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Ankylosing Spondylitis

A chronic inflammatory condition known as ankylosing spondylitis (AS) affects the joints of the spine, especially where they join the pelvis. AS causes lower back and hip pain, stiffness, and reduced mobility. AS can affect the eyes, skin, heart, and lungs as well. AS is not curable, but it can be controlled and its complications prevented with proper management.

Causes of ankylosing spondylitis

The exact cause of AS is unknown, but it is believed to be a combination of genetic and environmental factors. More than 85% of people with AS carry a gene called HLA-B27. It is important to note that not everyone with this gene develops AS, and some people can still develop AS without it. As a result, other genes and environmental triggers may also contribute to AS development.

AS may be caused by a variety of environmental factors, including:

  • Some bacteria and viruses may trigger an abnormal immune response in people with AS. This immune response may cause inflammation and damage to joints and other tissues.

  • Smoking can aggravate the inflammation and symptoms of AS. It can also increase the risk of lung problems or heart disease.

  • Trauma to the spine or pelvis can trigger or aggravate AS inflammation and pain.

Symptoms of ankylosing spondylitis

Asthma symptoms vary from person to person and may change over time. The most common AS symptoms include:

  • Pain in the lower back and buttocks that may radiate to the thighs is usually the first symptom of AS. It is usually worse in the morning or after a period of rest and improves with exercise.

  • A stiff back and hips can limit the spine's range of motion and flexibility. The stiffness is worse in the morning or after periods of rest and improves with exercise or movement.

  • Reduced mobility: As AS progresses, new bone formation and fusion of vertebrae in the spine can occur. This can result in a loss of the natural curves of the spine and a hunched posture. Shoulders, ribs, hips, knees, and ankles can also be affected by it.

  • Depending on which parts of the body are affected by AS, other symptoms might include:

    • Eye inflammation (uveitis): This can cause redness, pain, sensitivity to light, or blurred vision in one or both eyes.

    • Skin inflammation (psoriasis): This can cause red, scaly patches on the skin, especially on the scalp, elbows, knees, or nails.

    • Bowel inflammation (inflammatory bowel disease): This can cause diarrhea, abdominal pain, bleeding, or weight loss.

    • Lung inflammation (fibrosis): This can cause shortness of breath, coughing, or chest pain.

    • Heart inflammation (carditis): This can cause chest pain, irregular heartbeat, or heart failure.

Diagnosis of ankylosing spondylitis

AS is diagnosed based on a combination of clinical features and tests. The clinical features include:

  • A history of chronic back pain and stiffness that started before age 45

  • A history of improvement with exercise or movement and worsening with rest

  • A history of family members with AS or related conditions

The tests include:

  • Inflammatory markers (such as erythrocyte sedimentation rate or C-reactive protein) and genetic factors (such as HLA-B27) can be measured by blood tests.

  • AS or its severity can be determined by X-rays of the spine or pelvis.

  • It can show inflammation or damage to the soft tissues around the spine or pelvis that may not be visible on X-rays.

Treatment of ankylosing spondylitis

Treatment options for AS include reducing pain and inflammation, preventing joint damage and disability, and improving quality of life.

  • Asthma medicines can help control symptoms and slow down the progression of the disease. They include:

    • Ibuprofen, naproxen, indomethacin, and other NSAIDs reduce pain and inflammation.

    • Methotrexate, sulfasalazine, leflunomide, and other disease-modifying antirheumatic drugs (DMARDs) modify the immune system and prevent joint damage.

  • The spine and other joints can be improved with physical therapy. Exercises and stretches can be taught by a physical therapist to help strengthen your muscles, improve your posture, and relieve your pain, and prevent stiffness and deformity.

  • An occupational therapist can suggest modifications to your home, workplace, or school environment that can make your tasks easier and safer if you have AS. In addition to teaching you energy conservation and joint protection techniques, they can also teach you skills you can use daily.

  • In the absence of severe joint damage or compression of the spinal cord or nerves, surgery is rarely required for AS. A damaged joint can be replaced with an artificial one (joint replacement) or a spinal deformity corrected with rods and screws (spinal fusion).

Prevention of ankylosing spondylitis

As AS is a genetic disorder, there is no way to prevent it. However, you can prevent or delay the complications and disability associated with AS by following some tips, including:

  • You should see your doctor as soon as possible if you have symptoms of AS or a family history of AS. Early diagnosis and treatment can help control inflammation and prevent joint damage.

  • Taking your medications as prescribed by your doctor and following their advice on physical therapy and lifestyle changes is part of your treatment plan, as is monitoring your symptoms and reporting any changes or side effects.

  • Keeping your flexibility, strength, and posture can be achieved by exercising regularly. Choosing low-impact activities that don't strain your joints, such as swimming, cycling, or walking, can help reduce pain and inflammation. In addition, you should stay away from activities that involve twisting or bending your spine, such as golf or tennis.

  • Smoking can worsen the inflammation and symptoms of AS. Smoking can also increase your risk of developing lung problems and heart disease. Quitting smoking can improve blood flow and oxygen delivery to your tissues.

  • You can lower your cholesterol, blood pressure, and weight if you eat a balanced diet that contains fruits, vegetables, whole grains, lean proteins, and healthy fats. Additionally, it can help you maintain a healthy immune system and reduce inflammation by providing you with nutrients and antioxidants.

  • A good way to manage stress is to avoid or cope with the sources of stress in your life. You can also practice some relaxation techniques such as deep breathing, meditation, yoga, or massage to help you cope with stress.

A chronic inflammatory condition known as ankylosing spondylitis (AS) affects the joints of the spine, especially where they join the pelvis. AS causes lower back and hip pain, stiffness, and reduced mobility. AS can affect the eyes, skin, heart, and lungs as well. AS is not curable, but it can be controlled and its complications prevented with proper management.

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