Ankylosing spondylitis (AS)

is an inflammatory condition that affects the joints of the spine. Spondylitis simply means inflammation of the spine. As the inflammation dies down, new bone forms replacing the more flexible tendons and ligaments between the vertebrae. Eventually the individual bones of the spine may link up (fuse) resulting in stiffening of the spine (ankylosis).

Ankylosing spondylitis symptoms

In the early stages, ankylosing spondylitis is likely to cause low backache and stiffness, and pain in the buttocks and sometimes the backs of the thighs (likesciatica).

You may first notice symptoms after some unusual strain, so the condition is often mistaken for common backache.Pain in the neck, shoulders and hips, or in the thigh, may follow. Some people have pain, stiffness and swelling in the knees or ankles, or in the smaller joints of the hands and feet. For some people, especially children, the first signs may be in the hip or leg and not in the back at all.Other possible symptoms include:

  • tenderness at the heel bone – making it uncomfortable to stand on a hard floor.
  • tenderness at the bone of your ‘seat’ (ischium) – making sitting uncomfortable.
  • chest pain or a ‘strapped-in’ feeling – which comes from the joints between the ribs and the breastbone.
  • inflammation of the iris – see your doctor immediately if you suddenly develop pain or redness in an eye.
  • tiredness – caused by the activity of the disease, or by anaemia, or sometimes by depression and frustration associated with the condition.

Other conditions are sometimes associated with AS – for example, inflammation of the bowel (colitis) and the skin condition psoriasis.

Who gets ankylosing spondylitis?

Ankylosing spondylitis affects 2–3 times as many men as women. It’s most likely to start in your 20s or 30s

How does ankylosing spondylitis progress?

Ankylosing spondylitis is quite variable and difficult to predict. In its early stages it can cause considerable pain, although treatment will help to relieve this.

You may have phases when the symptoms become worse, or you may have relatively mild aches and pains coming and going over a period of months. You may at times feel generally unwell, lose weight or tire easily. Often the condition then settles down again and the symptoms gradually improve. After several months, the back may stiffen, usually lower down. The disease may then die out, causing no further trouble. A stiffened back is often painless and doesn’t interfere with physical activity because the upper part of the spine, the neck, hips and limbs can remain quite mobile. Rarely, there may be complications affecting the heart, lungs and nervous system. Less than 1 in 100 AS patients have these problems, and all these complications can be treated.

How is ankylosing spondylitis diagnosed?

Most back pain isn’t caused by ankylosing spondylitis. However, the symptoms of AS, especially in its early stages, are often very similar to the more common back problems. Because of this, it can take some time before AS is diagnosed – it may even be misdiagnosed initially.

What tests are there?

A blood test for inflammation may show an abnormal result in the early stages. There are three commonly used tests for inflammation.
You may have one or more of these tests:

  • CRP (C-reactive protein)
  • ESR (erythrocyte sedimentation rate)
  • PV (plasma viscosity).

Another blood test can confirm whether you have the HLA-B27 gene. Most people with ankylosing spondylitis test positive for HLA-B27, but so do some healthy people. A positive test may point to AS but it won’t confirm the diagnosis. X-rays sometimes help to confirm the diagnosis, though they may show nothing in the early stages of the disease. As the disease progresses new bone develops between the vertebrae, which can lead to stiffening of the spine. Any new bone will be visible in x-ray images.

Ankylosing spondylitis treatments.

There is no cure for ankylosing spondylitis at present, but treatments (that is drugs, physiotherapy and surgery) can relieve the symptoms, help to keep the spine mobile, and allow you to live a normal life. Exercise and close attention to your posture are just as important as medical treatments in reducing the impact of the disease.

Ankylosing spondylitis drugs.

Painkillers (analgesics) and anti-inflammatory drugs will relieve pain, which will help you to get a good night’s sleep. They can also ease stiffness, making it easier to exercise. You will probably need tablets during bad patches and you may need a maintenance dose over a longer period. Slow-release anti-inflammatory drugs remain effective over a longer period, so they may help with both night-time pain and morning stiffness. Pain-relieving tablets can sometimes irritate the stomach, but this should be less of a problem if you take them with food. Some drugs are called disease-modifying: they aren’t very effective for the spinal symptoms, nor do they have an immediate impact on the disease, but ultimately they can make a big difference to symptoms in your limb joints. Sulfasalazine and methotrexate are examples of disease-modifying drugs.

Some drugs are given by injection:

. Biological therapies are given either as an infusion over a few hours or as a twice-weekly injection. You may also feel early benefit with these drugs. Examples are etanercept and adalimumab.

. Bisphosphonates are given in short bursts over a period of a few weeks – an example is pamidronate. You may get pain relief in the spine soon after receiving this drug.

Physical therapies

Physiotherapy is a very important part of the treatment for ankylosing spondylitis. A physiotherapist can put together a programme of exercise that

will increase your muscle strength and help to maintain mobility in your spine and other joints.It’s especially important to exercise your hip to avoid it stiffening in a bent position.

Surgery

Occasionally, a new hip or knee joint may be needed if these joints are badly affected. Surgery may be used to straighten a bent spine, but this is rare. Most people with ankylosing spondylitis don’t need surgery.

Self-help and daily living

Medical treatments can help to control ankylosing spondylitis, and the disease will tend to become less active as you get older. However, ongoing attention to posture, mobility and exercise are needed to minimize the long-term effects of AS .

This section also covers: exercise, pain management, complementary therapies, supports and gadgets, sleep, posture, sex and pregnancy, work, driving and life insurance.

Exercise.

Bed rest isn’t recommended as this can speed up the stiffening of the spine. Exercises for your back, chest and limbs will keep them supple. Do at least some exercises each day. Many people find these are especially good for easing morning stiffness.