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Ankylosing Spondylitis

Definition


Disease: Ankylosing Spondylitis Ankylosing Spondylitis
Category: Bones, joints, muscles diseases
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Disease Definition:

Ankylosing spondylitis is an inflammatory disease that can cause some of the vertebrae in the spine to fuse together. This fusing makes the spine less flexible and can result in a hunched-forward posture. A severe case of ankylosing spondylitis can make it impossible for someone to lift the head high enough to see forward.


Ankylosing spondylitis affects men more often than women. Signs and symptoms of ankylosing spondylitis typically begin in early adulthood. Inflammation also can occur in other parts of the body — such as the eyes and bowels.


There is no cure for ankylosing spondylitis, but treatments can decrease the pain and lessen the symptoms.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Early signs and symptoms of ankylosing spondylitis may include pain and stiffness in the lower back and hips, especially in the morning and after periods of inactivity.
These symptoms may come on so gradually that people don't notice them at first. Over time, symptoms may worsen, improve or stop completely at irregular intervals.
The places most commonly affected are:

 

 

  • The joint between the base of the spine and the pelvis
  • The vertebrae in the lower back
  • The places where the tendons and ligaments attach to bones, mainly in the spine, but sometimes along the back of the heel
  • The cartilage between the breastbone and ribs
  • The hip and shoulder joints


A person should see a doctor if he/she has chronic pain and stiffness in the lower back and hips, or if deep breathing makes the chest hurt. One should seek immediate medical advice if they develop eye pain, light sensitivity or blurred vision.

Causes:

Ankylosing spondylitis has no known specific cause, though genetic factors seem to be involved. In particular, people who have a gene called HLA-B27 are at significantly increased risk of developing ankylosing spondylitis.


As ankylosing spondylitis worsens and the inflammation persists, new bone forms as part of the body's attempt to heal. This new bone gradually bridges the gap between vertebrae and eventually fuses sections of vertebrae together. Those parts of the spine become stiff and inflexible. Fusion can also stiffen the rib cage, restricting the lung capacity and function.
There are certain risk factors that contribute to having Ankylosing spondylitis, including:

Sex: Men are more likely to develop ankylosing spondylitis than are women.
Age: Onset generally occurs in late adolescence or early adulthood.
Heredity: Most people who have ankylosing spondylitis have the HLA-B27 gene. But many people who have this gene never develop ankylosing spondylitis.
 

Complications

Complications:

Ankylosing spondylitis doesn't follow a set course. The severity of symptoms and development of complications vary widely from person to another. Complications may include:


Eye Inflammation (Uveitis):
One of the most common complications of ankylosing spondylitis, uveitis can cause rapid-onset eye pain, sensitivity to light and blurred vision. A person should see doctor right away if he/she develops these symptoms.


Compression Fractures:
Some people experience a thinning of their bones during the early stages of ankylosing spondylitis. Weakened vertebrae may crumble, increasing the severity of the stooped posture. Vertebral fractures sometimes can damage the spinal cord and the nerves that pass through the spine.


Difficulty Breathing:
If ankylosing spondylitis affects the ribs, the fused bones can't move when the person breathes — making it difficult to fully inflate the lungs.


Heart Problems:
Ankylosing spondylitis can cause problems with the aorta, the largest artery in the body. The inflamed aorta can enlarge to the point that it distorts the shape of the aortic valve in the heart, which impairs its function.

Treatments:

The goal of treatment is to relieve the pain and stiffness, and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage to the joints.


Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as naproxen and indomethacin — are the medications doctors most commonly use to treat ankylosing spondylitis. They can relieve the inflammation, pain and stiffness. However, these medications also can cause gastrointestinal bleeding.


If NSAIDs aren't helpful, the doctor may suggest tumor necrosis factor (TNF) blockers. TNF is a cell protein that acts as an inflammatory agent in rheumatoid arthritis. TNF blockers target this protein to help reduce pain, stiffness, and tender or swollen joints. They are administered by injecting the medication under the skin or through an intravenous line.
Examples of TNF blockers include:

 

  • Adalimumab
  • Etanercept
  • Infliximab
  • Golimumab

 

TNF blockers can reactivate latent tuberculosis and may cause certain neurological problems.


Therapy
Physical therapy can provide a number of benefits, from pain relief to improved physical strength and flexibility. The doctor may recommend that the person should meet with a physical therapist to provide him/her with specific exercises designed for his/her needs.
Range-of-motion and stretching exercises can help maintain flexibility in the joints and preserve good posture. In addition, specific breathing exercises can help to sustain and enhance the lung capacity.
If the condition worsens, the upper body may begin to stoop forward. Proper sleep and walking positions and abdominal and back exercises can help maintain the upright posture. Even if portions of the spine eventually fuse, the person will be able to get around and perform daily functions more easily if the spine fuses in an upright position.


Surgery
Most people with ankylosing spondylitis don't need surgery. However, the doctor may recommend surgery if patients have severe pain or joint damage, or if a hip joint is so damaged that it needs to be replaced.
 

Prognosis:

Not Available

Expert's opinion

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