Ankylosing Spondylitis: What is it, Causes, Symptoms and Treatment

Ankylosing spondylitis is a type of rheumatoid arthritis (joint inflammation) that can affect different bones, joints and ligaments in the body, especially the spine. Ankylosing spondylitis occurs due to long-term inflammation. This disease is more common in men than in women.

What is Ankylosing Spondylitis Disease?

While ‘ankylosing’ in the name of ankylosing spondylitis means the union of the bone with other hard tissues; ‘Spondylitis’ means inflammation of the spinal bones.

Ankylosing spondylitis causes damage to some joints due to long-term inflammation. The disease causes the formation of new small bones, especially in the bones of the spine, and these newly formed small bones cause the spinal bones to fuse with each other. As a result of the fusion, the spine becomes less flexible and deformities occur in the spine.

Ankylosing spondylitis can affect the spine as well as large joints such as the shoulder, hip, and knee joints. Problems such as stiffness and pain may occur in these joints.

What are the symptoms of Ankylosing Spondylitis?

Ankylosing spondylitis causes pain and stiffness in the waist and hips in the early stages, especially in the mornings. This situation can also be seen clearly after being inactive for a long time. Neck, back, waist pain and fatigue are among the common symptoms in patients with ankylosing spondylitis.

Ankylosing spondylitis disease can affect the lower part of the spine, pelvic joints, and the patient may feel pain in these joints in the waist area. Ribs can also be affected by ankylosing spondylitis. Ankylosing spondylitis can also affect the tendons that connect muscles to bones, causing pain and joint stiffness in these structures.

Ankylosing spondylitis symptoms may get better or worse over time or remain stable. Symptoms related to the disease may appear at irregular intervals and then disappear again; in short, they progress with attacks.

What Causes Ankylosing Spondylitis?

The mechanisms that cause ankylosing spondylitis have not yet been fully elucidated. However, it is thought that genetic basis may play a role in the development of the disease. The risk of ankylosing spondylitis is quite high in people with the HLA-B27 gene. However, this does not mean that everyone who carries the HLA-B27 gene will have ankylosing spondylitis. There are also people who have ankylosing spondylitis and do not suffer from it.

Risk factors for ankylosing spondylitis are as follows:

• Gender: Ankylosing spondylitis is more common in men than in women.
• Age: The disease usually occurs in adolescence or young adulthood.
• Genetics: People who have a family history of ankylosing spondylitis or who carry the HLA-B27 gene are at risk for ankylosing spondylitis.

How to Diagnose Ankylosing Spondylitis?

Examination is very important in the diagnosis of ankylosing spondylitis. The doctor checks the range of motion of the spine by asking the patient to bend forward, backward and sideways. The doctor tries to create a feeling of pain by applying pressure to the patient’s pelvic area or by moving the legs in certain ways. If the patient feels pain during these movements, it may indicate that the relevant joints are affected by ankylosing spondylitis. During the examination, the expansion capacity of the chest can also be evaluated by asking the patient to take deep breaths.

Imaging techniques can help diagnose ankylosing spondylitis. The patient may have an X-ray taken to evaluate whether there are changes in his or her bones and joints due to the disease. However, the film may not adequately show the changes in bones and joints in the early stages of the disease. MRI imaging may be a better option to detect deteriorations in bones and joints in the early stages of the disease. Blood tests are used to monitor attacks.

There is no specific laboratory test to detect ankylosing spondylitis. Since ankylosing spondylitis is an inflammatory disease, inflammation markers may be high in the patient’s blood test. However, since these markers may be increased in different inflammatory diseases, test results may not be sufficient for diagnosis. Although the HLA-B27 gene is closely related to ankylosing spondylitis, it cannot be concluded that all people carrying this gene will have the disease. Therefore, genetic testing for suspected disease does not provide definitive results.

What are the symptoms that occur with Ankylosing Spondylitis?

In severe ankylosing spondylitis, new bone fragments may form in the bones as a result of the body trying to repair itself. These bone fragments gradually fill the spaces between the spinal bones and cause the spinal bones to fuse with each other. The joined part of the spine loses its flexibility and becomes stiff. This union can affect the rib bones. As a result, it leads to a decrease in lung capacity and function.

Other complications that may occur due to ankylosing spondylitis:

• Eye Inflammation (Uveitis): Uveitis is one of the most common complications of ankylosing spondylitis. Sudden onset of eye pain, sensitivity to light and blurred vision; are among the symptoms of uveitis.
• Compression Fracture: Some people’s bones are thin in the early stages of ankylosing spondylitis. Weak spinal bones can break down due to disease, increasing the patient’s spinal curvature. Fractures in the spinal bones can put pressure on the spinal nerves and damage them.
• Heart-related problems: Ankylosing spondylitis can cause problems with the aorta, the largest blood vessel in the body. The inflamed aorta can grow and impair the functions of the heart valves.

How is Ankylosing Spondylitis Treated?

It is not possible to completely eliminate ankylosing spondylitis. The main purpose of the treatment is to relieve the patient’s pain and stiffness in the joint and to delay the formation of deformities that may occur due to the disease.

It provides more successful treatment results before ankylosing spondylitis causes permanent damage to the joints.

The most commonly used method in the treatment of ankylosing spondylitis is drug therapy. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as naproxen and indomethacin can be used to relieve the patient’s symptoms such as pain and stiffness. If these drugs are not sufficient to relieve the patient’s symptoms, treatment can be continued with biological drugs. Tumor necrosis factor (TNF) blockers and interleukin-17 (IL-17) inhibitors can be used in the treatment of ankylosing spondylitis. TNF blockers stop cells that cause inflammation in the body. IL-17 is also a protein involved in inflammation. IL-17 inhibitors aim to reduce inflammation by preventing this protein from functioning.

TNF blockers; It relieves symptoms of pain and stiffness and reduces tenderness and swelling in the joint.

Adalimumab, certolizumab, etanercept, golimumab, infliximab; They are TNF blocker group drugs that can be prescribed in the treatment of ankylosing spondylitis.

Physical therapy and rehabilitation are one of the most important parts of ankylosing spondylitis treatment. Physical therapy helps reduce joint pain and increase the flexibility and strength of the joint. The therapist prepares specific exercise programs appropriate to the patient’s characteristics. Thus, it is aimed for the patient to get maximum benefit from the treatment.

Stretching exercises to ensure joint clearance help maintain proper posture. Practices such as maintaining a proper position while sleeping and walking, and abdominal and back exercises also enable the patient to stand in a correct and upright position.

Swimming is also an effective exercise in eliminating problems related to ankylosing spondylitis.

Surgery is usually not needed in the treatment of ankylosing spondylitis. However, if the patient’s pain is very severe and the patient’s joint damage is serious, surgical procedures may be used. For example, hip replacement surgery can be performed on patients with serious damage to the hip joint.

Some practices can be performed at home to relieve pain and stiffness caused by ankylosing spondylitis. These applications:

• To exercise
• Applying heat or cold to the painful area
• It can be considered as doing proper posture exercises during the day.

Since ankylosing spondylitis can reduce lung capacity, it would be beneficial for patients to quit smoking, if they do.

Ankylosing spondylitis is a disease that cannot be completely cured. However, satisfactory results can be achieved by detecting the disease at an early stage and starting its treatment. Therefore, people who complain of pain in their spine, hip, knee and shoulder joints should apply to a well-equipped health center. These people should have the necessary checks for ankylosing spondylitis and other types of arthritis at the relevant center.