Ankylosing spondylitis: symptoms, causes and treatment

Definition

What is ankylosing spondylitis?

Ankylosing spondylitis (AS) is a form of arthritis (arthritis) that primarily affects the joint area of ​​the spine. This condition causes the area of ​​your back, ribs, and neck to feel stiff and painful.

Over time, this inflammation causes the small bones in the spine to fuse together, making your spine less flexible. In serious cases, the joining of these small bones causes your posture to bend forward.

Ankylosing spondylitis is a chronic, incurable disease. However, the treatment given can reduce symptoms and slow the progression of the disease.

How common is ankylosing spondylitis?

Ankylosing spondylitis is a less common form of arthritis. Meanwhile, other types of arthritis are more common, such as osteoarthritis, rheumatoid arthritis, or gout (gout).

This disease generally occurs in men than women. In terms of age, ankylosing spondylitis is more common in people under 45 years of age.

Signs & symptoms

What are the signs and symptoms of ankylosing spondylitis?

The signs and symptoms of ankylosing spondylitis can vary from person to person. However, at the beginning of its appearance, some of the most common symptoms of ankylosing spondylitis are:

• Pain or aches in the lower back and hips, which usually occurs in the morning for 30 minutes and subsides throughout the day or with activity, and at night, which often causes you to wake up from sleep.
• The lower back feels stiff, which often occurs in the morning or after resting for too long.
• Feeling very tired.

These symptoms generally develop slowly over weeks, months, or years and may come and go. Over time, pain in the lower back can radiate to other joint areas, such as the neck, shoulders, or thighs.

In fact, some people may even experience pain, stiffness, and swelling in the joints of the knees, ankles, ribs, or shoulder blades. If most of the bones are affected, this condition can make it difficult for you to carry out activities.

Apart from the signs above, several other symptoms may also arise, especially if the disease has progressed. Symptoms of ankylosing spondylitis are:

• Decreased appetite.
• Weight loss.
• Fever.
• Skin rash.
• Stomach pain and diarrhea.
• Vision changes, eye pain, or redness of the eye due to inflammation in the eye.
• Chest pain or tightness around the chest, making it difficult for you to take deep breaths.

There may be other symptoms that are not listed. If you have questions about signs of illness, consult a doctor.

When to see a doctor?

You should immediately see a doctor if you feel any early signs or symptoms of ankylosing spondylitis as listed above, especially if they occur continuously and do not go away. Early treatment can reduce the risk of disease severity in the future.

Everyone's body generally shows different signs and symptoms. Therefore, always discuss with your doctor to find a method of diagnosis and treatment that suits your condition.

Causes & risk factors

What causes ankylosing spondylitis?

Until now, the cause of ankylosing spondylitis is not known with certainty. However, experts argue, this disease may be caused by genetic and environmental factors.

The main gene associated with ankylosing spondylitis risk is called HLA-B27. The reason is, some people with AS were detected to have this gene. However, not everyone who has this gene will develop ankylosing spondylitis.

The reason is, as reported by the Spondylitis Association of America, the HLA-B27 gene is likely to only play about 30 percent of the overall risk of US disease. The rest is thought to come from other gene disorders that are triggered by environmental factors, such as bacterial infection.

This other gene works together with HLA-B27 which then increases the risk of ankylosing spondylitis. Scientists have identified more than 60 other genes associated with AS. Among the genes that have been identified are ERAP1, IL-12, IL-17, and IL-23.

What increases your risk of getting ankylosing spondylitis?

Although the main cause is unknown, several factors are said to increase a person's risk of developing ankylosing spondylitis. The various risk factors for ankylosing spondylitis are:

• Gender

This disease is more common in men than women. Therefore men are more at risk of developing AS disease.

• Specific age range

This disease usually occurs between the ages of 20-40 years. However, AS may also start at the age of under 10.

• Family history and genetics

If you have a relative or family member with ankylosing spondylitis, you are more at risk of developing the disease. The reason is, the HLA-B27 gene can be passed from parent to child. It is also estimated that five to twenty percent of children with this gene will develop AS at some time.

• Certain medical conditions

You are also at risk for AS disease if you have certain medical conditions, such as Crohn's disease, ulcerative colitis (inflammation of the intestines), or psoriasis.

Complications

What are the possible complications of ankylosing spondylitis?

In severe cases, ankylosing spondylitis can cause new bone to form in the spine. This new bone formation gradually closes the gap between the vertebrae so that the small bones are joined together.

This condition causes the spine to become stiff and lose its flexibility. In addition, the small bones that stick together also cause the ribs to become stiff, thus interfering with the function of your lungs.

Apart from these conditions, complications of ankylosing spondylitis that may occur are:

• Inflammation of the eye or iritis

Inflammation of the eye (iritis), also known as uveitis, can occur in people with AS. This condition is characterized by red, sore, sensitive to light, and blurred vision.

• Osteoporosis and fractures

Ankylosing spondylitis can lead to osteoporosis of the spine, which is a condition in which the bones become brittle. This condition can increase the risk of fractures in the spine.

• Heart problems

Ankylosing spondylitis can cause inflammation of the aorta, which is the large artery in your body. The inflamed aorta can enlarge, then damage the aortic valve in the heart and interfere with its function. This condition can lead to heart disease.

• Cauda equina syndrome

Cauda equina syndrome is a rare complication of ankylosing spondylitis. This complication can occur when the nerves under your spine are compressed. This condition can cause a variety of symptoms, such as pain or numbness in the lower back and buttocks, weakness in the legs, urinary incontinence, and bowel incontinence.

• Amyloidosis

A very rare complication of AS is amyloidosis, which is a condition in which amyloid (a protein produced by bone marrow) builds up in organs, such as the heart, kidneys, and liver. This condition can cause several symptoms such as excessive fatigue, weight loss, fluid retention, shortness of breath, and numbness or tingling in the hands and feet.

Diagnosis & Treatment

The information described is not a substitute for medical advice. ALWAYS consult your doctor.

How do doctors diagnose ankylosing spondylitis?

To diagnose ankylosing spondylitis, your doctor will ask you about your symptoms, how long you've had your symptoms, any medical conditions you may have, and your family history. After that, the doctor will perform several tests to confirm the diagnosis. Some of the tests that are commonly done to diagnose ankylosing spondylitis are:

Physical examination

During a physical exam, your doctor will look for signs and symptoms, including pain along the spine. Your doctor may order you to move and bend in different directions and breathe deeply to check if you are having trouble breathing.

Imaging test

X-rays or X-rays and magnetic resonance imaging (MRI) is generally done to help diagnose AS, although both tests have limitations.

X-rays may show changes in the spine and joints, but it can take years to determine the cause. Meanwhile, with MRI, doctors can find a faster and more precise diagnosis, because it can show more detailed damage, even though this test is more expensive.

Blood test

Blood tests are generally done to look for inflammation in your body, which is an early sign of AS disease. In addition, a blood test is also possible to check for the HLA-B27 gene, although not all people with AS disease will have it.

What are the treatment options for ankylosing spondylitis?

There is no treatment that can completely cure ankylosing spondylitis. However, treatment still needs to be done to relieve symptoms and slow the progression of the disease. Some of the treatments for ankylosing spondylitis are:

Drugs

Some of the drugs commonly given by doctors to treat this disease, namely:

• Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen, or indometachin, to relieve pain and inflammation.
• Disease-modifying anti-rheumatic drugs (DMARDs), such as sulfasalazine and methotrexate, to reduce inflammation in the joints.
• Corticosteroids that are injected into the inflamed joints.
• Biological therapy, such as TNF inhibitors (including etanercept, adalimumab, infliximab, golimumab), to stop inflammation.

Physical therapy

Physical therapy can help you relieve pain, increase muscle strength, and maintain flexibility in your joints, making it easier for you to move around and carry out activities. In addition, this therapy can also help maintain your posture in order to stay upright.

Operation

Surgery may be needed if your pain gets worse, or if a joint has been damaged and needs replacement. However, most people with ankylosing spondylitis don't need this treatment procedure.

Home care

What are some lifestyle changes or home remedies that can treat ankylosing spondylitis?

Lifestyle and home remedies that can help treat ankylosing spondylitis include:

• Routine light exercise to help reduce pain, increase joint flexibility, and improve posture, such as swimming, pilates, yoga, and tai chi.
• Maintain your weight by eating a balanced nutritious diet that is low in fat.
• Don't smoke or drink alcohol.
• Apply a warm or cold compress to the affected joint to reduce pain, stiffness, and swelling of the joint.

If you have any questions, consult your doctor for the best solution to your problem.