Ankylosing Spondylitis (AS)

Ankylosing Spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and other large joints. It leads to pain, stiffness, and over time can cause the joints to fuse (ankylosis), which severely limits movement.

Causes of Ankylosing Spondylitis:

The exact causes of AS are not fully understood, but a combination of genetic and environmental factors seems to contribute to the development of the disease.

1. Genetic Factors: The HLA-B27 gene is strongly associated with AS. People who carry this gene are at a higher risk of developing the condition, although not everyone with HLA-B27 will develop AS.

2. Immune System: AS is considered an autoimmune disease, meaning the immune system mistakenly attacks the body's own tissues, particularly in the spine and joints, leading to inflammation.

3. Environmental Factors: Certain infections (like Salmonella, Shigella, or Yersinia) and stress may trigger the development of AS in genetically predisposed individuals.

Symptoms of Ankylosing Spondylitis:

Symptoms usually develop gradually and can vary in severity.

1. Back Pain: The most common symptom of AS is pain in the lower back and sacral (lower spine) area, which typically worsens at night or in the early morning. The pain often improves with movement and physical activity.

2. Morning Stiffness: Patients often experience stiffness in the back and joints, especially after rest. The stiffness typically reduces after movement or physical exercise.

3. Joint Pain: Although AS primarily affects the spine, it can also involve other joints such as the hips, knees, and shoulders, causing pain and swelling.

4. Fatigue, Fever, and Malaise: People with AS may experience general fatigue, low-grade fever, and a feeling of unwellness.

5. Increased Pain and Stiffness: As the disease progresses, pain and stiffness can worsen, leading to significant loss of flexibility and movement in the spine.

6. Eye Problems: Some patients with AS may develop inflammation in the eyes (iritis), which can lead to pain and blurry vision.

Complications of Ankylosing Spondylitis:

If left untreated or not managed properly, AS can cause serious complications:

1. Spinal Fusion (Ankylosis): As the disease progresses, the joints in the spine can fuse, leading to a complete loss of mobility in the spine. This can result in a stooped posture and a decrease in height.

2. Joint Damage: Other joints, apart from the spine, can be damaged, leading to deformities and loss of function.

3. Heart Problems: Inflammation can affect the heart, leading to conditions like aortic valve inflammation or thickening of the aorta, which can affect the heart's ability to function.

4. Kidney Damage: In rare cases, AS can cause inflammation in the kidneys, which may lead to kidney failure.

5. Breathing Problems: In severe cases, the disease can affect the lungs, restricting their expansion and impairing breathing function.

Diagnosis of Ankylosing Spondylitis:

Diagnosing AS can be challenging due to its slow progression and the overlap with other conditions.

1. Physical Examination: A doctor will check for signs of pain and stiffness in the back and joints, as well as reduced mobility. Special tests, such as the Schober or Faber tests, may be performed to assess flexibility in the spine.

2. X-rays and MRI: X-rays and MRI scans are key to diagnosing AS, as they can reveal inflammation, fusion, and other characteristic changes in the spine and joints.

3. Blood Tests: A blood test may show elevated markers of inflammation (e.g., C-reactive protein, erythrocyte sedimentation rate). The presence of the HLA-B27 gene can also indicate a predisposition to AS, although it is not definitive for diagnosis.

Treatment of Ankylosing Spondylitis:

Treatment is aimed at reducing inflammation, relieving pain, and maintaining joint mobility.

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen and diclofenac can help manage pain and reduce inflammation.

2. Biologic Drugs: Tumor necrosis factor (TNF) inhibitors (e.g., infliximab, etanercept) and interleukin-17 inhibitors (e.g., secukinumab) can effectively control inflammation and slow the progression of the disease.

3. Immunosuppressive Drugs: In severe cases, immunosuppressive medications such as methotrexate may be used.

4. Physical Therapy and Exercise: Regular physical activity and physiotherapy are essential for maintaining spinal flexibility and joint function. Stretching exercises and strength-building routines are often recommended.

5. Surgery: In advanced cases where joints become severely damaged or deformed, surgical intervention may be required, such as joint replacement or spinal surgery.

Prognosis:

The prognosis for AS varies from person to person. If diagnosed and treated early, many people with AS can lead a relatively normal life. However, if left untreated or not managed properly, the disease can lead to permanent disability due to loss of mobility in the joints and spine.