Ankylosing Spondylitis
Ankylosing spondylitis is an autoimmune arthritis affecting the spine and joints. The word “Ankylos” means crooked and “Spondylos” means joints of the back in Greek, therefore Ankylosing Spondylitis meaning crooked joints of the spine, as this condition leads to back deformities.
This condition is an inflammatory arthritis affecting the axial skeleton meaning neck, lower back and hip regions. Joints like knees, hands and feet can also be affected. Men are affected commonly, as compared to women, more so in younger age groups under 40 years.
Ankylosing spondylitis has a genetic predisposition and can run in families with higher incidence of Ankylosing spondylitis occurring when a family member is affected. HLA - B27 is a gene, commonly associated with Ankylosing spondylitis and individuals with a positive HLA-B27 can be affected up to 5-16 times more than those without the gene. It is important to note not all individuals with HLA-B27 gene develop this condition.
Ankylosing Spondylitis can be associated with Psoriasis. In individuals with Psoriasis or a family history of Psoriasis, symptoms of back pain associated with inflammation can occur. Similarly in patients with Inflammatory bowel disease or a family history of the same, Ankylosing spondylitis can be present. This constitutes a broad umbrella term called Seronegative Spondylarthritis arthritis.
Smoking is known to affect the outcome of the disease with more severe symptoms, deformities and less response to medication. Fusion of the spine occurs earlier in smokers than in non-smokers leading to more pain and stiffness. In long term, the movements at spine including neck and lower back will be restricted.
Symptoms include lower back pain and hip pain especially around the buttocks which is typically worse with rest or lying down. Frequent waking up at night during the sleep due to the pain is a characteristic feature of this condition. Pain improves with activity and exercise. Neck pain with painful and restricted movements is present. Joint pains with swellings can occur in the hands, knees and feet. Enthesitis, a feature commonly seen in this condition is pain across the tendon insertion sites such as Achilles tendon, sole of the foot termed Plantar Fasciitis and the chest which manifests as pain during breathing. Eye involvement can be commonly seen with a sudden onset of red painful eyes with decreased vision which can be an emergency.
Diagnosis is through careful clinical evaluation alongside blood tests and X-rays to differentiate from other forms of back pain. X rays of the spine and hips show features of vertebral changes and sacroiliitis which is inflammation seen at the sacro-iliac joint. MRI is a sensitive tool which can pick up the inflammatory changes at an early stage. Physiotherapy is an important tool for the management of Ankylosing Spondylitis with improvement in the symptoms with back strengthening and stretching exercises. Anti-Inflammatory medication called NSAIDs are used alongside DMARDs. In progressive cases Biologics will be used. Early treatment is a must as the progression of the disease causes decline in the quality of life and increased complications.
