Ankylosing Spondylitis – Understanding Causes, Symptoms, Diagnosis, and Treatment

What is Ankylosing Spondylitis?

Ankylosing spondylitis is a type of arthritis that primarily affects the axial skeleton, including the spine, pelvis, and rib cage. The hallmark feature of AS is inflammation at the entheses, where ligaments and tendons attach to bones. Over time, this inflammation can lead to the formation of new bone, causing sections of the spine to fuse together (ankylosis).

Causes of Ankylosing Spondylitis

The exact cause of ankylosing spondylitis remains unknown, but several factors are believed to contribute to its development:

1. Genetics:
   The HLA-B27 gene is strongly associated with AS, although not everyone with the gene develops the condition.

2. Immune System Dysfunction:
   AS is considered an autoimmune condition, where the immune system mistakenly attacks healthy tissues.

3. Environmental Triggers:
   Infections or other environmental factors may play a role in triggering the condition in genetically predisposed individuals.

Symptoms of Ankylosing Spondylitis

Symptoms of ankylosing spondylitis can vary in severity and often develop gradually. Common symptoms include:

• Lower Back and Hip Pain:
  Pain and stiffness, especially in the morning or after periods of inactivity, are early signs of AS.

• Reduced Spine Mobility:
  As the disease progresses, stiffness may extend up the spine, limiting flexibility.

• Pain in Other Areas:
  Inflammation may occur in other joints (peripheral arthritis) or at entheses, such as the heels or ribs.

• Fatigue:
  Chronic inflammation can lead to persistent fatigue and reduced energy levels.

• Postural Changes:
  Over time, spinal fusion can result in a hunched-forward posture.

• Breathing Difficulties:
  Inflammation of the ribs or fusion of the rib cage may restrict chest expansion, making breathing more difficult.

Diagnosis of Ankylosing Spondylitis

Diagnosing AS involves a combination of clinical evaluation, imaging studies, and laboratory tests:

1. Medical History and Physical Examination:

   • Symptoms, family history, and physical signs like limited spine mobility or tenderness are assessed.

   • The Schober’s test is commonly used to evaluate spine flexibility.

2. Imaging Tests:

   • X-rays: Detect structural changes in the spine and sacroiliac joints.

   • MRI: Identifies early inflammation and soft tissue involvement before structural damage occurs.

3. Blood Tests:

   • Testing for the HLA-B27 gene can support a diagnosis.

   • Markers of inflammation, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), may be elevated.

Treatment Options for Ankylosing Spondylitis

While there is no cure for AS, treatment focuses on managing symptoms, reducing inflammation, and preserving mobility.

Non-Medical Treatments

1. Physiotherapy:

   • A personalized exercise program helps maintain flexibility, improve posture, and strengthen muscles supporting the spine.

   • Techniques like hydrotherapy or Pilates may be incorporated for low-impact movement.

2. Exercise Physiology:

   • Guided exercise plans aim to improve cardiovascular health and reduce stiffness.

3. Occupational Therapy:

   • Advice on ergonomic adjustments and assistive devices to support daily activities.

4. Pain Management:

   • Heat or cold therapy can help relieve localized pain and stiffness.

Medical Treatments

1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):

   • NSAIDs like ibuprofen or naproxen are often the first line of treatment to reduce pain and inflammation.

2. Disease-Modifying Anti-Rheumatic Drugs (DMARDs):

   • Traditional DMARDs may be used for peripheral arthritis, although they are less effective for axial involvement.

3. Biologic Therapies:

   • TNF inhibitors (e.g., adalimumab) or IL-17 inhibitors (e.g., secukinumab) target specific inflammatory pathways to control symptoms and prevent progression.

4. Corticosteroids:

   • Local injections may be used for short-term relief of joint inflammation.

5. Surgical Intervention:

   • Surgery, such as joint replacement, is rarely needed but may be considered in cases of severe deformity or joint damage.

Living with Ankylosing Spondylitis

Self-management and lifestyle modifications are essential for living well with AS:

• Regular Exercise:
  Engage in activities like swimming or yoga to maintain spine mobility and cardiovascular fitness.

• Postural Awareness:
  Use supportive pillows and practice posture exercises to prevent deformities.

• Healthy Diet:
  Maintain a balanced diet to support overall health and bone strength.

• Quit Smoking:
  Smoking can exacerbate inflammation and worsen respiratory complications.

• Stress Management:
  Techniques like mindfulness or meditation can help reduce stress-related flare-ups.

Why Choose Palms Physiotherapy & Allied Health?

At Palms Physiotherapy & Allied Health, our experienced team offers tailored therapies for managing ankylosing spondylitis. From physiotherapy to exercise physiology, we help you stay active and reduce pain.