What is Ankylosing Spondylitis?
Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the vertebrae in your spine to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. If ribs are affected, it can be difficult to breathe deeply.
Ankylosing spondylitis affects men more often than women. Signs and symptoms typically begin in early adulthood. Inflammation also can occur in other parts of your body — most commonly, your eyes.
There is no cure for ankylosing spondylitis, but treatments can lessen your symptoms and possibly slow progression of the disease.
Causes of Ankylosing Spondylitis
Ankylosing spondylitis has no known specific cause, though genetic factors seem to be involved. In particular, people who have a gene called HLA-B27 are at greatly increased risk of developing ankylosing spondylitis. However, only some people with the gene develop the condition.
Symptoms of Ankylosing Spondylitis
Early signs and symptoms of ankylosing spondylitis might include pain and stiffness in your lower back and hips, especially in the morning and after periods of inactivity. Neck pain and fatigue also are common. Inflammation in the eyes may also occur. Over time, symptoms might worsen, improve or stop at irregular intervals.
The areas most commonly affected are:
• The joint between the base of your spine and your pelvis (sacroiliac)
• The vertebrae in your lower back
• The places where your tendons and ligaments attach to bones (entheses), mainly in your spine, but sometimes along the back of your heel
• The cartilage between your breastbone and ribs
• Your hip and shoulder joints
How is Ankylosing Spondylitis Diagnosed?
There is no specific test to diagnose ankylosing spondylitis, but imaging by X-ray and MRI may show evidence of inflammation of the sacroiliac joint between the sacrum (the triangular bone at the lowest part of the back) and the ilium (the bone felt on the upper part of the hip).
Your doctor may order a number of different blood tests that can suggest ankylosing spondylitis. For example, if you have the disorder, you are likely to have an increased erythrocyte sedimentation rate (the rate at which red blood cells settle out of your blood) and increased levels of C-reactive protein (a protein that is usually not in blood at high levels but may be elevated in cases of inflammation). These two tests are general indications of inflammation in your body.
Treatment of Ankylosing Spondylitis
The goal of treatment is to relieve your pain and stiffness, and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage to the joints.
Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as naproxen (Naprosyn) and indomethacin (Indocin) — are the medications doctors most commonly use to treat ankylosing spondylitis. They can relieve inflammation, pain and stiffness. However, these medications might cause gastrointestinal bleeding.
If NSAIDs aren’t helpful, your doctor might suggest starting a biologic medication, such as a tumor necrosis factor (TNF) blocker or an interleukin 17 (IL-17) inhibitor. TNF blockers target a cell protein that causes inflammation in the body. IL-17 plays a role in your body’s defense against infection and also has a role in inflammation.
TNF blockers help reduce pain, stiffness, and tender or swollen joints. They are administered by injecting the medication under the skin or through an intravenous line.
Physical therapy is an important part of treatment and can provide a number of benefits, from pain relief to improved strength and flexibility. A physical therapist can design specific exercises for your needs.
Range-of-motion and stretching exercises can help maintain flexibility in your joints and preserve good posture. Proper sleep and walking positions and abdominal and back exercises can help maintain your upright posture.
Most people with ankylosing spondylitis don’t need surgery. However, your doctor might recommend surgery if you have severe pain or joint damage, or if your hip joint is so damaged that it needs to be replaced.