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Ankylosing Spondylitis

Ankylosing Spondylitis

Introduction - What Is Ankylosing Spondylitis?

Ankylosing spondylitis (AS) is a systemic rheumatic disease characterized by chronic inflammation of spinal joints and nearby structures (such as the sacroiliac or hip joints). AS is related to a family of diseases commonly referred to as the spondyloarthropathies. The cause of AS is unknown but is thought to be the result of a combination of factors, including the environment, the individual immune response, and, possibly, genetics.11453  As of 2003, Newman, et al, reported that AS may affect up to 1 million adults in the United States.11420  The male-to-female prevalence rate may be as high as 3:1.11500  Males are most often affected in the spine and pelvis, and females are affected by symptoms occurring in the knees, wrists, hips, and pelvis.11452 

Causes of Ankylosing Spondylitis

The exact cause of AS is unknown, although there is evidence that genetics, the way your body’s immune system functions, your response to infections, and environmental factors may play a role in the development. It is thought that one of the factors or a combination of the following factors, in addition to currently unidentified elements, may lead to the development of AS.

  • Genetics (human leukocyte antigen [HLA]-B27)

  • Immune system

Signs and Symptoms of Ankylosing Spondylitis

The main features associated with AS are traditionally enthesitis, synovitis, and sacroiliitis.11477 

  • Enthesitis: inflammation at entheses (location where tendons and ligaments attach to the bone)

  • Synovitis: inflammation of synovial membrane (location is usually the membrane lining joints)

  • Sacroiliitis: inflammation of sacroiliac joints (location of joint between the sacrum, at the base of the spine, and the ilium of the pelvis, joined by ligaments)

Symptoms associated with AS typically begin when the individual is young: AS is most commonly diagnosed in the second and third decades of life. The peak age of onset is near the third decade of life (mean age around 28 years).11453  It is rare (approximately 5%) for symptoms to begin after the age of 40.11500  It is not unusual for the disease to be detected or diagnosed later in life because early symptoms are often minor or disregarded.

Diagnosis of Ankylosing Spondylitis

Physicians who specialize in diagnosing, detecting, and treating AS and other diseases of the joints are called rheumatologists. There is no single test that rheumatologists can use to diagnose a person with AS. Therefore, to accurately diagnosis the disease, a rheumatologist relies on a combination of factors, including patient’s symptoms, physical examination, blood tests, and x-rays of selected joints. The most common symptom in patients with AS patients is inflammatory back pain.11477  Inflammatory back pain during the undiagnosed phase of AS might last up to 5 to 10 years before the symptoms are specific enough to be diagnosed.11453  Inflammation of the back in AS is classically associated with morning stiffness (≤30 minutes), no improvement with rest but with exercise, back pain in the night/early morning, and buttock pain.11478,  11453  AS patients may have tenderness in the sacroiliac joint or pain with hip hyperextension, and these symptoms are considered some of the earliest signs of the disease. Many patients are initially thought to have sciatic nerve irritation from a ruptured disc; however, test results are usually normal. Physicians may also test deep tendon reflexes in the lower extremities with results that are often normal. Patients with advanced ankylosing spondylitis may appear to have a curved spine as seen in Fig.3105.

Figure 3105 – Posture of Patient With Severe and Advanced Ankylosing Spondylitis

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Davis JC Jr. Ankylosing Spondylitis. In: Koopman WJ, Moreland LW, eds. Arthritis and Allied Conditions, 15th Ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2005,1319-1334(chap 63). Figure 63.1, Page 1324. Copyright Lippincott Williams & Wilkins. All rights reserved.

11453

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Treatment of Ankylosing Spondylitis

There is no cure for AS; however, there are effective treatments. Treatment is directed toward reducing inflammation, sometimes suppressing the immune system, and managing the symptoms of disease. If left untreated, AS usually worsens over time. Therefore, rheumatologists generally recommend that once patients have been diagnosed with AS, they begin treatment as soon as possible. Certain medications help to decrease the inflammation of the spine and other joints. Physical therapy and exercise may help to decrease pain, improve posture and spinal mobility, and increase lung capacity.11477 

Medications for Ankylosing Spondylitis

There are several drugs that may be prescribed by your doctor for the treatment of ankylosing spondylitis symptoms. Some may act to reduce pain and inflammation while others work to slow the progression of joint damage. Any drug chosen by your doctor is based upon your individual situation, including your symptoms, other medicines you may be taking, your response to previous treatments, and other factors. Only your doctor can help you decide when a treatment is right for you. Listed below are examples of drug therapies used in the treatment of ankylosing spondylitis11477  :

  • Nonsteroidal anti-inflammatory drugs (known as NSAIDs)

  • Corticosteroids

  • Disease-modifying antirheumatic drugs (known as DMARDs)

  • Biologics

Lifestyle Changes

Patients with ankylosing spondylitis benefit from moderate exercise, which can keep joints moving, maintain flexibility, and potentially improve their symptoms. A safe exercise program can help improve stamina and the ability to perform daily tasks, such as walking and dressing.

Before starting any new exercise program, patients should talk with their doctors to make sure that they choose the appropriate exercises.11477  Gentle, low-impact exercise, such as swimming, water aerobics, and yoga, may allow patients greater mobility with less physical strain. A good diet is closely linked to good overall health and helps control your weight. A balanced diet should contain fruits, vegetables, and whole grains, while sugar, salt, and fat intake should be limited. Your doctor may suggest a weight-reduction program if you are overweight. Excess weight puts additional stress on your hips, back, hands, feet, and joints and can make symptoms worse.11453,  11477 

Discussing Ankylosing Spondylitis With Your Doctor

Your doctor will need to know about the effectiveness of your past treatments as well as your symptoms of ankylosing spondylitis and how it might be affecting your quality of life. It’s often a good idea to write down any questions you want to ask your physician before your appointment so you won’t forget to ask them during your visit. Your doctor will ask questions to help determine the most effective ankylosing spondylitis treatment for you. If you don’t understand your doctor’s answers, don’t be afraid to ask for further explanation.

Questions Your Doctor May Ask You About Your Disease

  • Do you have pain in your lower back?

  • How long have you had your back pain?

  • Do you have any other inflammatory conditions, such as Crohn’s disease or ulcerative colitis?

  • What medications have you taken or are you currently taking?

  • Do you have lower back pain and stiffness that improves from exercise, but not rest?

  • Have you had previous x-rays or MRI scans of your lower back?

  • Do you have any family members with ankylosing spondylitis?

Questions You May Want to Ask Your Doctor

  • How is ankylosing spondylitis diagnosed?

  • What is the cause of ankylosing spondylitis?

  • Is there a cure for ankylosing spondylitis?

  • Can ankylosing spondylitis continue to damage my joints and spine even if I am taking medical therapies?

  • How will I know if my ankylosing spondylitis is controlled?

  • Do I have any joint or spinal damage, and can I become disabled?

  • Can you tell me more about HLA-B27?

  • If a family member has ankylosing spondylitis, will testing for HLA-B27 indicate if I get the disease?

  • What kind of exercise is best?

Additional Information and Resources for Ankylosing Spondylitis

This concludes the discussion of the topic Ankylosing Spondylitis? We encourage you to read other topics on the MEDVERSATION™ website.

Content on this page was last changed on November 19, 2009.

References:

11420.  Newman PA, Bruckel JC. Spondylitis association of America: the member-directed, nonprofit health organization addressing the needs of ankylosing spondylitis patients. Rheum Dis Clin North Am. 2003;29(3):561-574.
11452.  Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A. Ankylosing spondylitis: an overview. Ann Rheum Dis . 2002;61(suppl III):iii8-iii18.
11453.  Davis JC Jr. Ankylosing spondylitis. In: Koopman WJ, Moreland LW, eds. Arthritis and Allied Conditions. 15th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2005:1319-1334.
11477.  Ankylosing spondylitis. In: Klippel JH, ed. Primer on the Rheumatic Diseases . 12th ed. Atlanta, GA: Arthritis Foundation; 2001:250-254.
11478.  Song IH, Sieper J, Rudwaleit M. Diagnosing early ankylosing spondylitis. Curr Rheumatol Rep . 2007;9(5):367-374.
11500.  Taurog JD. The spondyloarthropathies. In: Kasper DL, Braunwald E, Hauser S, Longo D, Jameson JL, Fauci AS, eds. Harrison’s Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2004:1993-1995.
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Last Complete Site Update On: July 22, 2010