Ankylosing Spondylitis(AS): Ankylosing spondylitis (AS) is a type of arthritis that are long-term inflammation of the spinal joints. Typically the spinal joins and pelvis are also affected. Occasionally other joints such as the hips and shoulders are also involved. Back pain is a characteristic symptom of AS, and it often comes and goes. The stiffness of the affected joints generally worsens over time. Bowel and eye problems may also occur.
The cause of ankylosing spondylitis(AS) is unknown, it is believed to involve genetic and environmental factors. More than 90% of involved have a precise human leukocyte antigen known as the HLA-B27 antigen. The underlying mechanism is considered to be autoimmune or autoinflammatory. The determination is typically based on the symptoms with support from medical imaging and blood tests. Ankylosing spondylitis(AS) is a type of seronegative spondyloarthropathy, meaning that tests show no presence of rheumatoid factor (RF) antibodies. It is also within a comprehensive category known as axial spondyloarthritis.
There is no cure concerning ankylosing spondylitis. Treatments may develop symptoms and avert worsening. This includes medication, exercise, and surgery. Medications used include NSAIDs, DMARDs such as sulfasalazine, and biologic agents such as infliximab and steroids. Onset is typically in young adults. Males are more often affected than females. Between 0.1% and 1.8% of people are affected. The condition was first thoroughly explained in the late 1600s by Bernard Connor, but skeletons with ankylosing spondylitis are detected in Egyptian mummies. The ankylosing spondylitis is from Greek ankylos meaning stiffening, spondylos meaning vertebra, and -itis meaning inflammation.
Causes Ankylosing Spondylitis(AS)
The ankylosing spondylitis is developed to be genetically inherited, and a majority (About 90%) of people with ankylosing spondylitis are born carried with a gene known as the HLA-B27. The HLA-B27 gene appears only to increase the tendency of developing ankylosing spondylitis, while some additional factor(s), possibly environmental, is important for the disease to appear. For instance, while 7% of the United States people have the HLA-B27 gene, but only 1% of the population actually, has the appear symptom of ankylosing spondylitis. In HLA-B27-positive individuals who have relatives with the disease, the risk of developing ankylosing spondylitis is six times greater than for those whose relatives do not have ankylosing spondylitis.
Other genes have been identified that are linked with ankylosing spondylitis, including ARTS1 and IL23R. These genes resemble to play a role in influencing immune function. It is anticipated that by understanding the effects of each of these associated genetic risk factors medical researchers will make notable progress in discovering a cure for ankylosing spondylitis.
How inflammation happens and insists on different organs and joints in ankylosing spondylitis is a subject of active health research. The initial inflammation may be a consequence of an activation of the body’s immune system, possibly by a preceding bacterial infection or an aggregate of infectious microbes. Once activated, the body’s immune system grows unable to turn itself off, even though the initial bacterial infection may have long subsided. Chronic tissue inflammation occurring from the continued activation of the body’s immune system in the absence of intense infection is the hallmark of an inflammatory autoimmune disease.
Symptoms of Ankylosing Spondylitis (AS)
Most Common Symptoms
The symptoms of ankylosing spondylitis (AS) varies greatly from person to person. Although symptoms of ankylosing spondylitis usually start to appear in late adolescence or early adulthood (between ages 17 to 45), symptoms can also occur in children or much later in life. The usual general early symptoms of AS are persistent pain and stiffness in the lower back and buttocks, which arises on gradually over the course of a few weeks or months. At first, ache may only be felt on one side or alternate sides. The pain is habitually dull and diffuse, rather than localized. This pain and stiffness are ordinarily worse in the mornings and during the night, however, may be improved by a mild shower or light exercise. Additionally, in the early stages of AS, there may be mild fever, loss of appetite, and general discomfort. It is significant to note that back pain from AS is inflammatory in nature and not mechanical.
The pain typically enhances persistent (chronic) and is perceived on both sides, ordinarily lasting for at least three months. Additionally the course of months or years, the stiffness and pain can develop up the spine and into the neck. Pain and tenderness scattering to the ribs, shoulder blades, thighs, hips, and heels is possible as well.
Varying levels of fatigue may additionally result from the inflammation caused by AS. The body must expend energy to deal with the inflammation, thus causing fatigue. Furthermore, mild to moderate anemia, may also result from the inflammation, can commit to an overall feeling of tiredness.
In a minority of AS, pain does not start in the lower back or neck, but in a peripheral joint such as the hip, knee, ankle, elbow, heel, or the shoulder joints. This pain is generally induced by enthesitis, inflammation of the site wherever a ligament or tendon connects to the bone. Inflammation and pain in peripheral joints are further commons in juveniles with AS. This can be confused since, without the immediate presence of back pain, AS may look like some other form of arthritis.
Many people with Ankylosing Spondylitis also experience bowel inflammation, that may be connected with Crohn’s disease or ulcerative colitis.AS is often characterized by iritis or uveitis (inflammation of the eyes). Signs of iritis or uveitis are Eye(s) becoming painful, watery, and red, blurred vision, and sensitivity to bright light. About one-third of people with AS will experience inflammation of the eye at least once.
Diagnosis of Ankylosing Spondylitis(AS)
The diagnosis of ankylosing spondylitis is based on estimating the patient’s symptoms, a physical examination, X-ray findings, and blood tests. Stiffness decreased the range of motion of the spine and pain, are indicative of the inflammatory back pain of ankylosing spondylitis. Symptoms combine pain and morning stiffness of the spine and sacral areas with or without accompanying inflammation in other joints, tendons, and the organs. Initial symptoms of ankylosing spondylitis can be extremely deceptive, as stiffness and pain in the lower back can be seen in many other conditions. It can be especially subtle in females, who tend to have further mild spine involvement. Years of the disease can progress before the diagnosis of ankylosing spondylitis(AS) is even considered.
The examination can manifest signs of inflammation and reduced the range of motion of joints. This can be especially apparent in the spine. The flexibility of the low back and/or neck can be reduced. There may be tenderness of the sacroiliac joints of the upper buttocks. Chest expansion with full breathing can be narrowed because of the rigidity of the chest wall. Rigorously affected people can have a stooped posture. Inflammation of the eyes can be assessed by the physicians with an ophthalmoscope.
Additional clues to the diagnosis are recommended by X-ray abnormalities of the spine and the carriage of the genetic marker HLA-B27 identified by a blood test. Other blood analyses may provide evidence of inflammation in the body. X-rays of the spine can progressively show straightening, “squaring” of the vertebrae, and end-stage fusion of one vertebra to the next. Fusion up and down the spine can lead to a “bamboo spine” appearance on X-ray tests with the total loss of mobility.
Urinalysis is usually done to look for accompanying abnormalities of the kidney as well as to exclude kidney disease that may contribute back pain that mimics ankylosing spondylitis. Patients are further simultaneously evaluated for symptoms of other related spondyloarthropathies, such as psoriasis, dysentery (Reiter’s disease or reactive arthritis ), venereal disease, and inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
Treatment of Ankylosing Spondylitis(AS)
There is no cure for ankylosing spondylitis(AS), although there are treatments that can decrease discomfort and improve function. The aims of treatment are to decrease pain and stiffness, maintain a good posture, limit deformity, and maintain the ability to perform normal activities. While accurately treated, people with ankylosing spondylitis may lead fairly normal lives. Under ideal circumstances, a team approach to treat spondylitis is recommended. Members of the treatment team typically include the patient, doctor, physical therapist, and occupational therapist. In patients with rigorous deformities, osteotomy and fusion can be performed.
Physical and occupational therapy-Immediate intervention with physical and occupational therapy is necessary to maintain function and minimize deformity.
Exercise-A schedule of daily exercise helps decrease stiffness, strengthen the muscles throughout the joints and limit or minimize the danger of disability. Deep breathing exercises may benefit keep the chest cage flexible. Swimming is a great form of exercise for people with ankylosing spondylitis.
Medications- Some drugs further provide relief from pain and stiffness and support patients to perform their exercises with minimal discomfort. Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as naproxen, ibuprofen, and aspirin — are the numerous commonly practiced drugs for spondylitis treatment. In mild to severe cases, other drugs may be combined with the treatment regimen. Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (Rheumatrex), can be applied when NSAIDs alone are not adequate to reduce the inflammation, stiffness, and pain. In addition, nearly new drugs called biologics — adalimumab (Humira), adalimumab-atto (Amjevita), etanercept (Enbrel), a biosimilar to Humira, certolizumab pegol (Cimzia), etanercept-szzs (Erelzi), a biosimilar to Enbrel,infliximab (Remicade), and infliximab-dyyb (Inflectra), a biosimilar to Remicade, golimumab (Simponi Aria, Simponi), and secukinimab (Cosentyx)– have been FDA-approved for treating ankylosing spondylitis. Furthermore, the antidepressant Cymbalta has been recommended for chronic back pain as well. Steroid injections into the joint or tendon may be effective in some cases.
Surgery- Artificial joint replacement surgery may be a mode of option for some people with high-level joint disease affecting the hips or knees.
You May Also Like: