What is Ankylosing Spondylitis and what are Its Symptoms?

The term ‘ankylosing’ refers to joints becoming stiff or rigid. The term ‘spondy’ is Greek for spine and ‘spondylitis’ refers to swelling, pain or tenderness in the spine. Thus, putting both together, ankylosing spondylitis is inflammation that affects the spine and makes it lose its flexibility. It is considered a kind of arthritis that starts by affecting the spine.

In time, the spinal vertebrae fuse together and this will manifest as a hunched back. While lower back pain is the expected symptom, this condition will in some cases manifest in other forms too – as eye inflammation, heart issues, etc.

Symptoms of Ankylosing Spondylitis (AS)

The spine meets the hip bone at the sacroiliac joint which is usually the first joint affected by AS. The initially noticeable symptoms might be any of the following:

• Feeling of pain and rigidity in the lower back and hips. This pain is felt more after a night’s rest or after any prolonged period of rest.
• Some people experience neck pain and a feeling of tiredness.

While lower back is the most commonly affected part, AS can affect other areas of the body as well. These include:

• Areas where tendons and ligaments affix to the bone. This is not limited to the spine and can affect the tendons of the heel as well.
• The cartilage between the ribs and sternum too can suffer damage because of AS.
• The ball and socket joint of the shoulder too can get affected.

Complications Associated with AS

• AS increases the chances of osteoporosis affecting the spine. In osteoporosis of the spine, the vertebrae might fracture. These fractures will not only affect a person’s posture, they will also compress the spinal nerves resulting in pain and damage to the nerves.
• In acute cases of AS, there might be new bone formation in the spine and this new bone will finally fuse with the vertebrae. This will result in severe stiffness of the back. When the new bone forms in the rib cage, the person’s ability to breathe comfortably will be affected.
• As already mentioned, AS can affect the eye. The patient will experience pain and the eyes will appear red. When the patient complains of blurry vision or reduced vision, an immediate consult with an ophthalmologist is advised as waiting might cause permanent damage to the eye. This eye condition is known as uveitis.
• The aorta in the heart may get affected by AS, as well. Swelling of the aorta as a result of AS will affect the aortic valve and hinder its normal functioning. This increases the risk of heart problems.

Who Is at Risk of Developing AS?

• AS is suspected to have genetic links. The HLA-B27 gene has been associated with it. But there have also been instances where people with this gene never developed the condition.
• More men than women develop AS.
• Towards the end of the teenage years and early 20s seem to be the time during which the condition has its onset.

Diagnosing AS

With lower back pain being a very common complaint among most people, associating lower back pain with AS is tricky. As the condition is rarer among women, diagnosis can be a little difficult. Till date there is no confirmatory test for it and hence doctors will have to rely on information obtained from a thorough physical examination of the patient along with imaging tests and blood tests for diagnosis of AS.

Treating AS

While there is no complete cure for AS, with proper treatment, patients can definitely lead comfortable lives. Treatment options vary from medicines to lifestyle modifications. It is important to remember that AS affects everyone differently and treatment protocol will depend on how an individual is affected.

Medication:

• The doctor will start off with non-steroidal anti-inflammatory drugs (NSAIDS). This will help with the pain and back stiffness. These NSAIDs will take some time to act and provide relief. All drugs need to be taken only after especially if the patient is also suffering from some other health condition.
• In the event of NSAIDs not helping much, disease modifying anti-rheumatic drugs will be given. While on this, the doctor will monitor the patient’s liver and kidney functioning to make sure no complications arise.
• Corticosteroids might be given in some cases to help with pain though it is only a short-term fix. They are given in the form of eye drops when AS affects the eye.
• Biologic drugs that are made from living cells too can be prescribed. The doctor will discuss the side effects of biologics before starting the patient on it.

Physical Activity:

• The benefits of physical activity are manifold if you suffer from AS– not only will it help with pain and stiffness, it will enhance muscle strength as well. People have reported a lot of improvement after starting physical activity.
• Low impact activities are the best option for people with AS. From walking and cycling to yoga, the patient can decide on what he/she enjoys and perform it regularly.
• Training with weights too will help but this must be performed under a physiotherapist’s guidance.

Lifestyle Modifications:

Eating healthy, quitting smoking and making sure the patient gets enough vitamin D are other options which will help greatly.

Surgical Options:

Surgery will be considered only as the last option, if the patient has severe pain and deformity. The options vary depending on the part affected.

Dealing with AS

• Being diagnosed with ankylosing spondylitis can be scary and overwhelming. But it is important to know and believe that with early treatment, physical activity and lifestyle modifications, a happy life is possible.
• Friends and family can play a huge role in supporting a patient who has been diagnosed with AS. Talking to them will definitely help and leaning on them for support will make adapting to the condition less stressful.
• Professional help too is always available and people should not hesitate to reach out if at all the need arises.