Summary about Disease
Ankylosing Spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine. It causes inflammation of the spinal joints (vertebrae) that can lead to severe, chronic pain and discomfort. In more advanced stages, this inflammation can lead to ankylosis (new bone formation) causing the spine to fuse in a fixed, immobile position. Other joints, such as the hips, shoulders, and ribs, can also be affected.
Symptoms
Pain and stiffness in the lower back and hips, especially in the morning or after periods of inactivity.
Pain and stiffness in other joints, such as the shoulders, knees, or ribs.
Fatigue.
Uveitis (inflammation of the eye).
Enthesitis (inflammation of the sites where tendons and ligaments attach to bones, especially at the heel).
Reduced spinal flexibility.
Stooped posture.
Difficulty breathing (if the ribs are affected).
Causes
The exact cause of ankylosing spondylitis is unknown. However, genetic factors play a significant role. Most people with AS have the HLA-B27 gene. Having this gene doesn't guarantee you will get the disease, but it does increase your risk. It's believed that a combination of genetic predisposition and environmental factors (such as bacterial infections) may trigger the disease.
Medicine Used
Nonsteroidal anti-inflammatory drugs (NSAIDs): These are often the first-line treatment to reduce pain and inflammation. Examples include ibuprofen and naproxen.
Tumor necrosis factor (TNF) blockers: These medications block a protein that causes inflammation. Examples include etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol.
Interleukin-17 (IL-17) inhibitors: These medications block another protein that causes inflammation. Examples include secukinumab and ixekizumab.
Janus kinase (JAK) inhibitors: These medications are oral medications that suppress the immune system and reduce inflammation. An example is tofacitinib.
Corticosteroids: Such as prednisone, can be used to reduce inflammation. They are often used for short-term relief or for specific problems like uveitis, due to potential side effects with long-term use.
Analgesics: Pain relievers like acetaminophen or tramadol may be used to manage pain, though they do not address the underlying inflammation.
Disease-modifying antirheumatic drugs (DMARDs): Sulfasalazine is sometimes used, particularly for peripheral joint involvement (joints other than the spine).
Is Communicable
No, ankylosing spondylitis is not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
Maintain good posture: Be mindful of your posture throughout the day.
Exercise regularly: Focus on exercises that improve flexibility, strength, and range of motion, such as swimming, yoga, and physical therapy.
Stop smoking: Smoking can worsen the disease.
Manage weight: Maintaining a healthy weight can reduce stress on joints.
Use proper lifting techniques: to avoid injury to the back.
Regular eye exams: Monitor for uveitis.
Avoid prolonged inactivity: Take breaks to stretch and move around if you have to sit or stand for long periods.
Support groups: Connect with others who have AS for emotional support and shared experiences.
How long does an outbreak last?
Ankylosing spondylitis is a chronic condition, meaning there isn't a single "outbreak" that resolves. Instead, people with AS experience periods of increased symptoms (flares) and periods of remission (reduced symptoms). The duration of a flare can vary greatly from person to person and can last from a few days to several weeks or even months. The length of remission periods also varies.
How is it diagnosed?
Physical Exam: A doctor will assess your posture, range of motion in the spine and other joints, and check for tenderness.
Medical History: The doctor will ask about your symptoms, family history of arthritis or back problems, and any other relevant medical information.
Imaging Tests:
X-rays: Can show changes in the sacroiliac joints (where the spine connects to the pelvis) and spine.
MRI (Magnetic Resonance Imaging): Provides more detailed images of the bones and soft tissues and can detect early signs of inflammation that may not be visible on X-rays.
Blood Tests:
HLA-B27 test: A blood test to determine if you carry the HLA-B27 gene.
Inflammatory markers: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels can indicate inflammation in the body.
Modified New York Criteria: Doctors often use the modified New York criteria to diagnose AS, which includes clinical, radiological, and genetic factors.
Timeline of Symptoms
The timeline of symptoms can vary significantly from person to person. However, a typical progression might look like this:
Early Stages:
Gradual onset of lower back pain and stiffness, often worse in the morning or after periods of inactivity.
Pain may radiate to the buttocks or hips.
Fatigue.
Progression:
Symptoms become more persistent and severe.
Stiffness and pain spread up the spine.
Other joints, such as the shoulders, hips, and knees, may become involved.
Uveitis (eye inflammation) may occur.
Advanced Stages:
Spinal fusion (ankylosis) may occur, leading to a fixed, immobile spine.
Stooped posture.
Difficulty breathing due to rib involvement.
Increased risk of fractures due to weakened bones.
Important Considerations
Early diagnosis and treatment are crucial: to slow the progression of the disease and prevent long-term complications.
Individualized treatment plans: Treatment should be tailored to the individual's specific symptoms and needs.
Multidisciplinary approach: Care should involve a team of healthcare professionals, including a rheumatologist, physical therapist, ophthalmologist, and primary care physician.
Potential complications: Besides spinal fusion, AS can lead to other complications, such as uveitis, osteoporosis, heart problems, and lung problems.
Pregnancy: Women with AS should discuss their condition with their doctor before becoming pregnant, as some medications may not be safe during pregnancy.
Mental health: Chronic pain and disability can lead to depression and anxiety. Seeking support from a therapist or counselor can be beneficial.