Ankylosing spondylitis (AS)
What is Ankylosing spondylitis (AS)?
It is a type of autoimmune disease which causes arthritis of the spine predominantly. It belongs to spondyloarthritis group of diseases.
What is the cause of Ankylosing spondylitis?
Exact cause is unknown. Most autoimmune disease have genetic risk factors and environmental triggers which dysregulate immune system. The immune system starts attacking the joints & other structures. In AS, it attacks the sacroiliac joints, joints of the spine, hip & occasionally the other joints. It may also cause inflammation in eyes which is called as iritis or uveitis, presenting with pain, redness and blurred vision.
What symptoms occur in Ankylosing spondylitis ?
Main symptom of AS is low back pain. It is associated with early morning stiffness. Back pain of ankylosing spondylitis usually is severe at rest and gets better with activity. It is more severe in the nights and is associated with a stiff back early in the morning for atleast more than 30 minutes.AS can also cause joint pains usually in the lower limbs. Heel pain, sole pain are also common.
How is Ankylosing spondylitis different from other types of arthritis like Rheumatoid arthritis?
In Rheumatoid arthritis, inflammation of small joints is the hallmark whereas in AS the sites of inflammation is predominantly spine and entheses which are sites of attachment of ligaments and tendons to bones.
How is Ankylosing Spondylitis diagnosed ?
Rheumatologist assesses your medical history, examines the musculoskeletal system and based on the clinical scenario orders for blood tests, X ray or MRI. HLA B27 genetic testing may also be ordered as a part of diagnostic work up.
If I have HLA B27 positivity, does that mean I have AS ?
Definitely No. Not all persons with HLA B 27 will AS. So it is important this test is interpreted by your Rheumatologist in conjunction with the clinical scenario and imaging evidence.
How does Ankylosing spondylitis progress?
Over a period of time with persistent inflammation, calcium gets deposited on ligaments of the spine. The vertebral joints fuse & become stiff. This leads to difficulty in bending, turning the neck.
Can Ankylosing spondylitis be cured ?
Early treatment which relieves symptoms and prevents progression of disease can help a person lead near normal life. There is no permanent cure without treatment.
How is Ankylosing spondylitis treated?
The first line of treatment are the NSAIDs (non-steroidal anti inflammatory drugs) like indomethacin, diclofenac, naproxen etc. No NSAID is superior to another. These drugs give relief from pain for most patients. For joint and tendon related pains local injections of steroids (localized joint pain, tendon sheaths) or oral steroids (multiple joint pains) are effective. If there is no response to the above treatment, disease modifying antirheumatic drugs (DMARDs) such as sulfasalazine, methotrexate, leflunomide may be useful. If there is no response to DMARDs, then biological injections like TNF alpha blockers or IL-17 blockers can be used. Biologics like TNF alpha blockers are the most effective drugs available in treating the spinal and peripheral joint symptoms. Examples of TNF alpha blockers available in our country are infliximab (administered as Intravenous infusion), etanercept, adalimumab, golimumab (administered under the skin).
Is there any role for physiotherapy in ankylosing spondylitis?
Yes. A very important role. Patients must do regular exercises that promote spinal extension and mobility as advised by the doctor and physiotherapist. Activities like aerobics, walking, swimming, cycling etc are encouraged
What are the problems other than joint pain that are seen in ankylosing spondylitis ?
Uveitis : Inflammation of a part of eye called uvea causing redness, pain and blurred vision. Eye examination by ophthalmologist as and when suggested by your Rheumatologist is a must for AS patients.
Psoriasis : Any changes in skin, nail and scalp must be reported to your Rheumatologist in the form of Patches, scaly plaques, discolored nails,excessive dandruff could be psoriasis which is seen in some patients with AS and vice versa. Psoriasis is managed in conjunction with a dermatologist.
Gastrointestinal symptoms : diarrhea and constipation could be due to intestinal inflammation which need further evaluation by Rheumatologist in conjunction with gastroenterologist.
Osteoporosis : Long standing AS and those with fused spine are at risk for developing osteoporosis which needs evaluation by the Rheumatologist. You may need to take calcium and vitamin D supplements and anti-osteoporotic as prescribed by Rheumatologist
I have AS. I have heard that it runs in families. Should I plan a family?
If you are HLA B 27 positive & your child inherits the gene, there is only 5- 20% chance that he/ she will develop AS. If you are HLA B 27 negative, then the chance of your child developing AS is even lower. Hence AS should not deter you from starting a family.
Is stem cell therapy useful for ankylosing spondylitis?
No. Stem cell therapy for AS is in experimental stages & is currently not approved/ proven to be useful for AS.
Does smoking affect ankylosing spondylitis?
Yes. Smoking has been shown to increase the inflammation of AS & also reduce the responsiveness to therapy.