Ankylosing Spondylitis – Symptoms, Diagnosis and Treatment

Ankylosing Spondylitis is a chronic inflammatory condition that predominantly affects the spine, causing pain, stiffness, and, if left unchecked, irreversible damage. This autoimmune disease is classified under spondyloarthritis, a group of inflammatory conditions that share certain clinical features. According to the Royal Australian College of General Practitioners, around 1 in 200 Australians live with ankylosing spondylitis ^[1]. While this condition can affect anyone, females are more commonly diagnosed with it ^[2]. Onset typically occurs in late adolescence or early adulthood. At 24-7MedCare, we provide accessible healthcare services, including virtual consultations, to assist individuals with ankylosing spondylitis. Our experienced GPs can offer guidance, diagnosis, and treatment options within the convenience of your own home.
 

What is Ankylosing Spondylitis?

As a condition, ankylosing spondylitis is an immune system overreaction. The body's defence system, in an attempt to protect itself, begins to attack healthy tissues, primarily in the spine and sometimes in other joints. The genetic component, particularly the HLA-B27 gene, plays a pivotal role in increasing the risk of this condition.

Ankylosing Spondylitis Causes

The causes of ankylosing spondylitis stem from a combination of genetic factors and environmental influences. Investigating why some individuals are more susceptible involves understanding the interaction between their genetic predisposition and external elements.

Genetic Factors

There is a strong genetic component to ankylosing spondylitis. The majority of individuals with ankylosing spondylitis carry a genetic marker called HLA-B27. However, not everyone with HLA-B27 develops ankylosing spondylitis, and not everyone with the condition has this genetic marker. This suggests that other genetic and environmental factors also play a role.

Family History

Having a family history of ankylosing spondylitis increases the risk of developing the condition. If a close family member, such as a parent or sibling, has ankylosing spondylitis, the likelihood of developing the condition may be higher.

Immune System Dysfunction

Ankylosing spondylitis is considered an autoimmune disease where the immune system mistakenly attacks the body's own tissues. In ankylosing spondylitis, the immune system primarily targets the joints of the spine, leading to inflammation and, over time, fusion of the vertebrae.

Environmental Factors

While the exact environmental triggers are not fully understood, some environmental factors may contribute to the development or exacerbation of ankylosing spondylitis. These factors could include infections, though specific infectious agents have not been consistently identified.

Gender and Age

Ankylosing spondylitis is more common in men than in women. It often begins in late adolescence or early adulthood. However, it can occur at any age.
 

Ankylosing Spondylitis: Symptoms and Signs

Ankylosing Spondylitis can lead to a range of signs and symptoms, primarily affecting the spine but potentially impacting other areas of the body. Common symptoms include:

• Chronic back pain, particularly in the lower back
• Morning stiffness
• Gradual loss of flexibility in the spine
• Stooped and/or hunched posture
• Fatigue and low energy
• Inflammation of the eye, leading to pain, redness, and sensitivity to light
• Difficulty with deep breathing due to stiffness across the back and ribs
• Unintentional weight loss

 

Ankylosing Spondylitis Diagnosis and Testing

Diagnosing ankylosing spondylitis involves multiple tests and assessments. Your GP may refer you to a rheumatologist, a specialist in autoimmune conditions. Thorough examinations, including medical history, physical assessments, and various tests, may be required for a comprehensive diagnosis ^[3].

Imaging Studies

Imaging techniques like X-rays and MRI scans play a crucial role in visualizing inflammation, joint damage, and other characteristic traits of ankylosing spondylitis. Comparing images over a certain period of time can help healthcare professionals monitor the progression of the condition.

HLA-B27 Blood Testing

While not everyone with ankylosing spondylitis carries the HLA-B27 gene, its presence may suggest an increased risk of the condition. A positive result doesn't confirm ankylosing spondylitis, but it guides healthcare professionals in their diagnostic process.
 

Ankylosing Spondylitis Treatment

Treatment for ankylosing spondylitis involves alleviating symptoms, slowing disease progression, and enhancing overall well-being. From medications targeting inflammation to tailored exercise regimens, the treatment journey will vary from person to person.

Ankylosing Spondylitis Medications

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are the frontline medications for managing symptoms. They help alleviate pain and inflammation, providing relief to individuals navigating the daily challenges of the condition. However, it's crucial to use them under medical supervision due to potential side effects. Disease-Modifying Antirheumatic Drugs (DMARDs), particularly biologics, have revolutionized AS treatment. By targeting specific components of the immune system, these drugs slow down the progression of the disease and improve long-term outcomes. However, their usage requires careful monitoring.

Physiotherapy and Exercise

Physiotherapy is crucial for managing ankylosing spondylitis ^[5]. It not only helps maintain flexibility but also assists in preventing complications such as joint deformities. Tailored exercise routines, focusing on stretching and strengthening, empower individuals to take an active role in their treatment.

Surgery

In severe cases where conservative measures are not enough, surgical interventions like joint replacement or spinal fusion may be considered. These procedures aim to alleviate pain and improve mobility, but they are typically required in cases where other treatments have proven insufficient.

Lifestyle Changes

There are a range of lifestyle changes that can assist with managing this condition, including:

• Regular exercise (e.g., cardiovascular, flexibility, strength training, etc.)
• Maintaining a healthy weight
• Dietary changes (e.g., eating an anti-inflammatory diet, etc.)
• Mental health support
• Talking to family and friends to help cope with living with ankylosing spondylitis

 

Ankylosing Spondylitis Complications

Ankylosing Spondylitis is associated with several complications that extend beyond its primary impact on physical health ^[4].

• Vertebral Fusion: The hallmark of AS involves the fusion of vertebrae, leading to reduced flexibility in the spine and potentially causing a stooped posture.
• Reduced Flexibility: As the condition progresses, limitations in the range of motion may occur, affecting daily activities and overall mobility.
• Rib Fusion and Respiratory Impact: In severe cases, fusion can extend to the ribs, impairing chest expansion and, subsequently, impacting respiratory function.
• Eye Inflammation (Uveitis): Persistent inflammation in AS may contribute to uveitis, causing eye pain, redness, and sensitivity to light.
• Cardiovascular and Respiratory Issues: In rare instances, chronic inflammation associated with AS may lead to complications affecting the heart and lungs, underscoring the systemic nature of the condition.