Ankylosing spondylitis (AS) is a rare form of arthritis affecting only 1% of Americans.
Also referred to as Bechterew disease, AS is a lifelong condition that causes pain and stiffness of the spine. AS typically starts with inflammation in the lower back, specifically in the sacroiliac joints. This inflammation affects places in the body where tendons and ligaments attach to the bone and over time, it can spread from the lower back up the neck or to other parts of the body. In some cases AS can cause the vertebrae to fuse together, hence the name ankylosing spondylitis. Ankylosing means fused bones and spondylitis means inflammation of the spinal bones. When this happens the spine becomes less flexible and can cause patients to present with a forward-hunch posture. AS can also affect the shoulders, hands, rib cage, feet, heels, and hips.
The onset of AS generally occurs in late adulthood or early adolescence. Men are much more likely to develop AS and experience symptoms earlier. Genetics also play a role in the development of AS. Most people who have AS have the HLA-B27 gene, however, not everyone that has the HLA-B27 gene will develop AS.
Symptoms of Ankylosing Spondylitis
AS is caused by inflammation but can create an entire host of symptoms in different areas of the body. Pain and stiffness are two of the most common symptoms especially in the hips and lower back. These symptoms worsen in the morning and after long periods of inactivity. Fatigue and trouble breathing may also be symptoms. In some cases, the vertebrae of the spine become weak and likely to fracture. Damaged vertebrae can put pressure on a group of nerves at the bottom of the spinal cord called the cauda equina. Damage to these nerves can cause problems with bladder control and sexual functions.
Trouble with eyesight is another symptom that occurs in about 40% of individuals with AS. Uveitis is an inflammation of the eye that is painful, causes blurred vision, and sensitivity to light. In addition to uveitis, some AS patients also find themselves with cardiovascular difficulties. In rare cases, AR can cause the aorta to be enlarged. When this happens, the shape of the aortic valve changes and blood can leak back into the heart. The heart is not able to pump as well leaving patients more fatigued and with shortness of breath.
Treatment for Ankylosing Spondylitis
There is no cure for AS but there are specific goals in regards to treatment. Alleviation of pain, recovery of any physical functions related to daily life and occupational activities, and the delay of structural damage responsible for physical impairments are the three objectives of treatment. The most important part of non-drug treatment is patient education and physical therapy. At-home exercise is effective, however, group physical therapy under appropriate supervision or individual physical therapy is recommended. Therapy and regular exercise can provide pain relief as well as improved flexibility and strength. Patients must also be educated on the proper exercises and how these exercises can alleviate pain as well as relax the joints so that day-to-day activities are not negatively affected.
Medications will likely be prescribed as part of a patient’s treatment. Nonsteroidal ant-inflammatory medications including Coxib are typically the first-line of defense from a medication standpoint. Doctors may also consider a biologic medication such as a tumor necrosis factor (TNF) blocker. Studies have proven that TNF blockers are effective at treating this disease in the early stages as well as the advanced stages. TNF blockers target a particular cell protein that causes inflammation in the body and help to reduce pain, stiffness, and swollen joints. The five TNF blockers that are approved by the FDA are Humira, Cimzia, Enbrel, Simponi, and Remicade.
Although treatment options may be limited, there are options available for treating and slowing the progression of AS.