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Ankylosing Spondylitis

Ankylosing Spondylitis belongs to a group of chronic inflammatory diseases of the spine called Spondylitis. (It is not the same as rheumatoid arthritis, which is another type of inflammatory arthritis).

Spondylitis means inflammation of the spine. Ankylosis means "fusion. Spondylitis is also known as Spondyloarthropathy or Spondyloarthritis.

Ankylosing Spondylitis is a type of arthritis causing inflammation of the spine. It is most common in teens and young adults although it can also affect children and older people. Ankylosing spondylitis affects about 1 out of every 200 adults.

The inflammation mainly affects the joints of the spine and the joints between the spine and pelvis (sacroiliac joints). However, inflammation may also affect other areas of the body.

Though ankylosing spondylitis is a chronic condition, there may be periods of remission. The severity and the progression of the disease varies from person to person.

Though the exact cause of ankylosing spondylitis remains unknown, genes that increase the chances of a person developing the disease have been identified. Because there is more that one gene involved, the chances of a person passing this disease to his or her children are fairly low.

Ankylosing Spondylitis Diagnosis

Diagnosis ankylosing spondylitis is often difficult in the early stages or in mild cases. An x-ray of the spine and sacroiliac joints is taken. Degenerative changes are usually first seen in the sacroiliac joints. A rheumatologist that specializes in ankylosing spondylitis can usually make an accurate diagnosis.

Ankylosing Spondylitis Symptoms

The symptoms and severity of ankylosing spondylitis vary - from mild to severe back pain, from mild stiffness to loss of mobility. Symptoms may come and go. In the early stages, inflammation of the sacroiliac joints causes hip pain (deep within the buttocks) and lower back and stiffness, especially at night, in the morning, and after periods of inactivity.

Later, the inflammation may spread further up the spine and to other joints. If inflammation occurs in the joints between the ribs and spine, pain may be felt in the chest area. The hips, shoulders, heels or knees are sometimes affected. Sometimes there is inflammation of the eyes. Very rarely, the inflammation may involve the heart.

There may be fatigue, lack of appetite, weight loss, a low-grade fever. In severe cases, the spine sometimes fuses in a stooped over position. This can be avoided.

Preventing Stooping

Inflammation damages the joints. Scarring of the tissues and extra bone overgrowth can develop as a result of chronic inflammation. Eventually, in some severe cases of ankylosing spondylitis, the ligaments of the spine become fused together by bony overgrowth of the vertebrae  this is called ankylosis.

Not all cases of Ankylosing spondylitis reach this stage, but maintaining good posture is essential so that if the spine does fuse the spine will be in a fixed upright position rather than a fixed hunched over position. Click here for information on proper posture.

Strengthening exercises for the muscles that support the spine and stretching exercises help maintain proper posture. A physical therapist can create a customized exercise program for a patient to follow. Exercise plays a vital role in managing this disease.

Medications Used to Treat Ankylosing Spondylitis

Medications for Ankylosing spondylitis are geared at reducing inflammation.

NSAIDs:

Ankylosing Spondylitis is with NSAIDs -nonsteroidal anti-inflammatory drugs. NSAIDs treat the pain and inflammation. Ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox, ) and indomethacin (Indocin) are NSAIDs.
When NSAIDs are not effective enough other medications are often used.

Sulfasalazine, often used for inflammatory bowel disease, also can reduce pain and inflammation in the joints and is sometimes used to treat ankylosing spondylitis.

Immunosuppressive agents:

Drugs that suppress the immune system, such as Azathiprine, or Methotrexate are sometimes used to treat Ankylosing spondylitis. Immunosuppressive agents are used to suppress the inflammatory response by suppressing the immune system.

The immune system seems to be overly sensitive in people with Ankylosing spondylitis and certain cells of the immune system that initiate inflammation may be triggered too easily.

Corticosteroids (such as prednisone) have extremely powerful anti-inflammatory properties and also suppress the immune system. The problem with corticosteroids is that the side effects are severe in long-term use and the person taking them can develop a host of other unwanted problems.

TNF Inhibitors:

One class of drugs,TNF Inhibitors (such as Remicade), has shown a lot of promise in treating ankylosing spondylitis along with other chronic inflammatory diseases. Remicade suppresses inflammation by binding to and neutralizing substances (TNFa) that act as an alarm signal that triggers inflammation. New drugs in this class are being developed.

Immunosuppressive agents, corticosteroids, and Remicade all increase the risk of infection.