Ankylosing Spondylitis

What is Ankylosing Spondylitis?

Ankylosing Spondylitis (AS) is a chronic, systemic and inflammatory disease of the spine in which the vertebrae, or the bones of the spine, fuse over time and lead to a rigid spine. This fusing is known as ankylosis.

Facts About AS:

• The incidence is 1 in 1,000 persons.
• In the US, about 500,000 people have the disease.
• About 90% of Caucasian people with AS have the HLA B27 gene.
• The gene is seen in about 8% of normal Caucasians.

Signs and Symptoms of Ankylosing Spondylitis (AS):

• Pain and stiffness in the buttocks and low back due to sacroiliac joint involvement which is worse in the morning and improves as the day progresses. This is due to Sacroiliitis. Sacroiliitis occurs when the joints between the pelvic bones and the lowest part of the spine become inflamed and is considered the hallmark of AS.
• Back pain which may wake the patient up at night.
• Movement up from the base of the spine to involve the low back, chest, and neck.

Causes and Risk Factors:

There is currently no known cause of AS, however there are several risk factors which may be associated with developing the diseases. Some risk factors are as follows:

• Gender: Men are at higher risk AS than women.
• Genetics: Most people who develop AS have the HLA-B27 gene. However, most people who have the gene also may never develop the disease.
• Age: The presence of the disease occurs generally in late adolescence or early adulthood.

Treatment:

Ankylosing Spondylitis has no known cure presently and the treatment is centered around preserving the quality of life. This is done by administering medications and performing activities which aim to decrease pain, stiffness, deformity, posture, rate of disease progression and preserve function.

• Exercise programs, stretching, postural training, deep breathing exercises and physical therapy.
• Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) such as cortisone or prednisone may be used for tendon or joints.
• Medications that are normally used for rheumatoid arthritis, such as sulfasalazine or methotrexate, may be used for the peripheral joints (hands, wrists, knees) involvement.
• Newer biologic medications such as etanercept, certolizumab, adalimumab, golimumab, infliximab, and secukinumab may not only help symptoms but also slow the progression of the disease.

Complications:

Fusion of bones of the spine can severely limit a patient’s movement.

• Fusion of the rib cage can lead to impaired lung capability and mobility.
• Loss of vision due to anterior uveitis if left untreated.
• If the eyes are involved (Anterior Uveitis); for example, a patient can have loss of vision if untreated.
• Fracture of the spine.
• LIBD
• Psoriasis

References:

• Everyday Health - What Is Ankylosing Spondylitis (AS)?
• Cleveland Clinic -  Ankylosing Spondylitis (AS)
• Mayo Clinic - Ankylosing Spondylitis