The chronic inflammatory condition known as ankylosing spondylitis (AS) mainly affects the sacroiliac joints, which are where the spine and pelvis connect. Vertebral fusion brought on by AS over time may cause decreased mobility and a distinctive hunched posture. It belongs to a class of diseases called spondyloarthritis, which also includes reactive arthritis and psoriatic arthritis.

Ankylosing spondylitis Symptoms

Ankylosing spondylitis symptoms might include the following and usually appear gradually:

Chronic back pain: Usually beginning in the buttocks and lower back, the discomfort may get better with exercise but go worse when you rest.

Stiffness: Especially after periods of inactivity or in the morning.

Fatigue: It’s normal to feel worn out or lacking in energy.

Inflammation: May also impact other joints, including the shoulders, knees, and hips.

Postural changes: As the spine fuses, AS may eventually cause a forward-stooped posture.

Ankylosing spondylitis Causes

The exact cause of AS is unknown, but it is believed to be a combination of genetic and environmental factors. The gene HLA-B27 is strongly associated with the condition, although not everyone with this gene will develop AS.

Ankylosing spondylitis Diagnosis

Physical examination: A doctor may assess range of motion, tenderness in the spine and joints, and signs of inflammation.

Imaging: X-rays, MRI, or CT scans can show changes in the spine and joints.

Blood tests: Testing for the HLA-B27 gene, as well as markers of inflammation such as ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein), can aid in diagnosis.

Treatment

Ankylosing spondylitis has no known cure, although treatment aims to control symptoms, lower inflammation, and stop long-term harm.

Treatment include:

NSAIDs (nonsteroidal anti-inflammatory drugs): To lessen inflammation and relieve pain.

DMARDs, or disease-modifying antirheumatic medications: If NSAIDs are not enough, drugs like methotrexate or sulfasalazine may be administered.

Biologic agents: IL-17 inhibitors (e.g., secukinumab) and TNF inhibitors (e.g., etanercept, infliximab) have demonstrated efficacy in lowering inflammation and slowing the course of disease.

Physical therapy: Stretching and exercise are essential for preserving range of motion and controlling pain.

Lifestyle modifications: Since they can enhance results, regular exercise, proper posture, and quitting smoking are advised.

When to see a doctor

1. Chronic or Persistent Back Pain
2. Morning Stiffness
3. Pain and Inflammation in Other Joints
4. Postural Changes
5. Fatigue or Unexplained Tiredness
6. Difficulty with Daily Activities
7. Eye Problems
8. Family History of AS or Related Conditions
9. Unexplained Weight Loss or Fever

Complications

Serious side effects from ankylosing spondylitis include the following if treatment is not received:

Spinal fusion: As the illness worsens, the vertebrae may unite, resulting in a permanent loss of spinal suppleness.

The forward-bent posture linked to AS is one example of a postural deformity.

Osteoporosis: This condition can make bones weaker and more brittle.

Lung and heart issues: In rare cases, AS can impact the lungs (resulting in restrictive lung disease) or the heart (creating issues with the aortic valve).

How Senocare can help

1. Personalized Care and Assistance with Daily Activities
2. Mobility Assistance and Safety Support
3. Medication Management
4. Pain Management and Comfort Care
5. Assistance with Physical Therapy Exercises
6. Coordination of Care with Medical Providers
7. Emotional Support and Social Interaction
8. Nutritional Support
9. Transportation and Errands
10. Preventive Care and Health Monitoring
11. Creating a Comfortable and Accessible Home Environment

FAQ

How serious is ankylosing spondylitis?

Ankylosing spondylitis (AS) can range from mild to severe, and its seriousness depends on how far the disease progresses and how well it is managed. While AS itself is not typically life-threatening, it can lead to significant long-term health issues if left untreated or poorly managed.

What activities should be avoided with ankylosing spondylitis?

High-Impact or Repetitive Activities

• Running or jogging on hard surfaces:
• Jumping or plyometric exercises:
• Weightlifting with heavy loads:

Excessive Spinal Twisting or Bending

Prolonged Static Positions

• Sitting or standing for long periods
• Poor posture

Activities That Can Lead to Falls or Injury

Extreme Heat or Cold

• Exposure to extreme temperatures.
• Overheating during exercise.

Overexertion

Activities That Involve Sudden, Intense Movements

Heavy Housework or Manual Labor

Sleep Positions

What are the risk factors?

Genetic Factors (HLA-B27 Gene)

• HLA-B27 gene: The most significant risk factor for developing ankylosing spondylitis is the presence of the HLA-B27 gene. About 90% of people with AS carry this gene, and it is strongly associated with the development of the disease. However, not everyone with the HLA-B27 gene will develop AS, suggesting that other factors also contribute to the condition’s onset.
• Family history: A family history of ankylosing spondylitis or other related spondyloarthropathies (such as psoriatic arthritis or reactive arthritis) increases the risk of developing AS. If a parent or sibling has AS, the risk of developing the condition is higher.

Age

• Young adulthood: AS typically begins in late adolescence or early adulthood (usually between 17 and 45 years old). The condition often starts between the ages of 20 to 30, though it can sometimes appear later.
• Gender: AS is more common in men than in women, with men being diagnosed at an earlier age and typically experiencing more severe symptoms. Women tend to have a more gradual onset and may experience milder forms of the disease.

Gender

• Male sex: AS is more prevalent in men than in women, with men being affected about three times more frequently. In men, AS tends to present earlier in life and often with more severe symptoms, including significant spinal involvement and fusion.
• Female sex: While less common in women, AS can still affect females, but they often have a milder form with less spine involvement. Women may also be at a greater risk of having peripheral joint involvement (such as the hips or knees).

Environmental and Infectious Factors

• Infections: Though no specific infection has been definitively linked to AS, some researchers believe that infections may trigger the disease in individuals who are genetically predisposed. Conditions like gastrointestinal infections (e.g., with Salmonella, Shigella, or Campylobacter) or urinary tract infections have been suggested as potential triggers for people with the HLA-B27 gene, leading to a condition called reactive arthritis, which can eventually develop into AS.
• Gut health: Some evidence suggests that abnormalities in the gut microbiome (the collection of bacteria and other microorganisms living in the digestive tract) could play a role in the development of AS. Inflammation in the gut, including conditions like inflammatory bowel disease (IBD), might trigger or exacerbate AS in genetically susceptible individuals.

Inflammatory Bowel Disease (IBD)

• People with inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis are at a higher risk of developing ankylosing spondylitis. These conditions involve chronic inflammation in the digestive tract and may be associated with increased inflammation in the joints, particularly in the spine and sacroiliac joints, which are commonly affected in AS.

Other Autoimmune Diseases

• Individuals with other autoimmune diseases, such as psoriatic arthritis, reactive arthritis, or rheumatoid arthritis, may have a higher risk of developing AS. These conditions belong to a broader group of diseases called spondyloarthropathies, which share certain genetic and environmental risk factors, including the HLA-B27 gene.

Lifestyle Factors

• Smoking: Smoking has been identified as a potential risk factor for ankylosing spondylitis and can also worsen the disease’s progression. Smokers with AS tend to experience more severe symptoms and greater spinal involvement. Smoking may contribute to inflammation and impair lung function, which is important in people with AS since lung complications can occur in severe cases.
• Obesity: Being overweight or obese can increase the strain on joints and may exacerbate the pain and stiffness associated with AS. Additionally, excess body weight can contribute to inflammation in the body, potentially worsening the disease’s effects.

Ethnicity

• AS is more common in Caucasians, particularly those of Northern European descent. However, it can occur in any ethnic group. The prevalence of AS is lower in certain populations, such as East Asians, Native Americans, and Sub-Saharan Africans.
  Certain populations, like the Yoruba people in West Africa, have been shown to have lower frequencies of the HLA-B27 gene, which explains the lower prevalence of AS in those regions.

Other Medical Conditions

• Having acute anterior uveitis (eye inflammation) can increase the likelihood of developing AS. This condition is common in AS and often occurs in the earlier stages of the disease. It involves inflammation of the middle layer of the eye and can cause pain, redness, sensitivity to light, and vision problems.
• Other inflammatory conditions: Conditions like psoriasis, which causes skin lesions, can increase the risk of AS, particularly in those who have the genetic predisposition (HLA-B27).

How important is physical therapy in managing ankylosing spondylitis?

Physical therapy is extremely important in managing ankylosing spondylitis (AS), as it plays a central role in maintaining mobility, reducing pain, and preventing long-term disability.

1. Improves Flexibility and Range of Motion
2. Reduces Pain and Inflammation
3. Increases Physical Endurance and Function
4. Prevents or Delays Disability
5. Helps With Breathing and Respiratory Health
6. Personalized Exercise Programs
7. Educates on Self-Management
8. Promotes Mental Well-being

REFERENCES:

American College of Rheumatology (ACR):

• The ACR provides extensive resources on ankylosing spondylitis, including guidelines for its management and the importance of physical therapy in managing the condition.
• Link: American College of Rheumatology – Ankylosing Spondylitis

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS):

• NIAMS offers comprehensive information on ankylosing spondylitis, including its symptoms, causes, and treatment options such as physical therapy.
• Link: NIAMS – Ankylosing Spondylitis

National Health Service (NHS), UK:

• NHS provides clear advice on ankylosing spondylitis management, including physical therapy and exercise guidelines to help individuals with AS manage their condition.
• Link: NHS – Ankylosing Spondylitis

Spondylitis Association of America:

• The Spondylitis Association of America provides valuable information on managing ankylosing spondylitis, including the role of physical therapy in treatment.
• Link: Spondylitis Association of America – Ankylosing Spondylitis

Arthritis Foundation:

• The Arthritis Foundation offers resources and guidelines on managing ankylosing spondylitis, with a focus on physical therapy, exercise, and lifestyle management.
• Link: Arthritis Foundation – Ankylosing Spondylitis

Mayo Clinic:

• Mayo Clinic provides a thorough overview of ankylosing spondylitis, including the role of physical therapy in managing pain and improving mobility.
• Link: Mayo Clinic – Ankylosing Spondylitis

British Journal of Pain:

• This journal includes studies and articles on the effectiveness of physical therapy in managing chronic conditions like ankylosing spondylitis, focusing on pain relief and improved function.
• Link: British Journal of Pain – Physical Therapy for AS