Ankylosing spondylitis (AS) is a type of arthritis that mainly affects the back, by causing inflammation in the spine and sacroiliac joints (lower back). This can make your back, neck, rib cage, stiff and painful predominantly in morning or after periods of rest .
In the early stages, ankylosing spondylitis is likely to cause:
In advanced cases this inflammation can lead to fusion/linking of the spine bones (ankyloses), resulting in immobile spine. In serious case this can make the spine curve forward more. This may be prevented, if you
Apart from spine, it also causes pain, stiffness, swelling, warmth in shoulders, hips, heels, ribs and small joints of the hands and feet. Other possible symptoms include: soreness at the heel (enthesitis) or in the arch of your foot, pain and swelling in a finger or toe. Sometimes the eyes may be involved (iritis or uveitis) and rarely the lungs and heart can be affected. Disease course is variable among different patients. Ankylosing spondylitis commonly affects young males (20-40yrs age). We exactly don’t know what causes ankylosing spondylitis. To some extent it may be genetically inherited, but the condition isn’t always pass from a parent to their children. The HLA-B27 gene can be detected in the blood of most (90%) patients with AS.
Symptoms of ankylosing spondylitis may be confused with other back pain causes. It’s usually diagnosed by a Rheumatologist, these are doctors who specialise in conditions affecting the joints, bones and muscles.
A number of treatment modalities can slow down the disease and controls the pain and stiffness. Exercise and close attention to your posture are just as important to keep your spine mobile and help you to live a normal life. Some of the drugs below can only be prescribed by a Rheumatology consultant.
Painkillers like paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), are usually the first choice of treatment for ankylosing spondylitis. For people who have symptoms that can’t be controlled by anti-inflammatories, other drugs are available to help reduce pain or limit the effects of the condition.
Drugs such as sulfasalazine and methotrexate, can treat arthritis in your arms and legs, although they’re not usually effective for spinal symptoms. These drugs, called disease-modifying anti-rheumatic drugs (DMARDs), can reduce the amount of inflammation that happens in your body. This means that as well as treating symptoms, they can help prevent joint damage. These drugs can sometimes take several weeks or months to take effect. When they do take effect, they can make a big difference to your pain and stiffness. They’re often long-term treatments. When taking DMARDs, you’ll need regular check-ups and blood tests to monitor their effect.
Biological therapies are newer treatments that can be very effective for some people with ankylosing spondylitis and related conditions. These drugs have a more targeted approach to stop inflammation than the older DMARDs. There are a group of biological therapies called anti-TNF drugs. The following can treat ankylosing spondylitis: like etanercept, adalimumab, certolizumab pegol, golimumab. Secukinumab (anti IL17) is a different type of biological therapy that can also treat ankylosing spondylitis. These drugs are given as an injection, which you, or a partner, relative or friend can learn to do.
Steroids can be used as a short-term treatment for flare-ups. They’re usually given as an injection into a swollen joint or as a slow-release injection into a muscle. Occasionally, you may be given a course of steroid tablets called prednisolone. While these treatments can be very effective at improving pain and stiffness, you may develop side-effects if you use them for long periods. If you develop eye inflammation, it will usually be treated with steroid eye drops. In more severe cases of eye inflammation, steroids may be given as tablets or as an injection into the eye.
Physiotherapy is a very important part of the treatment for ankylosing spondylitis. A physiotherapist can put together a programme of exercises to improve your muscle strength and help you maintain mobility in your spine and other joints. It’s especially important to exercise your back and neck to avoid them stiffening into a bent position.
Most people with ankylosing spondylitis don’t need surgery, although some people may need a hip or knee replacement if these joints are badly affected. This can get rid of pain and improve mobility.