Things to know about ankylosing spondylitis (AS)

What Triggers Ankylosing Spondylitis
Ankylosing spondylitis (AS) is an autoimmune disease that has no specific cause. While genetic factors are believed to be involved, particularly in people with a gene called HLA-B27, some people with the gene never develop the condition.

While the exact trigger of AS is unknown, the disorder is believed to have a genetic link. Research indicates that individuals who carry a gene known as HLA-B27 are at a higher risk of the condition, although most people who carry this gene never develop it.

  • Only a very small number of people with the gene HLA-B27 may develop AS. Because of this, researchers don’t fully know if the gene increases the risk of the disease.
  • Many people with AS either have another family member with the condition or have another family member that has some type of rheumatologic or autoimmune condition (a disease in which the body attacks its own proteins due to a faulty immune response). A person's risk of AS is increased if their family member has the condition, even if that person doesn’t have the HLA-B27 gene.
  • Age and gender appear to be the largest factors that influence whether a person develops AS, although medical researchers do not understand the reason.
  • AS affects men at a disproportionate rate, striking them earlier in life and causing more severe symptoms. Women who develop this health condition often have a milder form.
  • More than 80 and 95 percent of people with AS receive a diagnosis by the age of 30 and 45 years, respectively.
  • Research also suggests that environment, bacterial infections, and gastrointestinal infections may have roles in triggering this disease.
  • It is unknown which specific infection triggers the onset of AS. The most likely culprit is either an intestinal or urinary pathogen (bacteria). Chlamydia trachomatis and Neisseria gonorrhoeae, which cause sexually transmitted infections, are common organisms responsible for reactive arthritis, which is related to AS.
  • AS is more prevalent in Caucasian, Asian or Hispanic populations.
  • One survey of people with AS found that most people believed their flare-ups were triggered by an increase in stress or over-exertion, but the majority reported no long-term effects following a flare-up.

Recently, new genes (IL23R, ERAP1, and ARTS1) have been found to be associated with AS. Scientists believe that there are additional unknown factors that are necessary for the disease to appear. AS occurs when the body’s immune system begins to attack its own joints for reasons that are not yet understood. The joints between bones in the spine and/or the joints between the spine and pelvis are usually the first targets of this immune attack.

How does ankylosing spondylitis (AS) cause spinal stiffening?

Although the origin of ankylosing spondylitis (AS) is still unknown, we do know a lot about how it progresses and why it causes spinal stiffening.

  • When AS first appears, osteitis (inflammation of the bones) occurs around the edges of the joints.
  • In these areas, special cells called inflammatory cells begin to increase in number. These inflammatory cells produce chemicals that damage the bone, causing them to begin to dissolve and weaken around the edge of each joint.
  • Damage to the bone in this area starts a process where the body continuously tries to repair the damage with scar tissue and new bone tissue.
  • As the process continues, the bone becomes weaker and weaker. When the inflammation finally “burns out” and begins to disappear, the body responds by producing calcium deposits around the area of the damage, attempting to heal the bone.
  • As the bone heals itself, calcium deposits spread to the ligaments and disks between the vertebrae for some unclear reason. This is what leads to a fusion of the spine (sometimes referred to as bony ankylosis).

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24 common signs and symptoms of ankylosing spondylitis (AS)

It is crucial to remember that ankylosing spondylitis (AS) symptoms vary widely from person to person. Signs and symptoms of AS usually appear along the spine although they can advance throughout the illness. Because of inflammation, people with AS frequently feel spine stiffness and loss of spinal motion. Symptoms may intensify, improve or stop at unpredictable periods throughout time.

Twenty-four possible signs and symptoms of AS include

  1. Pain in the buttocks (can be unilateral)
  2. Pain in the back or neck (gradual in onset but consistent)
  3. Stiffness or pain in the morning (improves with movement)
  4. Pain may be better after exercise but worse after rest
  5. Inflammation in the joints (knee, tendon, and ankle)
  6. A bent-over posture to help relieve back pain
  7. Loss of appetite
  8. Weight loss
  9. Fever
  10. Inflammation in the eye (red and painful eye)
  11. Sleep issues
  12. Fatigue
  13. Dizziness
  14. Abdominal pain or cramping
  15. Diarrhea
  16. Difficulty doing daily activities
  17. Decreased range of motion
  18. Chest pain
  19. Heel pain
  20. Shortness of breath
  21. Bowel and bladder dysfunction
  22. Organ damage, such as to the heart, lungs, and eyes
  23. Skin rash
  24. Digestive illness (such as Crohn's or ulcerative colitis)
Inflammation in the spine and other musculoskeletal soft tissues and joints can lead to localized increased bone growth. Joints may stiffen, fuse, and lose functionality. This might make it difficult for a person to bend down or stretch.

How is ankylosing spondylitis (AS) diagnosed?

Following a comprehensive physical examination and detailed medical history, your doctor may request one or more of the diagnostic tests listed below to assess your condition:

  • C-reactive protein: A blood test that measures inflammation markers
  • X-ray or magnetic resonance imaging: Imaging studies detect bony abnormalities and inflammation in the spine
  • Genetic testing for HLA-B27: Most people with the disease carry a copy of this gene, and this test may help establish a diagnosis.

However, these tests are not unique to ankylosing spondylitis (AS) and can be recommended to rule out other factors such as infection, other autoimmune diseases, and even malignancy. Blood testing to check for anemia may also be conducted because this might be detected and be the cause of fatigue. The most obvious symptom of AS confirmed my diagnosis is a change in the sacroiliac joints at the base of the low back. An X-ray may not detect this change for several years.

QUESTION

Ankylosing spondylitis is a type of __________ that affects the __________. See Answer

How is ankylosing spondylitis (AS) treated?

There is currently no cure for ankylosing spondylitis (AS), but the illness can be managed through various treatment options. The main treatment's objectives include

  • Control inflammation
  • Relieve symptoms (such as pain and stiffness)
  • Preserve the mobility and function of the spine
  • Prevent complications (such as deformity of the spine)

Two early remedies for AS:

  1. Posture correction:
    • Good posture strategies can help you prevent some of the problems of spondylitis, such as stiffness and flexion deformities or kyphosis (downward curvature) of the spine.
  2. Heat and cold therapies:
    • Heat can help relieve pain and discomfort in stiff joints and tight muscles.
    • Swelling can be reduced by applying ice to inflamed regions.
    • Hot baths, massages, and showers can be beneficial.

Six types of medications for AS include

  1. Nonsteroidal anti-inflammatory drugs (NSAIDS):
    • NSAIDs are the first line of drugs for a person with AS.
    • These medications relieve AS pain while having few adverse effects.
    • There are some indications that they may reduce the chance of radiographic abnormalities progressing and the bones fusing together.
    • In most cases, people with AS will be prescribed a clinical-strength version of NSAIDs.
    • Antacids may be prescribed in conjunction with NSAIDS to reduce negative effects.
  2. TNF inhibitors:
    • TNF inhibitors (a type of biological drug) prevent your body from creating an inflammatory trigger called TNF-alpha protein.
    • Excess TNF is normally blocked by the body in healthy people, but people with AS frequently have more than required in their blood.
  3. IL-17 inhibitors:
    • Another form of biologic, known as an IL-17 inhibitor, works by reducing inflammation in the body.
    • These medications may be an alternative for those who do not react well to TNF inhibitors or who cannot take them.
  4. Corticosteroids:
    • Corticosteroids may be recommended for individuals experiencing a flare but only for a limited time.
    • Steroids have a strong anti-inflammatory effect, which is why they are occasionally recommended to treat an acute AS flare (for example, after an injury).
  5. Disease-modifying antirheumatic drugs (DMARDs):
    • These medications are beneficial in the treatment of peripheral joint pain.
    • People with AS who develop arthritis in these peripheral joints find them to be commonly effective and well-tolerated.
  6. JAK inhibitors:
    • Janus kinase inhibitors are medications that suppress the activity of one or more enzymes of the Janus kinase family.
    • JAK inhibitors work by inhibiting these enzymes to reduce the effect of your hyperactive immune system, reducing pain and swelling, and preventing joint injury.
    • Although these drugs have not yet been licensed for treatment, it is unclear if JAK inhibitors will be authorized for the treatment of AS.
    • Preliminary research is encouraging. These drugs, such as DMARD therapy for AS, suppress the immune system. They are just as effective as biologics may be given orally (in the form of a tablet), and operate quickly.

Two therapies for AS include

  1. Physiotherapy:
    • Through a variety of therapeutic treatments and tactics, a physiotherapist (PT) can create a tailored program to help you improve your strength, flexibility, range of motion, general mobility, and exercise tolerance.
    • These include exercise prescription, active and passive exercises, physical treatments and relaxation, as well as advice on various pain-reduction and quality-of-life strategies.
    • Physical therapists can refer you to other health experts and community agencies for additional measures that will assist you in adapting to your changing circumstances.
  2. Occupational therapy:
    • An occupational therapist (OT) specializing in arthritis treatment may assess your daily activities and create a program to assist you to protect your joints and reducing tiredness.
    • If required, an OT can assist you with redesigning your home or workplace to make it simpler to work or get around.
    • An OT can create or prescribe a variety of splints, braces, orthopedic shoes, and other devices to assist relieve pain and promote mobility and usefulness.
    • Their objective is to help you regain as much of your old life as possible by employing assistive equipment and adaptive tactics.

Three types of surgery for AS: The majority of people with AS do not require surgery. In some circumstances, surgery may be required. Treatment guidelines recommend using surgery who have with advanced AS.

  1. Osteotomy: Correct a deformity in the spine
  2. Spinal fusion instrumentation: Stabilize a weakened spine
  3. Spinal decompression: Relieve pressure on the nerves

Nine lifestyle changes recommended for people with AS: Many people with AS discover that they must adopt lifestyle adjustments to assist manage their illness and enhancing their health and well-being. Common tips may include

  1. Quitting smoking
  2. Diet
  3. Regular physical activity
  4. Maintaining a healthy body weight
  5. Daily stretching
  6. Stress management
  7. Meditation
  8. Recognizing and respecting personal limits
  9. Building a support team

Six possible complementary therapies for people with AS: People with AS may opt to supplement their therapy with alternative therapies to control their symptoms. Among the alternative medicine methods for AS include

  1. Yoga
  2. Bodywork
  3. Acupuncture
  4. Herbs and other supplements
  5. Medical marijuana
  6. TENS units

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5 stages of ankylosing spondylitis (AS)

Laboratory findings in ankylosing spondylitis (AS) are generally nonspecific but may help assist with diagnosis. They use radiographic bony changes of the sacroiliac joints and spine as the main parameter to differentiate between the stages of AS.

  1. Stage I:
    • Radiographic sacroiliitis on both sides
  2. Stage II:
    • Minor radiological evidence of spinal involvement in ≤1spinal segment (≤3 vertebrae or 15 percent of the spine)
  3. Stage III:
    • Moderate radiographic evidence of spinal involvement in ≤2 spinal segments (4 to 12 vertebrae or 15 to 50 percent of the spine)
  4. Stage IV:
    • Radiographic evidence of spinal involvement in more than two spinal segments (13 to 19 vertebrae or 50 to 80 percent of the spine)
  5. Stage V:
    • Widespread (≥80 percent) fusion of the spine (≥20 vertebrae)

Stages I to III are indicated by minimal to moderate radiographic evidence of structural deterioration affecting 50 percent of the spine in two spinal segments or less. Stages IV and V reflect advanced AS, with involvement of 50 to 80 percent of the spine in more than two spinal segments, and involvement of >80 percent of the spine. The rate at which you proceed through the phases is determined by a variety of circumstances, including how early you were diagnosed, how promptly you begin therapies, and how successful your treatments are. Whatever stage of AS you have, there are therapies available to control your symptoms and lessen the inflammation and lessen the complications.

6 exercises for people with ankylosing spondylitis (AS)

Exercise, in combination with adequate anti-inflammatory medicine, has been shown (and widely accepted) to have an essential role in the management of ankylosing spondylitis (AS). A personalized exercise program's goal is to assist

  • Alleviate a person's symptoms by improving spine mobility.
  • Educating and teaching good posture.
  • Improving postural stabilization and breathing strategies.
  • Retraining inadequate muscle recruitment caused by disease state alterations.

With AS treatment, consistency appears to be crucial; practicing a few activities every day will help reduce discomfort.

Six types of exercises for people with AS (both men and women) include

  1. Controlled breathing with spinal alignment:
    • This exercise helps with posture and rib mobility to improve breathing capacity.
    • If laying flat on the floor is too painful, place a cushion beneath your head.
    • Lie on your back with knees bent in, and a neutral spine.
    • Place hands on ribs and deep breathe, expanding ribs.
    • Repeat 15 times.
  2. Seated posture:
    • Sit tall on a chair or a swiss ball, with your chest out, chin in, and thumbs pointing away from your body.
    • Hold for 60 seconds if necessary. Repeat throughout the day.
    • This is excellent for stimulating the core and upper back muscles that support the spine.
  3. Core stability:
    • This exercise increases core stability by working the muscles that support the vertebrae, the Transverse Abdominus, and Multifidus.
    • Assume a four-point pose, with hands beneath shoulders and knees beneath hips.
    • In a neutral spine position, gently draw up the pelvic floor muscles and press the stomach button against the spine. Breathe for 20 to 60 seconds, relax and repeat it again.
  4. Spinal extensions:
    • This exercise helps put the spine in extension, which helps reverse the normal development of AS.
    • Lie on your stomach and slowly lift your elbows.
    • Breathe deeply and attempt to expand your chest and stretch your upper back.
    • Hold for five breaths and then relax. Repeat two to five times more.
  5. Lumbar flexion with thoracic mobilization:
    • This exercise helps mobilize the spine and thoracic region, which can become stiff as a result of AS.
    • Kneel and place your hands on a roller, elevated item, or chair.
    • Lower your bottom slowly toward your heels.
    • Breathe in and out of the stretch three to five times. Repeat two to five times and more.
  6. Total spine stretch:
    • Lying on your back is one of the greatest ways to straighten your spine, alleviate stress and help with the kyphotic posture that AS develops.
    • Simply rest on your back in a comfortable posture and take deep breaths. If necessary, place cloth beneath your head to assist support it.
    • Maintain for one to three minutes. Repeat every day.

Although exercise can help people with AS, some exercises should be avoided because they might cause more damage than good. Step aerobics, jogging, heavy weight lifting, kickboxing, burpees, cross-training, leaping, sit-ups, and leg lifts are examples of such exercises. These workouts place strain on the back and spine, which can aggravate symptoms and increase your risk of injury. Before beginning an exercise plan, consult with your doctor to confirm that it is safe for you. You could wish to start by seeing a physiotherapist learn how to do specific motions. Finally, listen to your body, if something doesn't feel right, stop doing it.

What is the life expectancy for people with AS?

A specific life expectancy for people with AS has not been established. However, proper diagnosis and treatment of AS are important not only to slow or stop joint progression and possible disability but also to reduce widespread inflammation in the body that can lead to complications such as heart disease.

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Medically Reviewed on 5/18/2022
References
https://www.ucsfhealth.org/conditions/ankylosing-spondylitis

https://www.healthywa.wa.gov.au/Articles/A_E/Ankylosing-spondylitis

https://www.neurosurgery.columbia.edu/patient-care/conditions/ankylosing-spondylitis

Differential Diagnosis and Management of Ankylosing Spondylitis Masked as Adhesive Capsulitis: A Resident's Case Problem

https://www.jospt.org/doi/10.2519/jospt.2012.4050