Introduction
Symptoms of ankylosing spondylitis may begin affecting individuals as young as 10 years old, although the disease usually peaks around the age of 28. It is a chronic inflammatory disease that usually involves the joints between your spinal vertebrae or the sacroiliac joint between your spine and pelvis. The cause of ankylosing spondylitis is unknown and there is no cure, but a variety of management techniques can be prescribed to lessen the symptoms.
Symptoms
- Lower back pain and stiffness
- Pain in the sacroiliac joint
- Fatigue
Near the onset of ankylosing spondylitis, lower back pain and stiffness may come and go. The pain commonly occurs in the spine and pelvis, but may affect other places where tendons and ligaments attach to bone; such as the hips, ribs and the heel of your foot. As the disease progresses, pain is worse in the morning or during periods of inactivity. Usually, the pain gets better with activity or exercise. Fatigue is a common symptom, but likely caused by the lack of sleep due to pain or stiffness.
Diagnosis
- Onset under 35 years
- Pain more than 3 months
- Pain worse with immobility
- Pain better with exercise
- Limited mobility
- X-ray evidence of sacroiliac joint inflammation
- Blood test for HLA-B27 genetic marker
Often, a rheumatologist will diagnose ankylosing spondylitis. They specialize in diagnosing and treating disease of the joints and connective tissues. A complete physical exam should check for multiple joint pain and reduced mobility. Also, measurement of chest expansion during regular breathing can help diagnose alkylosing spondylitis that affects the ribs. Your physician may inquire about possible correlated conditions, such as eye inflammation, digestive disorders or a family history of the disease. Diagnostically, it can take 7 to 10 years for alkylosing spondylitis to show up in X-rays, magnetic resonance imaging or computerized tomography. Each correctly diagnosed person will have the genetic marker HLA-B27, but having the marker does not mean you will get the disease.
Treatment
Since there is no cure, treatment of the disease involves relieving pain and stiffness. Treatment options include; physical therapy, anti-inflammatory medications and surgery. Improved posture will maintain spinal alignment and slow progressive worsening of the disease. Adjustments may need to be made in both work and recreation to assist with proper posture. Also, stretching and spinal exercises can help improve joint mobility to prevent joint fusion. Deep breathing exercises will help keep your chest and rib cage flexible.
Non-steroidal anti-inflammatory drugs, such as ibuprofen, naproxen and aspirin, can be used to control pain and inflammation. Long-acting anti-inflammatory medications can promote sleep and reduce morning stiffness. Corticosteroid injections may be used at painful connective tissue sites and severe flare-ups may benefit from treatment with oral corticosteroids. Corticosteroids cannot be used long term. Tumor necrosis factor inhibitors may be prescribed for akylosing spondylitis. Such medications block certain inflammatory proteins and often provide pain relief for those who suffer from the disease.
Sometimes the knees or hips can be severely affected by aklylosing spondylitis and the joints may need to be surgically replaced. Also, spinal vertebrae may become fused in a severely flexed position, which may require surgery.
Prognosis
Symptoms of the disease may be unpredictable with symptoms that come and go. Most people with ankylosing spondylitis continue to function and learn to manage their disease with the guidance of a physician. Following a proper treatment plan will help reduce joint pain and inflammation, which can help prevent or delay future physical deformities. It is a chronic disease that will affect you for the rest of your life.
