Ankylosing Spondylitis: Symptoms, Causes, and Treatment

If you have chronic back pain that lasts for more than three months, you might have a condition called ankylosing spondylitis. Ankylosing spondylitis is a type of inflammatory arthritis that mainly affects the spine, causing inflammation, stiffness, and fusion of the vertebrae. Ankylosing spondylitis can also affect other joints and organs, such as the eyes, heart, lungs, and kidneys.

In this blog post, we will explain what ankylosing spondylitis is, what causes it, how it is diagnosed, and how it can be treated. We will also share some tips on how to manage your symptoms and improve your quality of life.

What is ankylosing spondylitis?

Ankylosing spondylitis is a chronic autoimmune disease that causes inflammation in the joints of the spine. The inflammation can lead to new bone formation, which can fuse the vertebrae together and limit the mobility of the spine. This can result in a hunched posture and reduced flexibility.

Ankylosing spondylitis usually starts in the lower back (sacroiliac joints) and gradually spreads to the upper spine (cervical spine). It can also affect other joints, such as the hips, shoulders and ribs. In some cases, ankylosing spondylitis can cause inflammation in other parts of the body, such as the eyes, skin intestines, heart, lungs, and kidneys.

Ankylosing spondylitis affects about 0.5% to 1% of the population worldwide. It is more common in men than in women, and usually begins in early adulthood (between 15 and 45 years old). The severity and progression of ankylosing spondylitis vary from person to person. Some people may have mild symptoms that do not interfere with their daily activities, while others may have severe symptoms that affect their physical function and mental health.

What causes ankylosing spondylitis?

The exact cause of ankylosing spondylitis is unknown, but it is believed to involve a combination of genetic and environmental factors. The most important genetic factor is a gene called HLA-B27, which is found in about 90% of people with ankylosing spondylitis. However, not everyone who has this gene develops ankylosing spondylitis, and some people who do not have this gene can still develop ankylosing spondylitis. Therefore, other genes and environmental triggers may also play a role.

Some possible environmental factors that may contribute to ankylosing spondylitis include:

• Infections: Some bacteria or viruses may trigger an abnormal immune response that causes inflammation in the joints. 
• Smoking: Smoking can worsen the inflammation and damage caused by ankylosing spondylitis.
• Physical trauma: Injuries or stress to the spine or joints may trigger or aggravate ankylosing spondylitis symptoms.
• Hormones: Hormonal changes may influence the onset or severity of ankylosing spondylitis. For example, some women may experience improvement or worsening of their symptoms during pregnancy or menopause.
• Diet: Some foods may increase or decrease inflammation in the body. For example, some studies suggest that a low-starch diet may help reduce ankylosing spondylitis symptoms.

How is ankylosing spondylitis diagnosed?

There is no single test that can diagnose ankylosing spondylitis Instead, your doctor will use a combination of methods to evaluate your symptoms, medical history, physical examination, blood tests, and imaging tests.

Some of the methods used to diagnose ankylosing spondylitis include:

• Symptoms: Your doctor will ask you about your symptoms, such as when they started, how often they occur, how severe they are, and how they affect your daily life. Some common symptoms of ankylosing spondylitis include:

            Chronic back pain that lasts for more than three months
            Morning stiffness that improves with movement
            Reduced range of motion in the spine
            Pain and swelling in other joints
            Fatigue
            Fever
            Weight loss
            Eye inflammation
            Skin rashes
            Digestive problems

• Medical history: Your doctor will ask you about your personal and family history of ankylosing spondylitis or other related conditions. This can help determine if you have a genetic predisposition to ankylosing spondylitis or if you have been exposed to any environmental triggers.
• Physical examination: Your doctor will examine your spine and joints for signs of inflammation, stiffness, fusion, or deformity. They will also check your posture, flexibility, mobility, and strength.
• Blood tests: Your doctor may order blood tests to check for markers of inflammation (such as erythrocyte sedimentation rate or C-reactive protein) or genetic factors (such as HLA-B27). However, these tests are not conclusive and may be normal in some people with ankylosing spondylitis or abnormal in some people without ankylosing spondylitis
• Imaging tests: Your doctor may order imaging tests such as X-rays, MRI scans, CT scans, or ultrasound to visualize your spine and joints. These tests can show signs of inflammation, erosion, fusion, or new bone formation. However, these changes may not be visible in the early stages of ankylosing spondylitis or may be present in other conditions.

Therefore, the diagnosis of ankylosing spondylitis is based on a combination of clinical criteria and imaging findings. The most widely used criteria are the modified New York criteria, which require the presence of:

1. Low back pain and stiffness for more than three months that improves with exercise but not with rest
2. Limited motion of the lumbar spine in bending backwards and sideways
3. Limited chest expansion relative to normal values for age and sex
4. Radiographic evidence of inflammation of the sacroiliac joints

How is ankylosing spondylitis treated?

There is no cure for ankylosing spondylitis, but there are treatments that can help reduce the pain, inflammation, and progression of the disease. The main goals of treatment are to:

• Relieve symptoms
• Maintain function and mobility
• Prevent complications
• Improve quality of life

The treatment plan for ankylosing spondylitis may include:

1. Medications: There are different types of medications that can help manage ankylosing spondylitis symptoms, such as:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs can reduce pain and inflammation in the joints. They are usually the first-line treatment for ankylosing spondylitis
• Disease-modifying antirheumatic drugs (DMARDs): These drugs can slow down the progression of joint damage and prevent complications. They are usually used for people who have severe or active ankylosing spondylitis or who do not respond well to the above groups of medicines (NSAIDs).
• Biologic agents: These drugs are a newer class of medications that target specific molecules involved in the inflammatory process. They can be very effective in reducing inflammation and preventing joint damage. They are usually used for people who have moderate to severe ankylosing spondylitis or who do not respond well to the above 2 groups of medicines (NSAIDs or DMARDs).
• Corticosteroids: These drugs can provide rapid relief of pain and inflammation in the joints. They are usually given as injections into the affected joints or as pills for short-term use. They are not recommended for long-term use due to their side effects.
• Analgesics: These drugs can help relieve pain in the joints or other parts of the body. They are usually used as needed or as an adjunct to other medications.

2. Physical therapy: Physical therapy can help improve your posture, flexibility, mobility, strength, and endurance. It can also help prevent or correct spinal deformities and reduce the risk of fractures. A physical therapist can design an individualized exercise program for you that may include:

• Stretching exercises: These exercises can help loosen up your stiff joints and muscles and improve your range of motion.
• Strengthening exercises: These exercises can help build up your muscles that support your spine and joints and improve your stability and balance.
• Aerobic exercises: These exercises can help improve your cardiovascular health and endurance and reduce fatigue.
• Postural exercises: These exercises can help correct your posture and alignment and prevent or reduce spinal curvature.
• Breathing exercises: These exercises can help expand your chest wall and improve your lung function.

 3. Surgery: Surgery is rarely needed for ankylosing spondylitis, but it may be an option for some people who have severe joint damage or deformity that affects their function or quality of life. Some types of surgery that may be performed for ankylosing spondylitis include:

• Joint replacement: This surgery involves replacing a damaged joint with an artificial one made of metal, plastic, or ceramic. It can help restore function and mobility and relieve pain. The most common joints replaced are the hips and knees.
• Spinal fusion: This surgery involves joining two or more vertebrae together with metal rods, screws, or plates. It can help stabilize the spine and prevent further fusion or curvature. However, it also reduces the flexibility of the spine.
• Osteotomy: This surgery involves cutting and reshaping a bone to correct its alignment or position. It can help improve posture and appearance and relieve pressure on nerves or organs.

4. Lifestyle modifications: There are some lifestyle changes that can help you cope with ankylosing spondylitis and improve your well-being, such as:

• Quitting smoking: Smoking can worsen the inflammation and damage caused by ankylosing spondylitis It can also increase your risk of cardiovascular disease, lung disease, osteoporosis, and infections. Quitting smoking can improve your health and reduce your need for medications.
• Eating a healthy diet: Eating a balanced diet that includes plenty of fruits, vegetables, whole grains, lean protein, healthy fats, calcium, and vitamin D can provide you with the nutrients you need to support your immune system, reduce inflammation, and prevent weight gain. Some foods that may be beneficial for ankylosing spondylitis include omega-3 fatty acids (found in fish, nuts, seeds, and oils), antioxidants (found in berries, citrus fruits, green tea, and dark chocolate), and probiotics (found in yogurt, kefir, sauerkraut, and other fermented foods). Avoid foods that may trigger or worsen inflammation, such as processed meats, refined sugars, fried foods, and alcohol.
• Exercising regularly: Physical activity can help you maintain your flexibility, mobility, posture, and strength. It can also improve your mood, sleep quality, and energy levels. Aim for at least 150 minutes of moderate-intensity aerobic exercise (such as walking, cycling, or swimming) and two sessions of strength training (such as lifting weights or using resistance bands) per week. You can also try low-impact exercises that are gentle on your joints, such as yoga, tai chi, or pilates. Consult your doctor or a physical therapist before starting any exercise program and follow their recommendations on how to modify or avoid certain movements that may cause pain or injury.
• Managing stress: Stress can trigger or worsen inflammation and pain in ankylosing spondylitis It can also affect your mental health and quality of life. Finding healthy ways to cope with stress can help you reduce its negative impact on your well-being. Some examples of stress management techniques include meditation, breathing exercises, relaxation therapy, biofeedback, cognitive-behavioral therapy (CBT), mindfulness, hobbies, social support, and humor.
• Getting enough sleep: Sleep is essential for your body to heal and repair itself. It can also affect your mood, cognition, and immune function. Lack of sleep or poor sleep quality can worsen your symptoms and make you more susceptible to infections. To improve your sleep hygiene, try to follow a regular sleep schedule, avoid caffeine, nicotine, and alcohol before bedtime, limit screen time at night, create a comfortable and dark sleeping environment, use pillows or cushions to support your joints and spine, and avoid napping during the day.

These lifestyle modifications can help you manage ankylosing spondylitis better and enhance your overall health. However, they are not a substitute for medical treatment. You should always follow your doctor's advice on medication use, monitoring, and follow-up.

Remember that ankylosing spondylitis is a chronic condition that requires long-term care and attention. By taking care of yourself physically and mentally, you can live a fulfilling life with ankylosing spondylitis.