Overview
Ankylosing spondylitis is an inflammatory disease that affects the spine and other parts of the body. Over time, it can cause some of the bones in the spine to fuse, making the spine less flexible and potentially resulting in a hunched posture. It has two types: ankylosing spondylitis, which is diagnosed through X-ray, and nonradiographic axial spondyloarthritis, which is diagnosed based on symptoms, blood tests, and other imaging tests. Symptoms typically begin in early adulthood and can include back pain, stiffness, fatigue, and neck pain. Inflammation can also occur in other parts of the body, most commonly in the eyes. There is no cure for ankylosing spondylitis, but treatments can help manage symptoms and potentially slow the progression of the disease.
Understanding the disease
Symptoms
The symptoms of ankylosing spondylitis may include:
- Back pain and stiffness in the lower back and hips, especially in the morning and after periods of inactivity.
- Neck pain and fatigue.
- Inflammation in other parts of the body, most commonly the eyes.
- Worsening, improvement, or stoppage of symptoms at irregular intervals.
- Rapid-onset eye pain, sensitivity to light, and blurred vision (uveitis).
- Compression fractures due to weakened vertebrae.
- Heart problems due to inflammation of the aorta. It is essential to seek medical attention if you experience low back or buttock pain that worsens with rest, improves with exercise, or if you develop any symptoms related to eye inflammation or compression fractures.
Risk Factors
Risk factors for developing ankylosing spondylitis include having a gene called HLA-B27, which is associated with the condition, and a family history of the disease. However, having the gene does not necessarily mean a person will develop ankylosing spondylitis, and many people without the gene can still develop the condition. Onset typically occurs in late adolescence or early adulthood.
Development
Ankylosing spondylitis (AS) has two main types: radiographic and nonradiographic. Radiographic ankylosing spondylitis is diagnosed when the condition is visible on X-rays, showing changes in the spine such as fusion of the vertebrae. Nonradiographic axial spondyloarthritis, on the other hand, is diagnosed when the condition cannot be seen on X-rays but is suspected based on symptoms, blood tests, and other imaging tests. In both types, the inflammation caused by ankylosing spondylitis can affect various parts of the body, most commonly the eyes. Genetic factors seem to play a role in the development of AS, with the presence of the HLA-B27 gene increasing the risk of developing the condition. However, not everyone with the gene will develop AS, and some people without the gene can still have the condition. There are various complications associated with ankylosing spondylitis, including eye inflammation (uveitis), compression fractures, and heart problems. It is important to seek medical attention if you experience low back or buttock pain, especially if it worsens with rest and improves with exercise, or if you develop a painful red eye, severe light sensitivity, or blurred vision.
Assessment and Diagnosis
Triage
You should see a doctor if you have symptoms of ankylosing spondylitis, such as low back or buttock pain that worsens in the morning or during periods of inactivity, improves with exercise, and awakens you from your sleep. Neck pain, fatigue, and inflammation in other parts of the body, such as the eyes, are also common symptoms. If you experience a painful red eye, severe light sensitivity, or blurred vision, you should see an eye specialist immediately.
Diagnosis
To diagnose ankylosing spondylitis, doctors typically perform a physical exam to check your range of motion in the spine, pelvis, and legs. They may also try to reproduce your pain by pressing on specific portions of your pelvis or moving your legs into a particular position. Imaging tests, such as X-rays or magnetic resonance imaging (MRI), can help reveal changes in joints and bones. Although X-rays can check for changes in joints and bones, visible signs of ankylosing spondylitis might not be evident early in the disease. Blood tests can check for markers of inflammation, but they are not specific to ankylosing spondylitis. Testing for the HLA-B27 gene can also be done, but its presence does not confirm the diagnosis. The goal of treatment is to relieve pain and stiffness and prevent or delay complications and spinal deformity. Medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), tumor necrosis factor (TNF) blockers, and Janus kinase (JAK) inhibitors, can be used to manage the condition.
Management and Treatment
Complications
Potential complications of ankylosing spondylitis include compression fractures, heart problems, and eye inflammation (uveitis). Compression fractures can occur due to weakened vertebrae, which can lead to a stooped posture and pressure on the spinal cord. Heart problems can result from inflammation of the aorta, leading to aortic valve impairment and an increased risk of heart disease. Eye inflammation can cause rapid-onset eye pain, sensitivity to light, and blurred vision. It is essential to seek medical attention if experiencing symptoms such as low back or buttock pain, severe eye pain, or blurred vision.
Home Remedies
It is important to consult a healthcare provider for proper diagnosis and treatment of ankylosing spondylitis. They can recommend the best course of action, including medications and lifestyle changes, to manage the symptoms and slow the progression of the disease.
Treatment
The treatment options include medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), tumor necrosis factor (TNF) blockers, interleukin-17 (IL-17) inhibitors, and Janus kinase (JAK) inhibitors. Physical therapy and lifestyle changes, such as staying active, quitting smoking, and practicing good posture, are also important in managing the condition. Surgery is generally not recommended unless there is severe pain or damage to the hip joint.
Preparing for medical consultation
To prepare for an appointment for ankylosing spondylitis, you should:
- Make a list of your symptoms, including any that may seem unrelated to the reason for your appointment, and when they began.
- Note key personal information, such as major stresses, recent life changes, and family medical history.
- Create a list of all medications you take, including prescription and nonprescription drugs, vitamins, and supplements, and their doses.
- Bring a family member or friend along for support and to help remember the information provided during the appointment.
- Prepare a list of questions to ask your healthcare team, such as the cause of your symptoms, recommended treatment options, and any alternative approaches.
- Be aware of any pre-appointment restrictions and follow any instructions provided. Remember to be as specific and detailed as possible in describing your symptoms and experiences, and bring this information with you to the appointment.