Ankylosing Spondylitis

Ankylosing spondylitis is a chronic inflammatory disease predominantly affecting the spine and sacroiliac joints, which connect the lower back to the pelvis. Over time, this condition can cause the fusion of spinal vertebrae, leading to reduced flexibility and potential spinal curvature, known as kyphosis. It is characterized by pain and stiffness that worsens with inactivity and improves with physical activity. While the exact cause remains unclear, genetic factors, particularly the HLA-B27 gene, play a significant role in its development. Effective management includes combining medication, physical therapy, and lifestyle changes to maintain mobility and enhance quality of life.

Causes

The exact cause of ankylosing spondylitis (AS) is unknown, but several factors are known to influence its onset:

• Genetics: The HLA-B27 gene is present in up to 85% of AS sufferers. However, not everyone with this gene develops AS, indicating other genetic factors are likely involved.

• Environmental Factors: Environmental triggers are believed to contribute to AS onset, though the specifics are not yet understood.

• Family History: Individuals with a family history of AS have an elevated risk, particularly if a first-degree relative is affected.

• Demographics: AS is more prevalent among young males and non-Hispanic whites in the U.S. due to a higher frequency of the HLA-B27 gene.

• Associated Conditions: Conditions like Crohn’s disease, ulcerative colitis, uveitis, and psoriasis are linked with AS due to similar inflammatory mechanisms.

While these factors increase the risk of developing AS, they are not direct causes. Ongoing research aims to clarify these complex interactions.

Symptoms

Ankylosing spondylitis (AS) presents a range of symptoms, varying by affected body area:

• Lower Back Pain and Stiffness: Persistent lower back pain, experienced by up to 90% of AS sufferers, often accompanied by morning stiffness. This pain may radiate to the buttocks and typically improves with exercise.

• Joint and Spine Pain: Inflammation may spread to other joints, causing pain and stiffness in the hips, knees, ankles, shoulders, and chest.

• Coexisting Autoimmune Conditions: Approximately 25% may experience uveitis, with symptoms like redness and light sensitivity. Conditions like Crohn's disease, ulcerative colitis, and psoriasis also affect some individuals.

• Spinal Changes and Postural Effects: AS progression may lead to vertebral fusion, resulting in a hunched posture and breathing difficulties if rib joints are involved.

• Other General Symptoms: Fatigue is common, with less frequent symptoms including weight loss and, rarely, eye inflammation.

Symptoms typically manifest before age 30, with diagnosis often occurring by age 35. Seek medical advice for symptom evaluation, especially if back pain disrupts sleep or eye inflammation is present.

Diagnosis

Ankylosing spondylitis (AS) diagnosis can be challenging due to overlapping symptoms with other conditions. Diagnosis involves a comprehensive assessment, including physical examinations, symptom evaluation, and medical history. Imaging tests like X-rays or MRIs are vital, as X-rays might reveal inflammation at the sacroiliac joints. In some cases, MRIs may detect inflammation not visible on X-rays. Blood tests checking for inflammation markers (ESR, CRP) and the HLA-B27 gene can support diagnosis, though they cannot confirm it alone. Consulting a rheumatologist, an expert in autoimmune diseases, may also be necessary.

Treatments

Once diagnosed, patients are typically managed by a rheumatologist focusing on symptom relief, maintaining spinal and joint mobility, preventing permanent postural changes, and ensuring patient independence. Common treatments include nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen and Naproxen. For advanced cases, biologic medications such as TNF blockers and IL-17 inhibitors are recommended. Regular exercise, ideally supervised by a physical therapist, is crucial—while avoiding spinal manipulation to prevent injury. If standard treatments do not suffice, surgical options like hip replacement or, rarely, spinal surgery may be considered based on individual needs.

Medications

Various medications aim to reduce inflammation and relieve symptoms of ankylosing spondylitis (AS):

• NSAIDs: First-line treatments, including Indomethacin (Tivorbex, Indocin), Naproxen (Naprosyn, Anaprox Ds), Celecoxib (Celebrex), and Diclofenac (Arthrotec).

• Biologic Medications: TNF inhibitors like Adalimumab (Humira), Certolizumab pegol (Cimzia), Etanercept (Enbrel), Golimumab (Simponi), and Infliximab (Remicade), or, if needed, IL-17 inhibitors like Secukinumab (Cosentyx) or Ixekizumab (Taltz).

• JAK Inhibitors: Oral alternatives when biologics are unsuitable.

• Corticosteroids: Used cautiously for short-term inflammation control.

• Other Options: Methotrexate and Sulfasalazine for specific joint issues outside the spine.

Each treatment plan is customized, balancing symptom relief and quality of life under rheumatologist guidance.

Prevention

To prevent ankylosing spondylitis progression and manage symptoms:

• Maintain Good Posture: Reduces spinal stress and discomfort.

• Exercise Regularly: Alleviates pain and improves flexibility.

• Prioritize Quality Sleep: A firm mattress aids spinal alignment.

• Follow an Anti-Inflammatory Diet: Fruit and vegetable-rich diets help control inflammation.

• Use Warm Baths or Showers: Relaxes muscles and enhances joint mobility.

• Consult a Specialist: Obtain tailored management strategies from healthcare professionals.