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Ankylosing spondylitis – What are its symptoms, diagnosis, and treatment options

A rare form of arthritis, ankylosing spondylitis is a condition that is often identified by stiffness and pain in the spine. Also known as Bechterew’s disease, the condition starts in the lower back. It can progress to the neck and go on to damage various other joints in the body. While ankylosis is a term used for fused bones, spondylitis refers to inflammation in the vertebrae or the spinal bones.

Ankylosing spondylitis – What are its symptoms, diagnosis, and treatment options
In the most severe cases of the condition, the spine can become hunched. Ankylosing spondylitis cannot be cured. But with some medication and physical exercises, the pain can be controlled and the back can be strengthened.

The symptoms of ankylosing spondylitis

The symptoms caused by the condition can vary from case to case. But commonly, some flare-ups in inflammation are experienced. There are durations when there are no symptoms experienced.

Back pain is among the common symptoms of the condition. It occurs in the morning and at night. Pain in large joints such as shoulders and hips is also a common symptom. Other symptoms of ankylosing spondylitis can include the following:

  • Stiffness that occurs in the morning
  • Stooping shoulders or other posture-related problems
  • Appetite loss
  • Fever that remains low grade
  • Loss in body weight 
  • Fatigue
  • Low iron levels in the body or anemia
  • Problems with the functioning of the lungs.

The condition leads to inflammation. Therefore, it is highly likely to affect other body parts as well. When it does so, the following symptoms can be experienced:

  • Bowel inflammation
  • Mild inflammation in the eye
  • Inflammation in the heart valve
  • Achilles tendonitis.

There can be several causes of pain in the lower back area. Usually, it will be the result of a trauma caused by a sudden strain to the spine. However, one should be aware that back pain can also be a result of something more severe like ankylosing spondylitis. Therefore, make sure to note all the warning signs that could be pointing towards the condition. Some of the warning signs that one should pay attention to are:

An unexplained lower back pain: If lower back pain is not caused by something severe, it will go away after one takes some rest. However, with ankylosing spondylitis, it is the opposite. The pain worsens when the person wakes up. In most cases of ordinary back pain, exercises might not be recommended. But with ankylosing spondylitis, one might start feeling relieved from the symptoms after some exercise.

Pain in the lower back area is common in the younger population. So, if young adults or teens have been experiencing any problems in the lower back, they must get checked for ankylosing spondylitis. The pain resulting from ankylosing spondylitis will often be felt at the point where the spine and the pelvis meet, which is also known as sacroiliac joints.

A history of ankylosing spondylitis: If there has been a family history of the condition, a person can carry genetic markers that make them prone to ankylosing spondylitis. However, the presence of the gene does not always mean that the person will develop the condition. The reason behind this is yet to be ascertained. But if a person has a family member who has ankylosing spondylitis or psoriatic arthritis, it can put them at a higher risk of developing the condition.

Unexplained pain affecting the chest, joints, or heels in young people: In some cases of ankylosing spondylitis, people start experiencing stiffness or pain affecting their wrist joints, ankles, heels, or some other joints. In some cases, the rib bones can also be affected. The pain usually occurs at the point where the rib bones meet the spine. When the condition causes pain in the chest, it can cause difficulty breathing. 

Pain starts moving slowly toward the spine: Ankylosing spondylitis is a progressive disease. Some exercises can be done to get relief from the symptoms. However, the disease worsens with time. The symptoms might not be there all the time, but they never stop occurring completely. The inflammation and pain start from the lower back and move upwards. If the condition is not treated, the vertebrae of the spine bones might fuse into each other and cause the spine to bend forward. This may permanently affect the shape of the spine.

Anti-inflammatory medications can provide relief: In the initial stages, people with ankylosing spondylitis may get relief from the symptoms by taking anti-inflammatory medications. However, these meds do not cure the disease. Once a person is diagnosed with ankylosing spondylitis, the doctor will prescribe them stronger medications for the condition. These medicines will be focused on certain parts of the immune system. With the help of these medications, the progression of the disease can be slowed down with time.

Causes

The exact cause of ankylosing spondylitis is yet to be known. If an individual has a family history of the condition, they do face the risk of developing it. So, it is thought that genes might have a role to play in the development of the condition. If a person’s parents or other members in the family suffer from ankylosing spondylitis, researchers suggest that it can put the person at a risk that could be 10 to 20 times higher. Several factors can increase the chances of a person developing ankylosing spondylitis. These include the following:

  • Family history: Having the HLA-B27 protein present in the body, along with a family history of the condition, can increase the risk of developing ankylosing spondylitis. In a 2002 study, it was seen that over 90 percent of ankylosing spondylitis patients carried the gene expressing HLA-B27 protein.
  • Age: The symptoms of ankylosing spondylitis often appear in younger adults, which is unlike other bone-related disorders. Adults aged between 20 and 40 years of age experience the symptoms commonly.
  • Gender: The condition is three times more common in males. However, it affects females also.
  • Race and ethnicity: Caucasian people are more prone to ankylosing spondylitis than people from other ethnicities.

Complications to look out for

If the condition is not treated, it can lead to some complications. These can include the following:

  • Chronic inflammation can lead to the fusing of spinal bones or vertebrae
  • Inflammation can start affecting adjacent joints such as shoulders and hips
  • Inflammation can affect tendons as well as ligaments, which can cause worsening of the flexibility 
  • Breathing problems
  • Irritation in the eye
  • Damage to the heart or the bowel
  • Fractures in the spine, caused due to compression.

How does ankylosing spondylitis affect the body?

It can spread to other joints as it progresses, but ankylosing spondylitis primarily affects the spine. The inflammation caused by the condition can affect other joints in the body. It can even cause damage to other parts of the body such as the lungs, heart, and eyes. It can affect the body in the following ways:

Effects on the skeletal system: Inflammation caused by the condition mainly affects the spine, especially the lower spine area. One can experience stiffness and pain, which can become worse when one wakes up in the morning or after sitting for a long duration. As the condition progresses, it can lead to the curving of the spine and hence, stooping of the posture. Pain can start moving upwards and start affecting the neck, the upper part of the spine, and even the chest. There is data that also suggests that around 10 percent of ankylosing spondylitis patients suffer from jaw inflammation, which can even affect the process of chewing.

Effects on the nervous system: When the condition becomes severe, it leads to scarring on the nerve bundle, which is situated at the base of the spine. This can cause health issues such as sexual dysfunction and incontinence. The eyes are at the highest risk of getting affected by the condition. Almost one-third of ankylosing spondylitis cases suffer from eye inflammation. This often leads to a condition known as iritis. Here, bright light can be too intense for the eyes and can interfere with the vision. Although rare, blindness can also be a complication. With proper and early treatment, damage to the eyes can be prevented.

Effects on the integumentary system: This is not common, but ankylosing spondylitis can also lead to the development of psoriasis in some cases. Psoriasis is a skin condition that leads to the development of scaly patches and redness on the skin. The patches can be seen anywhere in the body, but usually, they can be seen affecting the elbows, knees, and scalp. In some cases, blisters or lesions can form on the skin. The symptoms usually include stinging, a burning sensation, itching, and tenderness.

Effects on the circulatory system: There can be a lack of red blood cells in the body due to ankylosing spondylitis. This leads to anemia or fatigue. In some rare cases, the ankylosing spondylitis inflammation reaches the point where the heart connects with the aorta, thus leading to enlargement of the aorta. Ankylosing spondylitis patients are also at a high risk of developing cardiovascular diseases and the ensuing complications, which include heart attack, stroke, and angina.

The ways in which ankylosing spondylitis is diagnosed

While conducting a physical exam, the doctor can check a person’s motion range. To do so, he/she might ask the patient to bend from different angles. The doctor might also want to check the points where it pains. For this, they might press various parts of the pelvis or move the patient’s legs to a different angle. To check if the chest area has been affected, the patient might also be asked to take a few deep breaths.

Various tests can be ordered to diagnose ankylosing spondylitis. These can include:

Imaging tests: Although in the early stages of the condition there might not be any visible signs of the disease, the doctor can order an X-ray to look for any changes in the bones and joints. MRI can also be ordered.

Lab tests: There are no lab tests specifically designed to diagnose ankylosing spondylitis. But with the help of some blood samples, inflammation markers can be identified in the body. However, the causes of inflammation are many.

Treatment options

The treatment for ankylosing spondylitis focuses on relieving symptoms such as stiffness and pain. It can also be aimed at delaying the progression of the disease. The best results from the treatment can only be achieved if the treatment starts before the condition has done irreparable damage to the joints.

The various treatment options for ankylosing spondylitis include:

Medicines: NSAIDs are the most commonly prescribed medications to manage the symptoms of ankylosing spondylitis. They can help in getting relief from stiffness and pain caused by the condition. But these medications can have side effects and lead to gastrointestinal bleeding. If NSAIDs don’t show the expected results, the patient might be prescribed biologic medication such as an interleukin-17 inhibitor.

Therapy: One of the important aspects of the treatment for ankylosing spondylitis is physical therapy since it can prove to be extremely beneficial. It can provide relief from pain and even strengthen the patient’s body. In consultation with a physical therapist, the patients can do specific exercises that help them benefit the most. Some exercises are specifically aimed at providing flexibility to the joints and helping the body to stay in the correct posture. 

Surgery: In most cases of ankylosing spondylitis, surgery is not required. But if the pain is unbearable and there is severe damage caused to the joints, the doctor might prescribe a surgery. Also, if there is serious damage caused to the hip joint, a surgery can be done to replace the hip.

Lifestyle changes: In addition to these treatments, several lifestyle changes can help an ankylosing spondylitis patient to manage the condition. These include:

  • Staying physically active
  • Using heat and cold therapy
  • Quitting smoking
  • Practicing good posture.

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