Ankylosing Spondylitis Causes, Symptoms and Management

Introduction

Ankylosing Spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints, leading to pain, stiffness, and eventual fusion of the vertebrae in severe cases. This condition belongs to a group of diseases known as spondyloarthropathies, which are types of arthritis that inflame the spine.

Let’s delve deeper into the meaning of Ankylosing Spondylitis, explore its causes, recognize the symptoms, understand the diagnosis process, and examine the available treatment options.

What is Ankylosing Spondylitis?

Ankylosing Spondylitis is a progressive autoimmune disease that causes long-term inflammation in the joints of the spine, particularly the sacroiliac joints located at the base of the spine where it connects with the pelvis. Over time, chronic inflammation can lead to new bone formation, causing the vertebrae to fuse together (ankylosis), which results in a rigid spine and reduced flexibility.

Although AS mainly targets the spine, it can also affect other joints like hips, shoulders, and ribs. In some cases, it may involve eyes, heart, and lungs, making it a systemic condition.

It typically starts in late adolescence or early adulthood, often between the ages of 20 and 40, and is more common in men than women.

Causes of Ankylosing Spondylitis

The exact cause of Ankylosing Spondylitis is not fully understood, but it is believed to involve a combination of genetic and environmental factors.

1. Genetic Factor (HLA-B27 gene) :- One of the strongest associations is with the HLA-B27 gene. Around 80–95% of people with AS test positive for this gene. However, not everyone with the gene develops the disease, suggesting other triggers are also involved.

2. Immune System Dysfunction :- AS is an autoimmune disorder where the body’s immune system mistakenly attacks its own joints, especially in the spine and pelvis.

3. Environmental Triggers :- Certain infections or gut bacteria may trigger the immune response in genetically susceptible individuals.

Symptoms of Ankylosing Spondylitis

The symptoms of Ankylosing Spondylitis usually develop gradually over time and can vary significantly from person to person. The hallmark features are chronic back pain and stiffness, especially in the lower back and buttocks.

Common Symptoms:

1.  Chronic Lower Back Pain :- Persistent pain in the lower back and buttocks lasting for more than 3 months. Often worse in the morning or after periods of inactivity. Improves with exercise, not with rest (a key distinguishing feature from mechanical back pain).
   
2. Morning Stiffness :- Stiffness that lasts for 30 minutes or more after waking up. Gradually eases with movement throughout the day.
   
3. Limited Spinal Mobility :- Decreased flexibility in the spine and loss of posture. Difficulty bending forward, sideways, or turning the head.
   
4. Pain in Other Joints :- Pain and swelling in large joints such as the hips, shoulders, or knees. It can also affect the sternum or ribs, causing chest pain and difficulty breathing deeply.
   
5. Fatigue :- Generalized tiredness and lack of energy due to chronic inflammation.
   
6. Enthesitis :- Inflammation of the entheses, where tendons and ligaments attach to bone. Common in areas like the Achilles tendon or under the heel.
   
7. Eye Inflammation (Uveitis/Iritis) :- Occurs in about 30-40% of cases. Causes eye pain, redness, blurred vision, and sensitivity to light.
   
8. Advanced Symptoms :- As the disease progresses, fusion of vertebrae can occur, leading to a forward-stooped posture (kyphosis). Breathing difficulty due to the stiffening of the chest wall.
   

Diagnosis of Ankylosing Spondylitis

Early diagnosis is essential to prevent permanent spinal damage. However, diagnosis can be delayed because symptoms often mimic common back pain in early stages.

Key Diagnostic Methods:

• Medical History and Physical Examination

1. Chronic back pain and stiffness lasting more than 3 months.
   
2. Positive family history of AS or related diseases.
   
3. Limited spinal movement and chest expansion on examination.
   

• Blood Tests

1. HLA-B27 test: Presence supports the diagnosis, though not definitive.
   
2. Elevated inflammatory markers like ESR (Erythrocyte Sedimentation Rate) or CRP (C-Reactive Protein).
   
3. Rheumatoid factor (RF) is usually negative, helping to differentiate from other forms of arthritis.
   

•  Imaging Tests

1. X-rays of the pelvis may show sacroiliitis (inflammation of sacroiliac joints).
2. MRI can detect early joint inflammation and soft tissue involvement before X-ray changes are visible.
3. CT scan may also be used for clearer imaging of the spine.
   

Treatment Options for Ankylosing Spondylitis

There is no permanent cure for Ankylosing Spondylitis, but treatments focus on managing symptoms, reducing inflammation, and preserving mobility.

1. Medications

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) :- First-line treatment for reducing pain and inflammation. Examples: Ibuprofen, Naproxen, Indomethacin.
  
• Disease-Modifying Anti-Rheumatic Drugs (DMARDs) :- Used when peripheral joints (like knees or hips) are involved. Example: Sulfasalazine.
  
• Biologic Agents :- TNF-alpha inhibitors is to  Reduce inflammation by blocking tumor necrosis factor. Examples: Etanercept, Infliximab, Adalimumab.
  IL-17 inhibitors is Newer drugs targeting another inflammatory pathway. Example: Secukinumab.
  
• Corticosteroids :- Used in short courses to manage flares or localized inflammation.  Not recommended for long-term use due to side effects.
  

2. Physical Therapy and Exercise :-

Regular physical activity is crucial in maintaining spinal flexibility, posture, and joint mobility.

• Stretching and strengthening exercises
• Swimming and yoga
• Postural training to avoid spinal deformities
• Breathing exercises to improve chest expansion
  

A physiotherapist can design a personalized exercise plan.

3. Lifestyle Modifications

• Quit smoking: Smoking worsens spinal damage and lung function.
• Maintain a healthy weight to reduce stress on joints.
• Balanced diet rich in anti-inflammatory foods (omega-3 fatty acids, fruits, vegetables).
  

4. Surgical Options

Surgery is rarely needed but may be considered for:

• Severe hip or knee joint damage (joint replacement surgery)
  
• Spinal deformities causing functional limitations
  
• Spinal fractures or instability
  

When to See a Doctor?

Seek medical attention if you experience:

• Persistent back pain and stiffness, especially in the morning or after rest
• Pain that improves with exercise, not with rest
• Unexplained fatigue or eye redness
• Difficulty breathing deeply or stooped posture
  

Early detection and prompt treatment can slow disease progression and prevent complications.

Conclusion

Ankylosing Spondylitis is a life-altering condition, but with proper treatment and lifestyle adaptations, many individuals lead active and fulfilling lives. Understanding the early warning signs, getting a timely diagnosis, and starting an appropriate treatment plan are critical for long-term management. If you suspect AS or have chronic back pain that doesn’t improve with rest, consult a rheumatologist for evaluation and care.