What is Ankylosing Spondylitis?
Ankylosing spondylitis is a form of arthritis that mainly affects the spine between the interverbral discs. In some people, joints in the shoulders, ribs, hands and feet are also affected due to inflammation.
This form of back pain condition usually begins in adolescence or young adulthood, with onset usually occurring between ages 20 and 40. About 80 percent of patients develop symptoms before age 30, and males are sometimes more likely to be affected than females.
While a concrete cause of ankylosing spondylitis, sometimes known as ankylosis spondylitis, has not yet been identified, evidence suggests that both genes and environmental factors play a role in its development.
Cervical spondylitis refers to inflammation of the joints in the neck. Factors that contribute to cervical spondylitis may include genetics and degeneration of the disks and vertebrae of the neck due to age.
Symptoms of Spondylitis
Spondylitis symptoms usually begin with intermittent low back pain. A patient may experience stiffness, as well as increase pain first thing in the morning or after periods of inactivity. Pain may be severe enough to interrupt sleep.
While pain often begins in the sacroiliac joint, which is located between the pelvis and lower spine, it may spread to include the entire spine. Patients may lose mobility in the lower spine, or experience inflammation between the ribs, leading to an inability to fully expand the chest. Eventually, the inflammation may cause the spinal joints to fuse.
Other symptoms of spondylitis may include:
- Eye inflammation
- Pain in the heel
- Stiffness or swelling in the shoulders, knees, ankles, or hips
- Loss of appetite
- Weight loss
- Mild fever
How Is Spondylitis Diagnosed?
Diagnosing ankylosing spondylitis begins with the patient's medical history and physical examination. Lab and imaging tests may also help confirm the diagnosis, although tests alone typically do not make the final determination.
During a physical exam, a physician will look for signs and symptoms consistent with ankylosis spondylitis, including pain or inflammation in the heels, joints, spine and pelvis. The physician may then direct the patient to move and bend the body in multiple ways to evaluate flexibility of the spine. By having the patient breathe deeply, the physician can check for problems with chest expansion. Difficulty expanding the chest may indicate inflammation of the joints between the ribs and spine.
Besides a physical exam, a doctor may order X-rays or an MRI. X-rays may show changes in the joints that indicate ankylosis spondylitis. However, damage to the joints by inflammation may not always be visible. An MRI is able to better detect damage to soft tissue, and therefore detect joint damage earlier than X-rays can. Both can be used to monitor the disease's progress as well.
The most common blood test used in diagnosing spondylitis is for the gene HLA-B27. This gene is present in over 95 percent of Caucasian individuals diagnosed with this disease. However, this test is not definitive. The HLA-B27 gene is found in lower percentages of sufferers of African American and Mediterranean heritage. The gene is also found in many people who do not suffer from the disease. The presence of HLA-B27 supports a diagnosis of spondylitis only in people with symptoms or X-ray evidence consistent with the disease.
Treatment for Spondylitis
No cure for ankylosing spondylitis currently exists. However, treatment may relieve symptoms and slow its progression. Treatment for spondylitis may include the use of several types of medications, diet and exercise.
Medications used to relieve pain and inflammation of spondylitis include non-steroidal anti-inflammatory drugs (NSAIDS), and disease-modifying anti-rheumatic drugs, and other biological agents.
Non-steroidal anti-inflammatory drugs, or NSAIDS, include both over-the-counter and prescription medications. NSAIDS block chemicals called prostaglandins that cause inflammation and pain.
Disease-modifying anti-rheumatic drugs, or DMARDS, are second-line medications that reduce inflammation. Examples of DMARDS include corticosteroids and methotrexate.
Biologic agents are newer drugs genetically engineered to suppress a protein that acts as part of the body's inflammatory response. Blocking this protein can lead to reduced inflammation.
Diet and exercise also play an important role in ankylosing spondylitis treatment. A diet rich in omega-3 fatty acids, such as salmon, may help reduce joint inflammation. Maintaining a healthy weight will also ease stress on joints. Exercise and stretching may help reduce stiffness in joints, increase flexibility and strengthen muscles that support the joints.
In cases of severe damage, joint replacement surgery may be recommended. Surgery to straighten the spine may be performed in very rare cases.
Progression of spondylitis varies with each individual. While some people will experience mild, intermittent episodes of back pain, others will have severe, chronic pain. Most sufferers experience painful episodes followed by periods of reduced pain called remissions. People diagnosed with ankylosing spondylitis should attend regular appointments with their physician and follow the prescribed treatment plan.