Ankylosing spondylitis

About

Ankylosing spondylitis (AS) is a type of inflammatory arthritis that primarily affects the spine, sacroiliac joints, and other joints of the body. The primary symptom of AS is pain and stiffness in the back and hips, but it can cause other systemic symptoms like fatigue, weight loss, and fever. People with AS may also experience inflammation in their eyes, lungs, and heart. Treatment for AS typically includes disease-modifying antirheumatic drugs, nonsteroidal anti-inflammatory drugs, and physical therapy to reduce pain and improve mobility. In some cases, surgery may be necessary to release the spine from abnormal fusion. With proper treatment, symptoms of AS can be managed and mobility preserved.

Symptoms

The most common symptoms of Ankylosing Spondylitis are pain and stiffness in the lower back and hips, particularly in the morning and after periods of inactivity. Other symptoms may include pain and inflammation in other areas of the spine, fatigue, loss of appetite, and reduced flexibility. In more severe cases, the condition can cause the affected joints to become permanently fixed in a bent or rigid position. In severe cases, the condition can also cause swelling and inflammation of the eyes, aching and stiffness in the ribs and chest, and difficulty breathing. In some cases, Ankylosing Spondylitis can also affect other organs outside the spine, including the lungs and heart.

Causes

The cause of Ankylosing spondylitis (AS) is not fully understood, however, it is believed to be due to a combination of genetic and environmental factors. Genetically, AS is linked with the presence of certain HLA-B27 subtypes, however, not all individuals who possess the HLA-B27 gene will develop the condition. Environmental factors may also contribute to the development of AS, and these likely include a variety of immune system triggers, such as infection by certain bacteria or viruses. In addition, a family history of AS may be an influencing factor.

Risk factors

The exact cause of ankylosing spondylitis is unknown, however, certain factors may increase a person’s risk:

Genetic factors: Ankylosing spondylitis appears to run in families, suggesting that certain genes may make a person more likely to develop it.
Gender: Men are roughly three times more likely to develop ankylosing spondylitis than women.
Age: The condition typically affects people aged 15 to 45, though it can begin at any age.
Ethnicity: People of Northern European ancestry are more likely to develop the condition.
Tobacco use: Regularly smoking cigarettes or other tobacco products increases one’s risk of developing ankylosing spondylitis.
Antibiotic use: Long-term use of certain antibiotics, including tetracyclines and sulfas, may increase the risk of developing the condition.

Diagnosis

Ankylosing spondylitis is typically diagnosed through a multi-step process that typically begins with a physical exam. If a physical exam suggests ankylosing spondylitis, a doctor may then order blood tests and X-rays of the affected area, as well as a combination of other medical tests. Additionally, doctors may also use imaging techniques, such as MRI and CT scans, to visualize joint and bone damage. Finally, tests may also be used to rule out other conditions that could be causing similar symptoms, such as rheumatoid arthritis or inflammatory bowel disease.

Sub-types

Ankylosing spondylitis is an inflammatory type of arthritis that affects the vertebrae and other joints in the spine, most commonly in men between the ages of 20 and 40. It is a chronic condition that can cause stiffness, pain and deformity of the spine.

There are two main subtypes of ankylosing spondylitis: radiographic axial spondyloarthritis (which is the most common) and non-radiographic axial spondyloarthritis.

Radiographic axial spondyloarthritis is the form most commonly seen in adults. It is characterized by changes in the vertebrae on an X-ray or other imaging that show evidence of progressive inflammation and erosion. It is usually accompanied by pain and stiffness in the lower back or hips, as well as other joints in the limbs. Over time, the inflammation leads to fusion of the vertebrae, causing a condition known as ankylosis.

Non-radiographic axial spondyloarthritis is the less common form of ankylosing spondylitis. It is characterized by the same symptoms as radiographic axial spondyloarthritis but without the changes seen on X-ray or other imaging. Instead, diagnosis of this form is usually made by examining the patient and performing specialized tests such as ultrasonography, magnetic resonance imaging, and computed tomography.

Treatments

The treatment options for Ankylosing spondylitis vary depending on the severity of the condition. Generally, the goal of treatment is to reduce inflammation, prevent and/or reduce further joint damage, and reduce pain and stiffness. Treatment options may include:

Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain, swelling, and stiffness
Disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate and sulfasalazine
Biologics, such as tumor necrosis factor (TNF) inhibitors and interleukin-17 (IL-17) inhibitors, to reduce inflammation
Physical therapy to improve flexibility, posture, and joint mobility
Stretching and exercise programs to maintain and improve strength
Occupational therapy to learn how to manage activities of daily living
Surgery to correct deformities or to stabilize joints
Assistive devices such as canes, walkers, and braces

Prevention

The best way to reduce the risk of Ankylosing spondylitis is to make lifestyle changes that support good physical and mental health, including:

Maintaining a healthy weight: Being overweight can increase the risk of Ankylosing spondylitis. Eating a balanced diet and engaging in regular physical activity can help to maintain a healthy weight.
Engaging in regular physical activity: People with Ankylosing spondylitis should exercise regularly to strengthen the muscles around the spine, improve posture and prevent the joints from becoming stiff. It is important to speak to a doctor or physical therapist to create an exercise plan that is tailored to the individual’s needs.
Practicing good posture: Good posture can help to reduce the stress on the spine and to prevent the spine from becoming stiff and painful.
Seeking treatment promptly: If a person experiences any signs or symptoms of Ankylosing spondylitis, they should consult their doctor as soon as possible. Early diagnosis and treatment can help to minimize the risk of complications and to improve the long-term prognosis.
Quitting smoking: Smoking is linked to an increased risk of developing Ankylosing spondylitis and can lead to more severe symptoms.

Gender differences?

Yes, there are differences between genders when it comes to the presentation and management of Ankylosing Spondylitis. Men seem to experience the condition at an earlier age and have a more severe form than women. In addition, men have a higher risk of developing uveitis, a common complication of AS. Women, on the other hand, tend to present more with arthritis-like symptoms as well as with enthesitis, which is pain and inflammation of the tendon-bone junction. Women also seem to have a more favorable response to medications such as non-steroidal anti-inflammatory drugs and biological agents. Women may also experience more gastrointestinal symptoms due to the underlying nature of spondyloarthropathies. Therefore, men and women with AS should be managed differently, and differential diagnosis should be made for symptom assessment in both sexes.

Nutrition

Nutrition plays a key role in the management of Ankylosing spondylitis. Eating a well-balanced diet that is high in fruits, vegetables, nuts, seeds, and whole grains, and low in saturated fat, can help decrease inflammation in the body, which can help reduce the symptoms of Ankylosing spondylitis. Additionally, research suggests that some dietary supplements and herbs may also help reduce inflammation, such as omega-3 fatty acids, garlic, and turmeric. Consuming a high-fiber diet can also help move digested food through the body faster, which can help reduce lower back pain and other symptoms of Ankylosing spondylitis. Lastly, staying hydrated is essential to keep the body functioning optimally, as dehydration can worsen symptoms and make them harder to manage.

Physical Activity

Physical activity can be beneficial for people with Ankylosing Spondylitis (AS). Regular physical activity can reduce the pain associated with AS, improve physical function, and decrease fatigue. Additionally, exercise can lead to an increase in the flexibility and range of motion in the joints, which can help to decrease further joint damage. Exercise can also help to maintain good posture and reduce the stress on the spine. It is important to note that people with AS should avoid activities that are high impact or strenuous, such as running, as they may cause further injury or strain on the joints. Low-impact physical activity, such as swimming and cycling, may be better options. In addition, stretching and strengthening exercises may be beneficial. Finally, it may be beneficial to work with a physical therapist to determine the best physical activity plan for your specific needs.