Ankylosing Spondylitis (AS): Symptoms, Causes, and More

Ankylosing Spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine, leading to severe pain and stiffness. This condition can significantly impact daily life, making even simple movements challenging. While AS primarily affects the spine, it can also extend to other joints and have a huge impact on one’s mobility. This blog dives deep into understanding AS, exploring its symptoms, causes, and the various ways to manage it. Whether you're looking for answers about your own aches or simply want to learn more about this condition, this article is for you.

What is Ankylosing Spondylitis?

Ankylosing spondylitis is a type of arthritis that primarily affects the spine, though it can also impact other joints and areas of the body. It is characterised by inflammation of the spinal joints (vertebrae), which can lead to severe, chronic pain and discomfort. In advanced cases, this inflammation can cause the vertebrae to fuse together, resulting in a loss of spinal flexibility and a hunched-forward posture.

Ankylosing spondylitis is a systemic condition, meaning it can affect more than just the spine. It can also cause inflammation in other areas of the body, including the eyes, heart, lungs, and even the skin. The exact cause of ankylosing spondylitis is not fully understood, but it is believed to involve a combination of genetic and environmental factors. The HLA-B27 gene is strongly associated with the condition, and having this gene increases the risk of developing ankylosing spondylitis.

What causes Ankylosing Spondylitis?

The exact cause of ankylosing spondylitis disease is not fully understood, but it is believed to involve a combination of genetic and environmental factors. Here are the main contributors:

Genetic Factors

• HLA-B27 Gene: The most significant genetic factor associated with ankylosing spondylitis is the presence of the HLA-B27 gene. People who carry this gene are at a much higher risk of developing the condition. However, not everyone with the HLA-B27 gene will develop ankylosing spondylitis, indicating that other genetic and environmental factors are also involved.

Immune System Dysfunction

Ankylosing spondylitis is considered an autoimmune disease, where the immune system mistakenly attacks the body's own tissues. In this case, it primarily targets the spine and other joints, causing inflammation and pain.

Risk Factors

• Age: Ankylosing spondylitis typically begins in late adolescence or early adulthood, most commonly between the ages of 17 and 45.
• Gender: Men are more likely to develop ankylosing spondylitis than women, although the condition can affect both genders.
• Family History: Having a family member with ankylosing spondylitis increases the risk of developing the condition, indicating a hereditary component.

While these factors are associated with ankylosing spondylitis, more research is needed to fully understand the complex interactions between genetics, the environment, and the immune system that lead to the development of this condition.

What are Ankylosing Spondylitis Symptoms?

Ankylosing spondylitis symptoms can vary widely among individuals, but they typically involve pain and stiffness in the spine and other joints. Here are the common symptoms associated with ankylosing spondylitis:

Early Signs and Symptoms

• Back Pain and Stiffness: Persistent pain and stiffness in the lower back and hips, especially in the morning or after periods of inactivity, are often the first signs. The pain typically improves with exercise, but not with rest.
• Neck Pain: Pain and stiffness may also occur in the neck.
• Fatigue: Chronic fatigue is a common symptom, as the body's immune response and inflammation can cause exhaustion.

Progressive Symptoms

• Reduced Flexibility: Over time, the inflammation can lead to a loss of flexibility in the spine, making it difficult to perform daily activities.
• Pain in Other Joints: Ankylosing Spondylitis (AS) can also affect other joints, such as the hips, shoulders, knees, and ankles, causing pain and swelling.
• Postural Changes: As the condition progresses, the inflammation can cause the spine to fuse, leading to a stooped posture or kyphosis.

Severe Symptoms

• Fusion of Vertebrae: In advanced cases, the vertebrae may fuse together, resulting in a rigid spine. This can severely limit movement and flexibility.
• Difficulty Breathing: If the joints between the ribs and spine are affected, it can make it difficult to take deep breaths.

Diagnosis of Ankylosing Spondylitis

Diagnosing ankylosing spondylitis (AS) can be challenging, especially in the early stages, as its symptoms often overlap with other conditions. Here are the key steps and tests typically involved in diagnosing AS:

Medical history review and symptom assessment

The doctor reviews the patient's medical history and asks for symptoms, particularly chronic back pain, stiffness, or pain. The onset of these symptoms at a young age (often under 45) may indicate ankylosing spondylitis.

Physical examination

After the initial assessment, a physical examination is carried out, during which the doctor may:

• Assesses the patient's flexibility, posture, and specific areas of pain or tenderness. 
• Check the range of motion in the spine and joints to identify any limitations or stiffness.
• Press specific areas around the pelvis and lower back to detect signs of inflammation. 
• Check for signs of reduced chest expansion, as limited chest mobility can be a symptom of ankylosing spondylitis.

Imaging tests

• X-rays: X-rays of the spine and pelvis can reveal characteristic changes, such as the fusion of vertebrae or inflammation at the sacroiliac joints. However, these changes may not be visible in the early stages of the disease.
• MRI (Magnetic Resonance Imaging): MRI scans can detect early signs of inflammation and structural changes in the spine and sacroiliac joints, making them useful for early diagnosis when X-ray results are inconclusive.
• CT Scans (Computed Tomography): In some cases, CT scans may be used to provide detailed images of the spine and joints.

Laboratory tests

• HLA-B27 Test: This blood test checks for the presence of the HLA-B27 gene, which is associated with a higher risk of developing ankylosing spondylitis. However, not everyone with this gene will develop the condition, and it is not present in all people with ankylosing spondylitis.
• Inflammatory Markers: Blood tests such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) can indicate the presence of inflammation in the body. Elevated levels of these markers are common in ankylosing spondylitis, but are not specific to the disease.
• Other Blood Tests: Additional tests may be conducted to rule out other conditions that can cause similar symptoms, such as rheumatoid arthritis or infections.

Early diagnosis is crucial for managing ankylosing spondylitis effectively and preventing severe complications. If you experience persistent back pain or other related symptoms, consult an ankylosing spondylitis doctor for a thorough evaluation.

How is Ankylosing Spondylitis Treated?

Managing ankylosing spondylitis focuses on relieving pain, reducing inflammation, and preventing or delaying complications and spinal deformity. Treatment typically involves a combination of medications, physical therapy, and in some cases, surgery: 

Medications 

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These are often the first line of treatment to reduce pain and inflammation. 
• TNF Blockers (Tumour Necrosis Factor Inhibitors): These biologic medications can help reduce inflammation by targeting specific pathways in the immune system. 
• IL-17 Inhibitors: Another type of biologic therapy that targets a different inflammatory pathway.
• Corticosteroids: Short-term use of corticosteroid injections can help manage severe inflammation and pain in specific joints.

Physical Therapy

• Stretching and Strengthening Exercises: Regular exercises to maintain flexibility and strength are crucial. Stretching exercises help maintain posture and reduce stiffness.
• Posture Training: Learning and maintaining good posture can prevent spinal deformity and improve overall function.
• Aerobic Exercise: Low-impact activities like swimming and walking can improve cardiovascular health and reduce stiffness.
• Physical Therapy Sessions: A physical therapist can design a personalised exercise program and provide hands-on treatments to improve mobility and function.

Surgical options (in severe cases)

• Joint Replacement Surgery: In severe cases where joints, such as the hips, are damaged, joint replacement surgery may be necessary.
• Spinal Surgery: In rare cases, spine surgery may be needed to correct severe deformities or to alleviate nerve compression.

Frequently Asked Questions

Who is at Most Risk for Developing AS?

Ankylosing Spondylitis tends to affect more men than women. Individuals with a family history of AS or related conditions, especially those carrying the HLA-B27 gene, are at higher risk. The condition often manifests between late adolescence and early adulthood.

Can Women Get Ankylosing Spondylitis?

Yes, women can get ankylosing spondylitis, but it is less common compared to men. Women may experience different symptoms and disease progression compared to men, often presenting with milder symptoms and less severe spinal involvement.

How Does AS Affect Daily Life?

AS can significantly impact daily life due to chronic pain, stiffness, and reduced mobility. Tasks requiring bending or twisting, such as tying shoelaces or reaching for objects, can become challenging. Fatigue and discomfort may also affect work productivity and social activities.

What Types of Exercises are Beneficial for AS?

Exercises that improve flexibility, strength, and cardiovascular fitness are beneficial for managing AS. Recommended exercises include stretching routines (especially for the spine), low-impact aerobic activities like swimming or walking, and strengthening exercises targeting core muscles and affected joints.

What is the Difference Between AS and General Back Pain?

Ankylosing Spondylitis is a chronic inflammatory condition that primarily affects the spine, causing prolonged stiffness and pain, particularly in the morning or after periods of inactivity. Unlike general back pain, which can result from muscle strains or injuries and typically improves with rest, AS pain tends to worsen with rest and improve with movement.

Is AS Hereditary?

Yes, genetics play a significant role in the development of ankylosing spondylitis. The presence of the HLA-B27 gene increases the likelihood of developing AS, although not everyone with this gene will develop the condition. Having a family history of AS or related autoimmune diseases also increases the risk.

Conclusion

Understanding ankylosing spondylitis is crucial for those affected by this chronic condition. By recognizing early symptoms, such as persistent back pain and stiffness, individuals can seek timely medical evaluation and begin appropriate management strategies. For those seeking specialised care and support for ankylosing spondylitis, Max Hospitals, a renowned ankylosing spondylitis hospital, offers comprehensive services and expertise. Contact Max Hospitals today to learn more about our specialised treatments and support programs.