Ankylosing spondylitis causes the vertebrae in the spine to fuse gradually. It is an autoimmune disease in which the body's immune system mistakes its own tissues as foreign and attacks them.
In AS, the immune system primarily targets the joints of the spine and sacroiliac joints at the base of the spine. Chronic inflammation damages the joints, cartilage, and ligaments, eventually leading the vertebrae to fuse together. As the fusion progresses up the spine, the ability to flex and extend the back decreases. The end result is a rigid, immovable spine.
Though there is no cure for AS, treatments like medication, physical therapy, and surgery can help manage symptoms and slow the progression of joint damage. By controlling inflammation, these approaches aim to maximize spinal mobility and flexibility for as long as possible.
What are The Symptoms of Ankylosing Spondylitis?
The symptoms of AS arise from chronic inflammation in the spine, pelvis, ribs, and other areas, leading to pain, fatigue, damage to joints and tissues, and impaired organ function.
Chronic low back pain and stiffness. Persistent low back pain and stiffness are hallmark symptoms of ankylosing spondylitis. The stiffness and pain usually worsen in the morning and improve with movement and exercise.
Limited range of motion. The fused vertebrae can make it difficult to bend and twist the spine.
Hip and neck pain. AS can also cause pain and stiffness in the hips, neck, and other joints. The joints where the ribs attach to the spine can also become inflamed and painful.
Fatigue. Many people with Ankylosing Spondylitis experience chronic fatigue and low energy. This could be due to the effects of the inflammation on the body and disturbed sleep from the pain.
Poor posture. Individuals may develop a forward-hunched posture to compensate for spine stiffness and pain. This posture can further aggravate back pain and spine damage.
Difficulty taking deep breaths. As the ribs fuse and chest wall mobility decreases, taking deep breaths can become difficult. This can lead to frequent upper respiratory infections.
Eye inflammation. Some people experience eye inflammation (uveitis) that can cause redness, pain, and blurred vision. Eye inflammation can lead to vision loss if left untreated.
Gastrointestinal issues. A subset of people with ankylosing spondylitis may develop inflammation in the gut that leads to diarrhea, cramping, and abdominal pain.
What Are The Causes and Risk Factors of Ankylosing Spondylitis?
The cause of ankylosing spondylitis appears to involve a combination of genetic, immune system, and environmental factors working together. The biggest known genetic factor is a gene called HLA-B27. Up to 95% of the genetic risk for ankylosing spondylitis comes from having the HLA-B27 gene. One can inherit this gene from a family member.
However, HLA-B27 alone does not directly cause the disease. This is clear from the fact that less than 5% of people with the HLA-B27 gene actually develop ankylosing spondylitis.
Other factors, including problems with the immune system and certain environmental influences, also play a role in determining who gets the disease.
Immune dysfunction. For unknown reasons, the immune system begins to attack the body's own tissues in the spine and pelvis, causing inflammation. This is an autoimmune response. What triggers the immune system to malfunction has yet to be fully understood.
Infection. Some research suggests that an unidentified infection may activate the immune system in susceptible individuals with a genetic predisposition. However, no definitive link between a specific infection and Ankylosing Spondylitis has been found.
Gut inflammation. Inflammation in the gut (enterocolitis) may affect immune system activation. Some evidence shows that treating gut inflammation may help reduce symptoms of ankylosing spondylitis. However, more research is needed to confirm if gut inflammation is a cause or just associated with the disease.
Age. While Ankylosing Spondylitis symptoms often first appear in the late teens and early 20s, age is not a cause. However, the disease may be more likely to develop in this age range due to hormonal changes and lifestyle factors during these years.
Sex. Ankylosing Spondylitis affects men more frequently than women. Estimates show 2 to 3 times as many men are affected. Estrogen may provide women some protection before menopause. However, sex alone does not cause the disease.
How is Ankylosing Spondylitis Diagnosed?
Ankylosing Spondylitis is diagnosed based on a combination of predictive factors, including characteristic symptoms and exam, positive HLA-B27 status, and imaging consistent with the disease. No single test alone confirms the diagnosis with high probability.
Medical history and physical exam
Your rheumatologist will ask about back pain, stiffness, and mobility symptoms. A physical exam checks for limited spine movement and other joints involved.
Imaging tests
X-rays can show loss of spine curvature and potential vertebral fusion, indicating long-term inflammation. MRI can detect more subtle inflammation of soft tissues. These findings have high predictability for Ankylosing spondylitis.
Blood tests
A positive HLA-B27 gene test significantly increases the probability of ankylosing spondylitis. About 90-95% of people with the disease test HLA-B27 positive. However, only about 5% of HLA-B27-positive people develop the disease. So blood tests should be combined with other diagnostic factors.
What Are The Treatments for Ankylosing Spondylitis?
There is no cure for AS, but the progression can be managed quite well with treatments targeting inflammation that causes the symptoms. The common treatments include:
Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs like ibuprofen and naproxen are typically used first to reduce pain and inflammation. However, long-term use can cause gastrointestinal issues in some people.
Biologic therapies. Biologic agents like TNF inhibitors (adalimumab, etanercept) and IL-17 inhibitors (secukinumab) are highly effective at relieving symptoms and preventing progression in most patients. They work by blocking inflammation at its source.
Exercise and physical therapy. Exercise and stretching help ease stiffness, increase mobility and flexibility, and improve posture and range of motion. Physical therapy utilizes targeted exercises for the individual patient. Low-impact cardio exercise can also help with fatigue and overall wellness.
Steroid injections. For some people, injecting steroids into the spine at inflammation sites can effectively relieve pain and stiffness. Steroids may also be used orally or topically but have higher risks of side effects
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Surgery. Surgery may be recommended in severe cases with significant joint damage or spine instability.
What Are The Complications and Prognosis of Ankylosing Spondylitis?
Some of the major complications and impacts on prognosis include:
Posture issues and spine deformities. The fused spine can lead to a hunched-forward posture and spine deformities like kyphosis. This can significantly impact the quality of life and the ability to walk and move.
Other joint involvement. In addition to the spine and sacroiliac joints, AS can also inflame other joints like the hips, knees, shoulders, and ribs. This can lead to additional pain, stiffness, and joint damage.
Organ complications. Ongoing inflammation may also lead to complications in other areas like the eyes, lungs, aorta, and kidneys. Regular monitoring by doctors is needed to minimize organ involvement.
Severe disability. The accumulating effects of joint damage, spine immobility, pain, and complications can potentially lead to a severe loss of function, disability, and decreased independence.
Increased health risks. Those with long-term AS have higher risks of heart disease, osteoporosis, spinal fractures, and other conditions. Managing other health risks is an important part of care and prognosis.
Ankylosing Spondylitis Treatment in Orange County
If living with ankylosing spondylitis has made basic functions difficult and diminished your quality of life, we invite you to start regaining independence and optimism.
Recognizing the debilitating effects of AS, we have built our practice around delivering personalized, multi-disciplinary care tailored to your specific needs and goals. Our board-certified rheumatologists and support staff stay up-to-date with the latest evidence-based and innovative AS treatments to provide the most effective management and relief possible.
Schedule your initial consultation with us today to discuss how we can help you through a customized and integrated approach to care. We look forward to partnering with you on the journey toward wellness and an improved, active lifestyle. Call us at 7148250891 to schedule an appointment.
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