- What Is It?
There is no permanent cure for ankylosing spondylitis, but symptoms can be managed effectively with appropriate treatment, physical therapy, exercise and lifestyle modifications. Although ankylosing spondylitis is a chronic condition, it is not a debilitating disease and most people are able to lead normal and productive lives with the condition.
What is ankylosing spondylitis?
Ankylosing spondylitis causes inflammation in the ligaments and joints that promote flexibility, making the joints in the spine swell and grow. Over time, the swelling can cause bones to fuse together (ankylosis) and the spine becomes rigid as a result.
In most cases, ankylosing spondylitis starts in the lower back where the backbone connects to the pelvis (sacroiliac joint), but it can spread to other joints such as the neck, jaws, shoulders, hips, knees and ankles. In some cases, it can spread to the eyes and in rare cases, the heart or lungs.
What are symptoms of ankylosing spondylitis?
Symptoms of ankylosing spondylitis may include:
- Lower back pain and stiffness that is relieved by exercise, but gets worse when inactive or resting
- Pain or stiffness in other areas of the body:
- Shoulders and neck
- Rib cage
- Feet and heels
- Swelling, redness and tenderness in the affected joints
- Difficulty and/or pain when taking deep breaths
- Loss of appetite and weight
- Gastrointestinal problems
- Skin rash
- Vision problems and light sensitivity if the eye is affected
What is the main cause of ankylosing spondylitis?
While the cause of ankylosing spondylitis is unclear, research indicates that genes may be involved. Studies have identified over 60 genes linked to ankylosing spondylitis and related conditions. More than 90% of people with ankylosing spondylitis have a variant of a gene called human leukocyte antigen-B (HLA-B), which produces HLA-B27 protein.
Approximately 8% of the general population have an HLA-B gene mutation; however, most do not develop ankylosing spondylitis. For example, research shows that 80% of children who inherit the gene do not develop the disease.
Who is at risk for ankylosing spondylitis?
Ankylosing spondylitis is more common and severe in men than in women, and in most cases the disease develops at a young age, before the age of 45.
The risk of developing ankylosing spondylitis may increase if you have certain autoimmune conditions such as:
What are potential complications of ankylosing spondylitis?
Potential complications of ankylosing spondylitis may include:
- Inflammation in multiple joints in the body
- Bone loss (osteoporosis) and spinal fractures
- Permanent damage to affected joints resulting in joint deformity
- Forward curving of the spine (kyphosis)
- Eye inflammation:
- Heart disease:
- Breathing problems from lung scarring and stiffening of the chest wall, which can restrict lung expansion
- Cauda equina syndrome from nerve compression in the lower back, which can cause:
- Amyloidosis, a rare complication that causes an abnormal accumulation of proteins called amyloids in the heart, kidneys or liver
What is the best treatment for ankylosing spondylitis?
Goals for treating ankylosing spondylitis are to provide symptom relief, prevent or slow down disease progression and reduce the risk of long-term complications.
Combination of therapies
While treatment plans are tailored to each individual, the best treatment for ankylosing spondylitis may be a combination of two or more of the following therapies:
- Exercise: Regular physical activity helps reduce pain and prevent muscle and joint stiffness. Low-impact exercise such as swimming in a warm pool can be beneficial because it helps to stretch the muscles.
- Physical therapy: Physical therapy exercises and massages can improve flexibility and reduce pain.
- Medications: These can provide symptom relief as well as prevent disease progression. Medications may include:
- Non-steroidal anti-inflammatory drugs (NSAIDs): Treats swelling and pain from inflammation.
- Opioid painkillers: Manages severe pain.
- Corticosteroids: Controls acute inflammation.
- Disease modifying anti-rheumatic drugs (DMARDs): Suppresses the immune system and prevents inflammation, usually used if other anti-inflammatory agents cannot be given for any reason.
- Biologic DMARDs: Lab-produced proteins called monoclonal antibodies which specifically inhibit the activity of certain proteins or cell mechanisms that trigger inflammation.
- Surgery: Surgery is not commonly required to treat ankylosing spondylitis, but joint replacement or corrective surgery may be performed to treat people with severe joint damage.
Lifestyle changes and home remedies
Lifestyle changes and home remedies can help manage ankylosing spondylitis symptoms:
- Stay active and exercise regularly. Swimming and working out in water may be particularly helpful.
- Try to maintain good posture and keep your spine straight.
- Avoid smoking, as this can aggravate symptoms and accelerate the disease.
- Limit alcohol consumption, as alcohol can weaken bones.
- Maintain a healthy weight and eat nutritious food. Foods rich in omega-3 fatty acids may be helpful in reducing inflammation.
- Manage stress by engaging in calming activities like yoga and meditation.
- Apply heat to tight muscles and stiff joints, and take hot baths and showers to reduce muscle and joint pain. Applying ice can reduce swelling and inflammation.
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