Ankylosing Spondylitis
What is Ankylosing Spondylitis?
Ankylosing spondylitis is a systemic (generalized) rheumatic disease that involves chronic inflammation of the spine and the sacroiliac joints. It is more common in men than in women, predominantly affecting the 20-30 age group. Chronic inflammation may lead to fusion (making it rigid) of vertebral bodies and ankylosis (another term meaning “making rigid” but specifically related to the spine) of the spine, producing pain and decreased mobility. However as it is a generalized condition, the inflammation also may affect other joints and organs, with possible involvement of the eyes, heart valves, lungs, and kidneys.
Ankylosing spondylitis belongs to a group of inflammatory diseases referred to as spondyloarthropathies. Diseases of this group share similar inflammatory processes, with arthritic conditions affecting joints and other organs. Examples include the many types of psoriatic and reactive arthritis as well as Crohn's disease and ulcerative colitis.
How do you get Ankylosing Spondylitis?
Although the cause of ankylosing spondylitis is unknown, it is believed to be genetically based as 90% of patients with ankylosing spondylitis have the HLA-B27 gene. However, while the HLA-B27 gene is a strong indicator for the disease, up to 8% of the white population carry this gene without any signs or symptoms.
How is Ankylosing Spondylitis diagnosed?
It may present as decreased flexibility in the spine, and stiffness associated with pain in the sacroiliac joints. When it involves other organs and causes rather vague symptoms of stiffness and pain, it may be misdiagnosed as other conditions.
Radiographic imaging with specific detail for ankylosis (X-rays or CT scan) and blood tests may help identify ankylosing spondylitis in patients with decreased range of motion and tenderness in the hip or sacral area. Blood tests such as HLA-B27 may be used as a genetic marker, and the erythrocyte sedimentation rate (ESR), a nonspecific indicator for inflammation, may be elevated.
How is Ankylosing Spondylitis treated?
Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered the first line of medical treatment. However, the chronic use of NSAIDs has been associated with significant side effects.4 If NSAIDS must be discontinued because of side effects or if they are not adequate to control pain, second-line agents such as antirheumatic medications may be beneficial. These include steroids, methotrexate, and sulfasalazine. However, medical therapy must be supplemented with physical therapy to provide patients with an improved functional quality of life.
Physical Therapies: Physical therapy, consisting of exercises that will decrease stiffness and improve flexibility and mobility, often is used to treat ankylosing spondylitis. Treatment goals are to generate better posture and flexibility, and to decrease pain.
Surgery: In older patients with ankylosing spondylitis, fractures are common, and surgical treatment of thoracic or cervical injuries often is necessary. Fractures in older patients with ankylosing spondylitis must be considered highly unstable and should be treated aggressively. Multiple fixation points often are required to achieve adequate fracture correction and stabilization, and osteotomies may be necessary. A "chin on chest" deformity may occur in patients with fractures that heal in kyphosis.