Understanding Ankylosing Spondylitis

Ankylosing spondylitis mostly affects the spine and sacroiliac joints. This condition is not to be confused with rheumatoid arthritis, which is also an inflammatory arthritis that usually affects the joints in the extremities, such as hands and wrists.

Ankylosing spondylitis symptoms

Symptoms vary from person to person and develop gradually over months or years. Symptoms include:

• Low back pain that develops gradually. The pain is worst in the morning (after rest) and is associated with morning stiffness. The pain improves with activity. Pain can last more than 3 months.
• Arthritis (inflammation of joints)
• Fatigue
• Hip, heel, and shoulder pain

Ankylosing spondylitis risk factors

• Those with the HLA-B27 gene are at higher risk of developing ankylosing spondylitis.
• Family history plays a role too. If a close relative such as a parent or a sibling has ankylosing spondylitis, you are three times more likely to develop the same condition.
• Smoking

Ankylosing spondylitis diagnosis

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

It can be challenging to diagnose ankylosing spondylitis as the condition develops gradually, and there is no conclusive test to confirm the diagnosis.

1. Blood test is done to check for signs of inflammation. When inflammation is present, the erythrocyte sedimentation rate (ESR) is elevated. 
2. Lower back x-ray can be done to see the damage to the joints at the base of your spine (the sacroiliac joints) and the formation of new bone between the vertebrae (backbone). These are common signs of advanced ankylosing spondylitis.
3. Magnetic resonance imaging (MRI) scan may highlight changes in the sacroiliac joints that are not apparent in the x-ray.
4. Genetic testing can be done to find out if you have theHLA-B27 gene. Most individuals with ankylosing spondylitis carry the HLA-B27 gene. However, not everyone with the HLA-B27 develops the disease.

Ankylosing spondylitis treatment

Treatment options will depend on symptoms and the severity of the condition. The goal of treatment is to relieve your symptoms so that you can carry out your regular activities. Treatment also aims to prevent further complications.

1. Physiotherapy and exercise

   Physiotherapy is critical to treating ankylosing spondylitis. A physiotherapist can recommend the most effective exercise programme that would suit your needs.

   Being physically active can improve your posture and spinal range of motion, as well as to prevent your spine from becoming stiff and painful.

2. Medication

   Non-steroidal anti-inflammatory drugs (NSAIDs) are used to ease joint pain and inflammation.

   Steroid injections may be recommended if a particular area is causing the most pain. 

   Anti-tumour necrosis factor (anti-TNF) therapy may be recommended if your symptoms are still uncontrolled despite NSAIDs and exercises. 

   Disease-modifying anti-rheumatic medicines (DMARDs) such as sulfasalazine and methotrexate are used to ease inflammation and control the disease.

3. Surgery

   Most patients with ankylosing spondylitis will not require surgery. However, joint replacement surgery may be needed if a joint is severely damaged.

Complications of ankylosing spondylitis

Ankylosing spondylitis usually affects the lower back due to the fusing of the bones. This makes it difficult to move your back, causing your posture to be fixed.

Iritis is a condition whereby the front part of the eye becomes red and swollen. This causes your eye to be sensitive to light (photophobia) and painful. Seek immediate medical attention if you develop iritis, as it can lead to complete or partial vision loss if not treated immediately. 

Other complications include joint damage, spinal fractures, spinal cord injuries, and heart valve disease.

Make an appointment at Gleneagles Hospitals

Speak to your doctor to know more about ankylosing spondylitis. If you are experiencing any of the symptoms of ankylosing spondylitis, get in touch with us to find out more about our Orthopaedic Services at your nearest Gleneagles Hospital.

Gleneagles Hospital works with orthopaedic specialists to assist patients through diagnosis and treatment. The caring and multidisciplinary team of healthcare professionals are available for consultation and to provide the best care.