Ankylosing Spondylitis: Treatment & Complications

What is ankylosing spondylitis?

Ankylosing spondylitis (AS) is a chronic form of arthritis that primarily affects the spine or back, although other joints, ligaments or tendons in the hips, shoulders, knees or ankles may also get affected. The joints and ligaments of the spine that allow it to move become inflamed and stiff in this condition. The spine’s bones may grow together, making the spine inflexible and rigid.

Ankylosing spondylitis generally starts in individuals towards late adolescence or in the early twenties, and men are more likely to be affected than women.

What are the causes of the disorder?

The exact cause for the condition is unknown but researchers have identified a genetic marker, human leukocyte antigen B27 (HLA-B27), which is present in most people with ankylosing spondylitis. Ankylosing spondylitis can run in families, and the gene can be inherited from a family member. However, even though the marker is seen in most people with the disease, not all individuals who carry the marker develop ankylosing spondylitis.

What one needs to know about symptoms or signs?

The main symptoms of ankylosing spondylitis are as follows:

  • Back pain and stiffness that lasts for more than three months. The pain is worse in the mornings and improves with movement and exercise.
  • Pain in the buttocks.
  • Inflammation of joints.
  • Painful inflammation at places where ligaments or tendons attach to the bone.
  • Bowel problems (inflammatory bowel disease).
  • Fatigue.

Which specialist should be consulted in case of signs and symptoms?

People who show the above symptoms must consult a general practitioner, who will refer them to a rheumatologist (a doctor specialising in diagnosis and treatment of conditions of the musculoskeletal system).

What treatment modalities are available for management of the disorder?

Treatment for ankylosing spondylitis aimed at reducing pain and stiffness, preventing deformities and allowing a patient to perform daily activities. The treatment approaches include:

  1. Medication – Non-steroidal anti-inflammatory drugs like ibuprofen or alternate painkillers like paracetamol may be prescribed to relieve symptoms. Depending on the patient’s condition, tumour necrosis factor (TNF) blocker, bisphosphonates or anti-rheumatic drugs may be               used to treat AS.
  2. Physiotherapy – A key part of treating ankylosing spondylitis, physiotherapy helps to improve posture and range of spinal movement and prevents the spine from becoming painful and stiff.
  3. Surgery – Most cases of AS do not require surgery, but a replacement surgery is suggested for patients whose hip or knee becomes severely affected. Surgery of the neck or spine is rare, and performed only in case of a severe stoop in posture.

What are the known complications in management of the disorder?

Complications of ankylosing spondylitis include:

  1. Iritis – The eye may get inflamed, red, painful and sensitive to light. This requires immediate treatment as the condition can damage the eye.
  2. Osteoporosis – Osteoporosis in the spine may develop an after-effect of ankylosing spondylitis. The bones become weak and brittle, increasing the chances of fracture.
  3. Heart and lung conditions – Patients with AS are prone to problems of the heart and lungs, like the heart disease or fibrosis (scarring) of lung. These problems are, however, rare.

Is ankylosing spondylitis life threatening?

Ankylosing spondylitis is a chronic condition that may display periods of severity followed by remissions in which symptoms subside. Though there is no known cure for AS, it is not life threatening and treatments can help reduce the severity of symptoms. Patients with ankylosing spondylitis can expect to lead normal lives, as only few people develop severe disability. Pain management, control of inflammation, exercise and good posture helps individuals controls many effects of the disease.

However, a recent study has thrown light on a serious heart complication of ankylosing spondylitis that may occur late in the course of the disease. These complications include aortitis and periaortitis, which represent the involvement of aortic valve of the heart and the heart conduction system, and may require rapid treatment. This develops due to inflammatory lesions primarily localized in the aortic root, but can extend into the heart conduction system, leading to first, second and third degree atrioventricular blocks. For this reason, patients who show signs of heart involvement will require an accurate cardiovascular assessment during every medical examination.

Is there any risk to other family members of having the disorder?

Heredity is thought to play a role in ankylosing spondylitis. The genetic marker, HLA-B27, is found in most people with AS. However, most people who test positive for the marker do not develop the condition, which is why the exact trigger of the disease is not yet established.

What precautions or steps are necessary to stay healthy and happy during the treatment?

Though patients with AS are able to carry on with their daily life, they might require some adjustments in their working and personal environment, like the use of special equipment, to carry out their tasks easily.


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