Ankylosing Spondylitis

Ankylosing Spondylitis (AS) is an inflammatory disease that can cause some bones in your spine to fuse. Inflammation of your spine's joints and tissues and vertebrae fusing over time cause reduced flexibility and pain.  

The main ankylosing spondylitis symptoms include back pain and stiffness. Over time a hunched posture may develop. There are a number of treatments that can slow AS down and treat its symptoms. The most common treatments are medications, physiotherapy and exercise.

What is ankylosing spondylitis?

Ankylosing spondylitis (AS) is a painful and progressive type of inflammatory arthritis that primarily affects the spine. 

The name ankylosing spondylitis stems from Ancient Greek words. Knowing what these Greek words mean can help you to understand the condition. Ankylosing means stiff, spondyl means spine, and itis refers to inflammation.

AS causes inflammation in the joints and ligaments of your spine. This can be followed by wearing of the bone where your ligaments or tendons attach to it. As your body heals, new bone develops and may replace the elastic tissue of ligaments or tendons. This repeats and can cause your vertebrae to fuse together, making your spine less flexible and can result in a hunched posture. It can also cause damage to your sacroiliac joint between your spine and hipbone. 

Ankylosing Spondylitis (AS) is a type of Axial spondyloarthritis where changes to your spine or sacroiliac joints can be seen on an X-ray. Another type is non-radiographic axial spondyloarthritis.

Non-radiographic Axial Spondyloarthritis
Non-radiographic axial spondyloarthritis (nr-axSpA) is a similar condition to AS with similar symptoms. However, unlike AS, the physical changes to your spine in nr-axSpA cannot be seen on an X-ray. They can sometimes be seen on an MRI scan.

What causes spondylitis?

The exact cause of ankylosing spondylitis is unknown, genetics seem to play a role. People with the gene called HLA-B27 have a much greater risk of developing ankylosing spondylitis. However, only some people with the gene develop the condition.

Symptoms

Ankylosing spondylitis symptoms tend to develop slowly over months or years. They usually start to present between the ages of 18 and 40 and may come and go, worsen or improve, over many years. 

Signs of ankylosing spondylitis include:

• Back pain and stiffness - especially in the morning and after periods of inactivity. These are usually the main symptoms of AS.
• Joint inflammation (arthritis) - in other parts of your body, such as your hips and knees. This can cause pain, swelling, tenderness, and warmth in the affected joint. 
• Inflammation pain - at the top of your shin bone, behind or under your heel, and where your ribs join the breast bone. 
• Chest pain and an inability to take a deep breath - if the joints between the ribs and spine are affected.
• Fatigue – as the inflammation throughout your body can make it difficult to sleep and also changes how your body uses energy.

Complications

In severe ankylosing spondylitis, your body forms new bone to heal itself, leading to fusion of vertebrae. This stiffens your spine and can also can stiffen your rib cage which restricts your lung capacity and function.

Possible complications:  

• Eye inflammation (uveitis) – is a common complication of AS. It causes eye pain, light sensitivity, and blurred vision. Seek immediate care if these symptoms occur.  
• Osteoporosis and spinal fractures – your bones can become weak and brittle, with an increased risk of fracturing. Weakened vertebrae may crumble, worsening your posture, and vertebral fractures can put pressure on and potentially injure your spinal cord or nerves.  
• Heart issues - inflammation can enlarge the largest artery in your body called the aorta, affecting the aortic valve and its function, increasing your overall risk of heart disease. A Rheumatologist can advise you about lifestyle changes that can minimise your risk of developing cardiovascular disease.
• Psoriasis – commonly occurs with AS. It is a skin condition that causes flaky patches of skin.
• Inflammatory bowel disease (IBD) – may occur with AS. IBD is a group of conditions that cause swelling and inflammation of the tissues in your digestive tract.

How is ankylosing spondylitis diagnosed?

Ankylosing spondylitis can be difficult to diagnose. It develops slowly and there is no one test that shows for certain that you have AS. 

An ankylosing spondylitis diagnosis will be made based on the following:

Medical history, symptoms and physical exam

If you think you might have AS, you should see your doctor. They will look at your medical history, ask you about the symptoms you are experiencing, and perform a physical exam. The physical exam may test the range of motion in your spine, reproduce your pain, and check if you have difficulty expanding your chest.

Blood tests

• Inflammation - you may have blood tests to check for signs of inflammation in your body. However, if your results do not show inflammation, this does not rule out AS.
• Genetics - a genetic blood test may be recommended to see if you have the HLA-B27 gene, which is found in most people with AS. This can contribute towards an AS diagnosis, but not everyone with the condition has this gene variant and not everyone with this gene develops AS.

Imaging tests

• X-rays - check for joint and bone changes in joints and bones. However, there may be no visible signs early in the disease.
• Magnetic resonance imaging (MRI) – provides more-detailed images of your bones and soft tissues. It can show earlier spine changes of non-radiographic axial spondyloarthritis that are not evident on X-rays.

Ankylosing spondylitis treatment

There are a number of treatments that can ease your pain and stiffness, help prevent deformities, and allow you to have as normal a lifestyle as possible. Ankylosing spondylitis treatment depends on your symptoms, your age, your general health, and the severity of your AS. 

AS treatments include:

Medication

Medications can help relieve the pain and inflammation of AS. They include:

• Pain killers and non-steroidal anti-inflammatory drugs (NSAIDs). 
• Disease-modifying anti-rheumatic medicines (DMARDs), such as sulfasalazine, to ease inflammation and control AS.
• Biological therapies including tumour necrosis factor (TNF) blocker or an interleukin-17 (IL-17) inhibitor.
• JAK inhibitors that target enzymes involved in inflammation.
• Corticosteroids to ease inflammation.

Physiotherapy and exercise

Exercise can improve your posture and range of spinal movement, as well as helping to prevent your spine becoming stiff and painful.

A physiotherapist can advise you on the most effective exercises for your needs to help improve your strength and flexibility and relieve your pain. An ankylosing spondylitis therapy treatment plan for AS can include:

• A range-of-motion and stretching exercises.
• Strengthening exercises for your abdominal and back muscles.
• Optimal sleeping and walking positions.

Hydrotherapy is another option that may be recommended, where you carry out specific exercises for your spine, hips and shoulders in a special warm-water pool.

Surgery

Most people with AS will not need surgery. 

Joint replacement surgery may be recommended to improve pain and movement in a severely damaged joint. For example, hip replacement surgery may be carried out if your hip joints are affected.

Rarely, corrective surgery is performed on a badly bent spine.

Is there a cure?

There is no cure for ankylosing spondylitis (AS), but treatments can help relieve your symptoms. In most cases, these include medication, physiotherapy and exercise.

Ankylosing spondylitis treatment at Ramsay Health Care UK

At Ramsay Health Care, we offer fast and convenient appointments with our expert physiotherapists.

Contact us today to speak to our friendly team for more information, or to book an appointment.