What Is Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory arthritic disease. Its primary target joints are the spine and sacroiliac joints. It can also affect the peripheral joints in a more limited manner.

It can be associated with eye inflammation and visual signs and symptoms. Most patients will complain of chronic fatigue, aortitis, or inflammation of aorta. This is a less common associated condition but is very serious.

What Causes AS

Although there is no known specific cause, it has a very high genetic association. About 90% of all AS patients possess the HLA-B27 gene. Interestingly, of all the people that possess the HLA-B27 gene only about 5% actually suffer with the disease.

There is some scientific evidence that AS results from antigenic cross-reaction with bacteria (Klebsiella) or other substances. This will then trigger the body to develop an autoimmune reaction in which it treats its own cells as if they were a foreign substance.

Signs and Symptoms of AS

Males are predisposed to AS three times more than females. The typical patient is between 20 and 40 years of age. Early symptoms are often stiffness in the spine, chronic lower back pain and fatigue. Pain and stiffness may also be present in one or both sacroiliac joints. Referred pain into the buttocks or sciatica like symptoms are also common..

The symptoms are often present for about 10 years before a diagnosis is made.

Although women may also suffer with AS, it has a more serious and aggressive course in men.

Eye signs and symptoms such as inflammation, floaters, pain, and visual loss are present in about 40% of ankylosing spondylitis patients.

Pain and stiffness is more noticeable with rest; whereas, physical activity tends to decrease pain and stiffness.

Some signs and symptoms to look for are:

  • Reduced trunk flexion or the inability to fully bend forward.
  •  Decreased lung excursion due to calcification of rib cartilage and thoracic spine.
  • Sacroiliac joint pain.
  • Stiffness - particularly trunk flexion, head rotation and extension.
  • Sciatica like symptoms such as pain in the buttocks and down the lower extremity.
  • Pain or a dull aching sensation with percussion to the lumbar spine.
  •  Heel spurs or heel pain.
  • Eye inflammation, pain, redness, floaters.

How Is AS Diagnosed

There are no specific tests that can identify ankylosing spondylitis at this time. However, when a young male patient has complaints of stiffness and pain that is relieved with activity, reduced spinal range of motion, heel spurs or pain, possibly eye complaints and reports a family history of similar complaints ankylosing spondylitis should be suspected. A blood test to identify HLA-B27 should be ordered and x-rays taken.

X-rays have limited value in the early onset as radiological signs of AS will not be present until about 10 years after the onset of symptoms.

With the clinical complaints and a positive HLA-B27 test ankylosing spondylitis should be the primary diagnosis. This should then direct early treatment intervention and possibly decrease the chances of the condition becoming more disabling.

How Is AS Treated

Although there is no known cause, it can often be successfully treated with physical therapy, exercise, nutrition and chiropractic adjustments. These lower back pain therapies may reduce the damaging effects to cartilage and joints in the early inflammatory state.

Ankylosing spondylitis has an unpredictable course. It can often cause only mild to moderate symptoms and disability throughout life. Or it can progress to a more serious nature and give rise to extreme pain, loss of motion, aortitis, and visual problems.

In most cases it will subside after the early inflammatory stage and result in mild to moderate signs and symptoms and permit a normal lifestyle with continued treatment or remedies that address the chronic ache and stiffness.

Medications often used in the treatment usually have serious side effects and you should consider this when evaluating the benefits versus the risks. The more common medications are NSAIDs, methotrexate, sulfasalazine, cortocosteroids and opiod analgesics.

Some patients have a very favorable response to acupuncture, regular exercise, nutritional supplements and diet modifications.

The more favored and recommended physical activities include swimming, walking, tai chi, yoga and pilates.

Stretching may have very favorable results and may decrease the chance of more permanent stiffness or loss of motion. If you wish to include stretching exercises make sure you do them following physical activity as this will permit a greater range of motion and will not risk exacerbating your symptoms.

Although I have a family history of AK, tested positive for the HLA-B27 antigen and have suffered with many of the symptoms of AK throughout my life, I have never progressed into the ankylosing stage. I have regularly engaged in strength exercises (weightlifting) for over 30 years and attribute most of my success with managing ankylosing spondylitis to it.

Prognosis

This disease can wax and wane. Some patients will have mild symptoms throughout life. Whereas, others may experience a progressive, more debilitating course. Most AS patients will fall somewhere between the two.

Most authorities will not render an ankylosing spondylitis diagnosis in the absence of visible radiological findings that are associated with ankylosing.

However, it is this author's belief, from personal experience, that in the absence of true ankylosis and visible x-ray findings, patients suffering with the associated symptoms and related signs, and a positive HLA-B27 an ankylosing spondylitis diagnosis is warranted and appropriate treatment should be rendered. This will result in a more favorable prognosis even in the absence of frank ankylosing.

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