Ankylosing spondylitis is a connective tissue disease characterized by spine and extensive joints inflammation, which causes stiffness and pain. The cause of the disease is unknown, but heredity appears necessary. It is ten to twenty times more common in people who have parents or siblings with the disease.
ANKYLOSING SPONDILITIS: General | Symptoms | Diagnosis and Treatment | Prognosis and Treatment | Questions and Answers | Sources/references
About half of patients develop mild, non-progressive arthritis in the knees and other large joints. Inflammation of blood vessels (vasculitis) throughout the body leads to the formation of blood clots, aneurysms (bulging in the weakened wall of a blood vessel), heart attacks, and kidney damage. Affection of the gastrointestinal tract manifests symptoms ranging from mild problems to severe cramps and diarrhea.
The recurring symptoms of Behcet's syndrome are bothersome for the patient. Symptomatic periods and improvement (remission) can last several weeks, months, years, or decades.
Image: The most common symptom is lower back pain.
A possible complication is paralysis. In sporadic cases, damage to the nervous system, gastrointestinal tract, or blood vessels can end in death.
Symptoms
Mild to moderate outbreaks of inflammation alternate with periods of almost no symptoms. The most common symptom is lower back pain, which varies between each outbreak and for each patient. It is usually worse at night. Morning stiffness is also joint and improves with movement. Low back pain and related muscle spasms improve when leaning forward.
This is why patients are often in a forward position and can stiffen in such a position if they are not treated in time. In other patients, the spine becomes markedly straight and stiff. Low back pain can be accompanied by loss of appetite, weight loss, fatigue, and anemia. If inflammation develops in the joints that connect the ribs to the spine, the pain reduces the mobility of the chest and, thus, the ability to breathe deeply.
Video content: Living with ankylosing spondylitis: "I have AS. What to do next?"
Sometimes, pain starts in large joints, e.g., hips, knees, and shoulders. A third of patients have attacks of mild inflammation of the iris (acute iritis), which usually does not impair vision. Inflammation can also damage the heart valves. If the damaged vertebrae press on the nerves or the spinal cord, numbness, muscle weakness, or pain can occur in the areas supplied by the affected nerves.
A rare complication is a set of symptoms that appear due to the pressure of the inflamed spine on the bundle of nerves that run in the spinal canal below the spinal cord. These signs are impotence, nocturnal incontinence, altered sensations in the bladder and rectum, and loss of reflexes in the ankles.
Diagnosis and treatment
Diagnosis is based on the disease picture because laboratory tests cannot detect the disease. It can take several months before a doctor confirms the diagnosis. The symptoms are similar to many other diseases, including Reiter's syndrome, Steven-Johnson syndrome, systemic lupus erythematosus, Crohn's disease, and ulcerative colitis.
Diagnosis is based on a characteristic pattern of symptoms and X-rays of the spine and large joints, which show erosions in the joint between the spine and pelvis (sacroiliac joint) and ossified connections between the vertebrae, causing the spine to stiffen. The sedimentation rate of erythrocytes is high. In addition, a specific gene, HLA-B27, is detected in 90 percent of patients with this disease.
Image: In 90 percent of patients with this disease, a specific gene, HLA-B27, is found.
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Although the disease cannot be cured, specific symptoms can be improved with treatment. For example, inflamed eyes and skin changes improve with the external use of corticosteroids. It is not recommended to give the patient injections because inflammation may develop at the injection site. Severe eye or nerve inflammation should be treated with prednisone or another corticosteroid. If the eye defects are severe or the symptoms of the disease do not improve after corticosteroids, the immunosuppressive drug ciclosporin can be used.
Prognosis and treatment
Most patients do not develop a disability and live an everyday, working life. In some, the disease progresses and causes severe deformities. Treatment aims to alleviate pain in the lower back and joints and prevent or improve spinal deformity.
Acetylsalicylic acid and other nonsteroidal anti-inflammatory drugs reduce pain and inflammation. Indomethacin is the most effective, but its side effects, risk, and price differ significantly.
Corticosteroids are only helpful for short-term treatment of iritis and severe joint inflammation, where they are injected directly into the joint. Muscle relaxants and narcotic analgesics should only be used for a short time to relieve severe pain and muscle spasms.
Video content: Ankylosing spondylitis - causes, symptoms, diagnosis, treatment and pathology.
Operative hip or knee replacement reduces pain and improves joint function when erosions develop or the joint stiffens flexibly. The long-term goal of treatment is to maintain good posture and strengthen solid muscles in the back. With daily exercises, the patient strengthens the muscles that oppose the locked posture.
Questions and answers
What causes the development of ankylosing spondylitis?
The cause of the disease is unknown, but it appears that heredity is essential. It is 10 to 20 times more common in people who have parents or siblings with the disease. A specific gene, HLA-B27, is found in 90 percent of patients with this disease.
What are the symptoms of ankylosing spondylitis?
Symptoms include back pain, early morning numbness, and a hunched posture AS can cause other symptoms such as loss of appetite, weight loss, fatigue, fever, anemia, eye inflammation, and digestive disorders[1].
Who most often gets ankylosing spondylitis?
Symptoms of ankylosing spondylitis most often appear before the age of 40, but in some people, symptoms appear before the age of 16. Men are more likely to be diagnosed with the disease than women[2].
Is ankylosing spondylitis curable?
Ankylosing spondylitis has no cure, but treatments are available to relieve symptoms. Treatment can also help delay or prevent the process of spinal fusion and stiffness. These treatments may also help with non-radiographic axial spondyloarthritis[3].
What are the complications of ankylosing spondylitis?
AS can cause complications in daily life and cause additional medical conditions:
- psoriasis
- reduced mobility
- joint injuries
- osteoporosis and spinal fractures
- diseases of the heart and blood vessels
- Cauda equina syndrome
- inflammatory bowel disease
- iritis[3]
Sources and references
Veliki zravstveni priročnik za domačo uporabo, Založba mladinska knjiga
- Ankylosing Spondylitis - https://www.hopkinsmedicine.org
- Who Gets Ankylosing Spondylitis? - https://www.webmd.com
- Ankylosing spondylitis - https://www.nhs.uk
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