What is Ankylosing Spondylitis?

Causes of Ankylosing Spondylitis

Ankylosing spondylitis may be caused by various factors:

Family history: If you have family history of ankylosing spondylitis, you are more likely to have it as well.

Age: Most people get symptoms of ankylosing spondylitis before the age of 45, though some have developed the disease while they were children or in their teens.

Genetics: Studies have shown that people with mutations of a specific gene, HLA-B27, are at greatly increased risk of developing ankylosing spondylitis.

Other conditions: People with other diseases (Corhn’s disease, psoriasis, ulcerative colitis, etc.) may be more likely to develop ankylosing spondylitis as well.

Symptoms of Ankylosing Spondylitis

Early symptoms include back pain and stiffness in the lower back and hips, especially after a long period of inactivity or in the morning. Neck pain and fatigue are also common, and the pain can spread to cause other types of pain, such as:

Buttock pain
Hip pain
Stomach/abdominal pain

Other symptoms of ankylosing spondylitis include:

Having trouble moving your hips and lower back
Constant fatigue
Shortness of breath
Lost appetite and unexplained weight loss
Diarrhea
Skin rashes
Vision problems and inflammation of the eye

Associated Conditions

People with certain conditions are more likely to also have ankylosing spondylitis:

Crohn’s Disease: an inflammatory bowel disease that causes the digestive tract to be swollen

and irritated.

Ulcerative colitis: a chronic condition in which the colon is inflamed.

Psoriasis: an autoimmune skin condition that causes itchiness and discomfort.

Prognosis

Ankylosing spondylitis is a long-term, chronic condition, and some patients have periods of remission (less, milder symptoms). Patients should expect to manage the symptoms for a long time, as there is no cure. The disease is manageable after starting treatment, and some patients couple it with following a diet and exercise plan that is healthy for them, along with quitting smoking and limiting alcohol intake.

Complications of Ankylosing Spondylitis

People with severe ankylosing spondylitis may have other complications later on, including:

- Spinal fractures: Broken bones in the spine.

Fused vertebrae: When the bones of the spine join together in an attempt to heal, leading to even more stiffness.

- Kyphosis: A forward curve in your spine.
- Uveitis: Inflammation of the eye, causing light sensitivity, blurred vision, and eye pain.

Osteoporosis & compression fractures: The bones have weakened overall, leading to fractures in the spine that could potentially cause damage to the spinal cord.
Heart problems: Ankylosing spondylitis can affect the aorta, the largest artery in your body. The inflammation causes the aorta to enlarge, affecting its function and causing greater risk of heart diseases in general. These include aortitis (inflammation of the aorta, the largest artery in the heart), arrhythmia (abnormal heartbeat), and cardiomyopathy (heart muscle disease).

Lumbar Medial Branch Block/Radiofrequency Ablation

Diagnosis of Ankylosing Spondylitis

Diagnosing ankylosing spondylitis typically involves:

Medical & Family History: Discussion of symptoms, past medical conditions, and any family history of back pain, joint pain, or arthritis.

Physical Examination: Assessment of spinal flexibility and back motion, pain levels, and examination of your joints. The healthcare provider may also check your breathing, to look for rib stiffness and difficulties breathing.

Diagnostic Imaging: X-rays to assess changes in joints and signs of arthritis, Magnetic Resonance Imaging (MRI) scans to provide more detailed images of the spine and soft tissues.

Treatment of Ankylosing Spondylitis

There is no cure for ankylosing spondylitis, so treatments are mainly for pain management and prevention of the disease woresning. Common treatments include:

Exercise & Physical Therapy: Regular, safe physical activity can reduce stiffness and prevent ankylosing spondylitis from worsening into complications. Range-of-motion exercises aim to prevent further back pain, strengthen the abdominal and back muscles, and to improve sleeping and walking postures.

Surgery: It is rare to receive surgery for ankylosing spondylitis, but may be suggested by your provider if the case is severe enough.

Pain Medicine Interventions

Most people with ankylosing spondylitis take medications to manage their back pain, including:

Over-The-Counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs): To relieve pain and inflammation. Common ones are ibuprofen and naproxen.

Biologic disease-modifying anti-rheumatic drugs (DMARDs): Prescription medications that also reduce inflammation and pain.

Corticosteroids: Prescription anti-inflammatory drugs. These could include a direct injection of the drug into the affected joints.

Tumor Necrosis Factor (TNF) or Janus kinase (JAK) inhibitor: These types of drugs may be prescribed if your body does not respond well to other medications, but can increase risk of infections from other diseases.