Conditions / Ankylosing Spondylitis
Ankylosing Spondylitis
Overview
Ankylosing Spondylitis (AS) is a chronic, progressive form of inflammatory arthritis that primarily affects the spine and sacroiliac joints (where the spine meets the pelvis). Over time, inflammation can lead to fusion of the vertebrae, causing stiffness and reduced flexibility in the spine. AS can also affect other joints, tendons, and even organs like the eyes or heart. It typically begins in early adulthood, more often in men, and symptoms can vary from mild discomfort to significant disability. While there is no cure, early diagnosis and treatment can help manage symptoms and slow disease progression.
Symptoms
Symptoms of ankylosing spondylitis can come on gradually and may vary in intensity. Common signs include:
• Chronic lower back pain and stiffness: Especially in the morning or after periods of inactivity.
• Pain in hips, shoulders, or neck: Can spread to other joints and tendons.
• Improved pain with activity: Unlike mechanical back pain, AS pain often eases movement.
• Fatigue: Ongoing inflammation can cause tiredness or low energy.
• Stooped posture: As the spine stiffens, posture may become hunched.
• Eye inflammation (uveitis): Redness, pain, and blurred vision in one or both eyes.
When to see a doctor
Talk to your healthcare provider if you experience:
• Persistent lower back pain or stiffness, especially if it improves with activity.
• Pain that wakes you in the second half of the night.
• Eye redness or pain, blurred vision, or sensitivity to light.
• Unexplained fatigue or joint swelling.
Early evaluation is key to slowing progression and preserving mobility.
Causes
The exact cause of AS is unknown, but it is strongly linked to genetics:
• HLA-B27 gene: Most people with AS have this genetic marker, although having it doesn’t guarantee you’ll develop the condition.
• Immune system involvement: AS is considered an autoimmune or autoinflammatory condition, where the body’s immune system attacks its own joints and tissues.
Risk Factors
Factors that may increase the risk of developing AS include:
• Family history: A close relative who has AS.
• Gender: More common in men than women.
• Age: Onset usually occurs between the ages of 17 and 45.
• HLA-B27 gene: Presence of this gene significantly raises risk.
Complications
If left untreated, AS can lead to:
• Spinal fusion: Severe inflammation can cause vertebrae to fuse, reducing mobility.
• Limited chest expansion: Inflammation of the rib joints can make breathing difficult.
• Eye inflammation (uveitis): A common extra-articular complication.
• Fractures: Especially in the spine due to reduced flexibility and bone loss.
• Heart or lung issues: In rare cases, inflammation can affect the aorta or lungs.
• Reduced quality of life: Due to chronic pain and limited mobility.
Mediacal Risk
There is no cure for AS, but treatment focuses on managing symptoms, reducing inflammation, and maintaining mobility:
• NSAIDs (nonsteroidal anti-inflammatory drugs): First-line treatment to reduce pain and inflammation.
• Biologic medications: Such as TNF inhibitors (e.g., adalimumab, etanercept) or IL-17 inhibitors (e.g., secukinumab) for more advanced disease.
• Physical therapy and regular exercise: Critical to maintaining posture, flexibility, and lung capacity.
• Posture training: Prevents the spine from becoming rigid in a stooped position.
• Surgery: Rare, but may be needed in severe cases (e.g., hip replacement).
Medical risks of treatment may include:
• Side effects from long-term NSAID use: Such as gastrointestinal bleeding or kidney issues.
• Increased risk of infections: From immune-suppressing biologics.
• Delayed diagnosis: AS is often mistaken for mechanical back pain, delaying treatment.
With the right care, many individuals with AS are able to stay active, maintain independence, and lead fulfilling lives.
Treatments