to turn in different directions to test the range of motion in the spine. Your doctor may attempt to reproduce your pain by pressing on a specific part of the pelvis, or by the movement of his legs in a particular position. You may also request that you take a deep breath to see if you have difficulty for the expansion of his chest.

Imaging tests

X-rays allow doctors to detect changes in the joints and bones, also called radiographic axial spondyloarthritis, despite the visible signs of ankylosing spondylitis, also called axial spondyloarthritis, it may not be evident early in the disease.

Magnetic resonance imaging (MRI) uses radio waves and a strong magnetic field to provide more detailed images of the bones and soft tissues. Magnetic resonance imaging can reveal evidence of nonradiographic axial spondyloarthritis earlier in the disease process, but are much more expensive.

Laboratory tests

There are No specific lab tests to identify ankylosing spondylitis. Certain blood tests can check for markers of inflammation, but many different health problems can cause the inflammation.

The blood can be tested for the HLA-B27 gene. But many people who have the gene does not have ankylosing spondylitis, and the people can have the disease without having the HLA-B27 gene.

Treatment

The goal of treatment is to relieve pain and stiffness and prevent or delay complications and spinal deformity. Ankylosing spondylitis is the most successful treatment before the disease causes irreversible damage.

Drugs

Nonsteroidal anti-inflammatory drugs (Nsaids), like naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others) — are the medications of health care providers most commonly used for the treatment of axial spondyloarthritis and nonradiographic axial spondyloarthritis. These medications may relieve the inflammation, pain and stiffness but can also cause gastrointestinal bleeding.

If non-steroidal anti-inflammatory drugs (Nsaids) are not helpful, your doctor may suggest starting tumor necrosis factor (TNF) blocker or an interleukin-17 (IL-17) inhibitor. These drugs are injected under the skin or through an intravenous line. Another option is the Janus kinase (JAK) inhibitor. Janus kinase (JAK) inhibitors are taken by mouth. These types of drugs that can reactivate tuberculosis is not treated, and make you more susceptible to infections.

Examples of tumor necrosis factor (TNF) blockers include:

  • Adalimumab (Humira).
  • Certolizumab pegol (Cimzia).
  • Etanercept (Enbrel).
  • Golimumab (Simponi).
  • Infliximab (Remicade).

Interleukin-17 (IL-17) inhibitors used for the treatment of ankylosing spondylitis are secukinumab (Cosentyx) and ixekizumab (Taltz). Janus kinase (JAK) inhibitors available for the treatment of ankylosing spondylitis are tofacitinib (Xeljanz) and upadacitinib (Rinvoq).

Therapy

Physical therapy is an important part of treatment and can provide a series of benefits, from pain relief to improved strength and flexibility. A physical therapist can design exercises specific to your needs. To help maintain a good posture, it can be taught:

  • The range-of-motion and stretching exercises.
  • Strengthening exercises for the abdominal muscles and lower back.
  • Suitable for sleeping and walking positions.

Surgery

Most people with ankylosing spondylitis or nonradiographic axial spondyloarthritis not need surgery. Surgery may be recommended if you have severe pain, or if a hip joint is so damaged that it needs to be replaced.

Self-care

Lifestyle choices can also help you to manage ankylosing spondylitis.

  • Stay active. Exercise can help to relieve pain, maintain flexibility and improve your posture.
  • Do not smoke. If you smoke, stop smoking. Smoking is generally bad for your health, but it creates additional problems for people with ankylosing spondylitis, including making it difficult to breathe.
  • Practice good posture. Practice standing directly in front of a mirror can help to avoid some of the problems associated with ankylosing spondylitis.

Coping and support

The course of their status can change from time to time, and you may also have painful episodes and periods of less pain throughout his life. But most people are able to live a productive life despite a diagnosis of ankylosing spondylitis.

You may want to join an online or in-person support group for people with this condition, to share experiences and support.

Preparing for your appointment

You could bring your symptoms to the attention of your family doctor. Your doctor may refer you to a specialist in inflammatory disorders is called a rheumatologist.

Here's some information to help you prepare for your appointment.

What you can do

Make a list of:

  • Your symptoms, including any that may seem unrelated to the reason he made the appointment, and when they began.
  • Key personal information, including major stresses, recent life changes and family medical history.
  • All the drugs, vitamins, and other supplements you take and their dosages.
  • Questions to ask your doctor.

Have a friend or family member, if possible, to help you remember the information they give you.

For ankylosing spondylitis, basic questions to ask your health care team include:

  • What is likely causing my symptoms?
  • Other that the most likely cause, what are other possible causes of the symptoms?
  • What tests do I need?
  • Is my condition likely temporary or permanent?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • There are restrictions that must be followed?
  • You should see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

What to expect from your doctor

Your doctor may ask you questions, such as:

  • Where is the pain?
  • How severe is your pain?
  • The symptoms been continuous or occasional?
  • What, if anything, seems to improve or worsen your symptoms?
  • Have you taken medication to relieve the pain? What helped the most?
Symptoms and treatment of Ankylosing spondylitis