Ankylosing spondylitis: Causes, symptoms, treatment
A type of inflammatory arthritis, ankylosing spondylitis primarily affects an individual’s back or spine. The condition causes inflammation of the vertebrae and can lead to severe and chronic pain and discomfort. The pain tends to start in the lower back or the buttocks and may move into the chest, upper spine and neck. Ankylosing spondylitis also impacts other joints including the hips, shoulders, ribs, feet and knees. The systemic disease may also affect various organs.
The condition is within a group of disorders known as seronegative spondyloarthropathies. Individuals who test negative for an autoantibody known as rheumatoid factor are referred to as seronegative. Spondyloarthropathies are a group of similar conditions that also cause joint and spine inflammation. Psoriatic arthritis, chronic reactive arthritis, and enthesitis-related idiopathic juvenile arthritis are other forms of spondyloarthropathies.
What causes ankylosing spondylitis?
There is no known specific cause for ankylosing spondylitis, however it is believed that genes and hereditary factors play a role in the development of the condition. Scientists have discovered that individuals with the HLA-B27 gene are at greater risk for developing the condition compared with people who do not have the gene. However, not everyone with the gene develops the condition. Scientists have also suggested that the condition may be triggered by an onset of certain infections.
Men are more susceptible to ankylosing spondylitis and the onset of symptoms typically happen during late adolescence or early adulthood.
According to data from the CDC’s NHANES study, 2.7 million U.S. adults have axial spondyloarthritis. Furthermore, ankylosing spondylitis is more common than multiple sclerosis, cystic fibrosis and Lou Gehrig’s disease combined, per the Spondylitis Association of America.
Early symptoms of the condition might include pain and stiffness in the lower back and hips, particularly in the morning and after periods of inactivity. Other common symptoms include neck pain and fatigue. Symptoms may improve, worsen or stop at irregular intervals.
According to the Mayo Clinic, the most commonly effected areas include:
- vertebrae in the lower back;
- hip and shoulder joints;
- cartilage between the breastbone and ribs; and
- joints between the base of the spine and the pelvis.
Ankylosing spondylitis is primarily diagnosed with a physical exam and review of an individual’s medical history. Some of the questions a physician might ask during a medical history review include:
- Are you also experiencing skin rashes such as psoriasis?
- Are you experiencing vision problems or fatigue?
- How long has the pain persisted?
- Does the pain get better with exercise or worse after periods of inactivity?
- Where, specifically, is the pain?
- Is there a family history of back problems or arthritis?
In addition, a physician may want to check the range of motion in an individual’s spine. The physician may also try and replicate the pain by repositioning the legs or pressing on specific locations of the pelvis.
An X-ray, MRI or laboratory test may also help with the diagnosis. Although lab tests do not specifically identify the condition, certain markers of inflammation can be identified, such as HLA-B27.
Stiffness in the spine and reduced lung capacity can occur due to new bone formation and the fusing of vertebrae.
Other complications associated with ankylosing spondylitis, include:
- eye inflammation, or uveitis;
- compression fractures; and
- cardiovascular problems.
Uveitis is the most common complication of ankylosing spondylitis and can cause rapid-onset eye pain, sensitivity to light and blurred vision.
Ankylosing spondylitis has no cure; however, the prognosis for ankylosing spondylitis can differ between patients, with some experiencing complete spinal ankylosis and others achieving clinical remission between intermittent flares. The long-term focus for ankylosing spondylitis, however, is to alleviate symptoms and slow disease progression.
How to treat ankylosing spondylitis
Remaining active and exercising is considered a good way to mitigate the effects of ankylosing spondylitis. Exercise may help ease pain, maintain flexibility and improve a person’s posture. Applying heat to stiff joints and tight muscles using a heating pad or hot baths and showers may help alleviate the pain. While the addition of ice may help reduce swelling in inflamed areas. A physician or specialist will also likely recommend quitting smoking, if applicable. Not only is smoking considered bad for a person’s health, it can also worsen symptoms of ankylosing spondylitis by further hampering breathing.
Physicians may also prescribe certain medications to treat the condition. The most common medications physicians prescribe are nonsteroidal anti-inflammatory drugs — such as naproxen and indomethacin. Although the medications may relieve inflammation, pain and stiffness, NSAIDs also have the potential to cause gastrointestinal bleeding.
A physician might also consider prescribing a biologic medication, such as a tumor necrosis factor blocker or an interleukin 17 inhibitor. According to the Mayo Clinic, TNF blockers approved by the FDA to treat the condition include:
- certolizumab pegol (Cimzia, UCB);
- etanercept (Enbrel, Amgen);
- adalimumab (Humira, AbbVie);
- infliximab (Remicade, Janssen); and
- golimumab (Simponi; Simponi Aria, Janssen).
Cosentyx (secukinumab, Novartis) is an FDA approved IL-17 inhibitor to treat ankylosing spondylitis. However, TNF blockers and IL-17 inhibitors can reactivate latent tuberculosis and make an individual more susceptible to infection.
Physical therapy is often recommended to patients suffering from ankylosing spondylitis to improve strength and flexibility. A physical therapist will work on range-of-motion and stretching exercises to help the joints and preserve good posture.
Though typically avoided, surgery may be recommended if a person suffers from severe pain or joint damage, or if the hip joint is too damaged and needs to be replaced.
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