ANKYLOSING SPONDYLITIS – Causes, Symptoms,Test and Treatment

Ankylosing Spondylitis is a type of seronegative Spondyloarthropathy (Rheumatoid Factor Negative). It is also known as Bechterew’s disease or maria stamped disease. A chronic inflammatory disease commonly involving joints of the spine and later causes the fusion of vertebrae (bamboo spine). The condition is more common among males and symptoms are more severe in males. Females often get a milder form of Ankylosing Spondylitis. Symptoms usually occur below 20 years of age. The underlying mechanism of Ankylosing is autoimmune. 4th May is celebrated as the world Ankylosing Spondylitis day all over the world.

SYMPTOMS

Symptoms typically appear in early adulthood and include reduced flexibility in the spine. This reduced flexibility eventually results in a hunched forward posture. Pain in the back and joints is also common.

  • Pain in the ankle, eyes, heel, hip, joints, lower back, middle back. neck or shoulder.
  • Pain decreases with activity.
  • Back joint dysfunction or stiffness.
  • Enthesopathy – Swelling of tendon Achilles is a definitive feature of Ankylosing Spondylitis.
  • Anterior Uveitis – eye redness, pain, light sensitivity, blurred vision is associated with 25% cases of Ankylosing Spondylitis.
  • Fatigue, Hunched back, Inflamed tendons, Inflammatory bowel disease, Bone tissue formation, Physical deformity or sleep disorder.

DIAGNOSIS

After clinical suspects, one should go for investigation.

There is no specific test to diagnose Ankylosing Spondylitis.

Physical examination is done to demonstrate to reduce joint movements and flexibility. Tenderness over Sacroiliac Joint often found due to inflammation. Schober test is often done by Rheumatologist to measure the flexibility of the lumbar spine.

  • To see inflammatory changes in Sacroiliac joints at early stages imaging by X-ray and MRI may show evidence of inflammation of the sacroiliac joint between sacrum (the triangular bone at the lowest part of the back) and the ilium ( the bone felt on the upper part of the hip). Sacroiliac is a hallmark of Ankylosing Spondylitis. Other radiographic findings are Syndesmophyte ( a syndesmophyte is a bony growth originating inside a ligament, commonly seen in the ligaments of the spine, specifically the ligaments in the intervertebral joints leading to fusion of vertebrae) formation.
  • Serological Test – ESR and CRP are often raised during the acute phase of inflammation. HLA-B27 is positive in almost 90% of Ankylosing Spondylitis patients. It is a non-specific test as it may be positive in 8% healthy people.

TREATMENT

Ankylosing Spondylitis is neither preventable nor curable. Treatment is given to reduce symptoms and complications for a better lifestyle. It is treated by Rheumatologists.

  • PHYSIOTHERAPY – Extension exercise and physiotherapy are the main treatment. It keeps the joint mobile also reduces pain and helps in a better lifestyle of Ankylosing Spondylitis patients. TENS ( Transcutaneous Electrical nerve Stimulation) and Thermotherapy also used in the management of Ankylosing Spondylitis.
  • DRUGS – NSAIDs remain 1st choice for Ankylosing Spondylitis. It not only reduces pain but also reduces disease progression. Ibuprofen, Naproxen, Etoricoxib, Aceclofenac, etc are the most commonly used NSAIDs.
  • TNF alpha Blocker – Infliximab, Adalimumab, Etanercept, Golimumab, Certolizumab are used in parenteral route for NSAID resistant AS and severe form of Ankylosing Spondylitis.
  • Sulphasalazine is a DMRD commonly used for peripheral joint involvement in Ankylosing Spondylitis.
  • SECUKINUMAB – IL17A inhibitor is highly effective to treat Ankylosing Spondylitis patients.

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