Ankylosing spondylitis is a type of spondyloarthritis, a chronic, inflammatory autoimmune disease that is a rare form of arthritis. It primarily affects the sacroiliac joints between the bones of the pelvis, and the axial skeleton, which includes the spinal column, ribcage, neck, and skull bones.
What Are Symptoms of Ankylosing Spondylitis?
Symptoms of ankylosing spondylitis usually start in late adolescence or early adulthood, and may include:
- Pain and stiffness in the lower back and buttocks
- Mild fever (early stage)
- Loss of appetite (early stage)
- General discomfort (early stage)
- Stooped posture (advanced stage)
- Irritation of soft tissues (muscles, ligaments, tendons) where they enter the bones (enthesitis), especially in extremities
- Bowel inflammation, which may be associated with Crohn’s disease or ulcerative colitis
- Eye inflammation (uveitis or iritis)
- Painful, watery, and red eyes
- Blurred vision
- Sensitivity to bright light
What Causes Ankylosing Spondylitis?
The cause of ankylosing spondylitis is unknown. A combination of genetic and environmental factors is believed to play a role.
Risk factors for ankylosing spondylitis include:
- Family history of the condition
In people who may have a genetic predisposition, triggers for ankylosing spondylitis may include:
- Infections, such as gastrointestinal infections, urinary tract infections (UTIs), and respiratory infections
- Heavy physical activity
- Work stress
- Emotional stress
How Is Ankylosing Spondylitis Diagnosed?
Ankylosing spondylitis is diagnosed with a patient history and physical examination to look for inflammatory back pain and irritation of soft tissues (muscles, ligaments, tendons) where they enter the bones (enthesitis), or arthritis.
Tests used to help confirm the diagnosis of ankylosing spondylitis or rule out other conditions include:
- Blood tests
- HLA-B27 gene
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- Imaging tests
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
- Power Doppler ultrasonography
What Is the Treatment for Ankylosing Spondylitis?
Treatment for ankylosing spondylitis is based on symptoms and severity of the condition and may involve a combination of exercise and physical therapy, medication, and surgery.
Physical therapy and exercise used to treat ankylosing spondylitis includes:
- Core strengthening
- Isometric strengthening
- Breathing exercises
- Dynamic movements
- Fall-prevention exercises
- Posture training to help prevent the spine from becoming “frozen”
- Safety measures to minimize accidents caused by limited mobility
- Modify the home to decrease the risk of falls
- Always wear seatbelts in motor vehicles
- Limit alcohol
- Sleep on a thin pillow to help avoid developing deformities of the neck
- Use narcotics and sleeping pills with caution or avoid them entirely
- Avoid contact sports and high-impact activities if the spine is inflexible
- Support groups to help patients cope
Medications used to treat ankylosing spondylitis include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and stiffness
- Sulfasalazine (a DMARD) and methotrexate for arthritis symptom relief
- Tumor necrosis factor-α (TNF-α) antagonists such as infliximab (Remicade), etanercept (Enbrel), adalimumab (Humira), certolizumab pegol (Cimzia), and golimumab (Simponi), may help improve symptoms
- Anti-interleukin 17 therapy such as secukinumab (Cosentyx) and ixekizumab (Taltz) may be used in place of anti-TNF therapy
- Corticosteroid injections for swollen, painful joints or an inflamed tendon or bursa or the sacroiliac joints. (Oral corticosteroids are not used.)
- Opioids (narcotics) for pain
Surgery used to treat ankylosing spondylitis may include:
- Total hip replacement for severe, chronic hip pain and limited mobility
- Spinal surgery to fuse the bones in the cervical or upper thoracic spine
- Wedge osteotomy to remove a wedge-shaped piece of bone from a vertebra, followed by realignment of the spine which is braced so it can heal in a better position
- Fracture stabilization
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