The term ‘ankylosing spondylitis’ is derived from the Greek words ankylos which means ‘bent’, spondylos which means ‘spinal vertebra’ and -itis that refers to inflammation.
AS is a condition where there is swelling (inflammation) and pain in the spine or in the joint where the pelvic bone meets the base of the spine. Some of the other joints can also be affected.
The symptoms of AS are first seen in individuals when they are under the age of 30 years. Early symptoms of AS include increasing stiffness in the spine and chronic back pain.
Stiffness is severe in the morning. There may also be pain in the hips, knees, buttocks or shoulders. Some patients may also have diarrhoea, fever and weight loss as well as inflammation of the middle layer of the eye (uveitis) and heart trouble.
The pain and stiffness are worse when the patient is inactive for a long time, but it is relieved with exercise or a hot bath.
We do not clearly understand what causes AS, but we do know that genetics and the environment have a role to play. The vast majority of those with AS have the HLA-B27 gene, but not all with this gene develop the disease.
A rheumatologist is a specialist who diagnoses and treats AS. The diagnosis is based on a clinical examination and some diagnostic tests. The doctor evaluates an individual’s medical history and conducts a physical examination.
Blood tests to check Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP) and screen for a genetic marker HLA-B27 are also used to aid in the diagnosis of AS. X-rays of the joints do not provide a clear picture of AS in the early stages but an MRI scan is more reliable to visualize early changes in the affected joints.
The purpose of AS treatment is to relieve pain, maintain spinal flexibility and either stop or slow down the progression of the disease.
Treatment for AS includes:
- Non-steroidal anti-inflammatory drugs (NSAIDs): Help to relieve the pain and slow down the progression of the disease
- Corticosteroids: offer immediate relief but can only be used for a short span of time
- Disease-modifying anti-rheumatic drugs (DMARDs): Prescribed to limit joint damage, though their use for AS is limited
- Biologics (a type of ‘DMARDs): Particularly useful when people do not respond to other types of treatment. Biologics can halt or slow down disease progression
In addition to medication, physical exercise that helps to improve posture, stretch muscles and strengthen the core is important to manage AS. Swimming and deep breathing are very useful.
We have no cure for AS, but we can treat it effectively as long as it is diagnosed early. With regular treatment and lifestyle changes, patients with AS can live a fulfilling and rich life.
The author is a consultant Rheumatologist