What is Ankylosing Spondylitis? Causes, Symptoms and Treatment

Ankylosing Spondylitis (AS) is a chronic disease of the spine and other joints. It is an inflammatory disorder that primarily affects the axial skeleton, peripheral joints and extra-particular structures.

It is a form of arthritis that causes severe pain and discomfort to the patient and results in physical deformity as well. It usually begins in the second or third decade of life with the affected male to female ratio being 2:1.

Causes:
The exact cause of this disease is as yet unknown. However, genetics play an important role in determining who is at risk.

What is Ankylosing Spondylitis

Symptoms:

The symptoms of AS progress so gradually, that it is easy to overlook the early signs. The symptoms of the disease are usually first noticed in late adolescence or early adulthood. It rarely begins after 40 years of age. Initial symptoms are:

• Dull pain in the lower back accompanied by morning stiffness of the back. This morning stiffness improves with activity. The symptoms return following inactivity.

• Pain usually increases during the night, forcing the patient to wake up and move about

• Neck pain and stiffness is due to the involvement of cervical spine

• Patients who have a history of Ankylosing Spondylitis should watch out for the above symptoms.

Prognosis Ankylosing Spondylitis:

The severity of AS differs a lot from person to person. While some people only experience back pain and discomfort, others suffer extreme pain and stiffness in multiple joints. The limitation of movement is usually out of proportion to the radiological findings.

The course of the disease is variable, ranging from mild stiffness and normal radiograph to totally fused spine (bamboo spine) and joints with severe disability.

Gradually the disease may spread from one part of the spine to the other. New bone forms over the joint. This fibrous tissue slowly hardens and becomes bony ankylosis. Once ankylosis sets in, the disability is server and joint movement is not possible.

In many instances, the body is then fixed in a forward stooping posture. This disease can also be associated with Planter Fasciitis (heel pain) and Achilles Tendinitis.

Diagnosis of Ankylosing Spondylitis:

Early suspicion is the key to establishing diagnosis and early diagnosis is the key to preventing complications. Important criteria for suspicion of this disease include:

  • Age of onset (below 40 years of age)
  • Insidious onset (slow and gradual onset)
  • Improvement of the condition with exercise
  • No improvement with rest
  • Pain at night which improves on getting up

Early symptoms as can be deceptive, as stiffness and pain in the lower back can be seen in many other condition. In early stages, it can be difficult to diagnose in spite of blood tests.

At times, it can be years before the diagnosis of AS Is even considered. After a certain stage only do x-rays show fluid in the joints and arthritic changes as well.

Diagnosis of advance stages of as is done by:

• X-rays

• Computerized Tomography (CT) – CT scans provide a more detailed examination of the bones than X-rays

• Magnetic resonance imaging (MRI) – MRI scans can visualize soft tissues and cartilages as well

Treatment:

If Ankylosing Spondylitis is established, management of the condition includes:

• Exercise programs to maintain posture and range of motion of the joints

• Anti-inflammatory medication

• Newer drugs like infliximab are tried of late

• Sometimes patients need corrective surgery of the spine and hip joints including total hip replacements

In diagnosed early, Ankylosing Spondylitis can be contained with proper medication and physiotherapy. A person may experience relapses and remissions, but continued therapy enables the person to lead a normal life.

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