BackCare

Ankylosing spondylitis

2009 Author: Patricia Watber

Ankylosing spondylitis (AS) is a form of chronic arthritis which affects the joints, tissues, bones and ligaments of the spine.

Ankylosing spondylitis (AS) is a form of chronic arthritis which affects the joints, tissues, bones and ligaments of the spine. It is an autoimmune disorder which affects both women and men, although it is five times more common in men. Its onset usually occurs between the ages of 15 and 35 and, although there is no known cause, it appears to have a genetic element to it. AS belongs to a group of diseases known as spondarthritides which includes other disorders such as psoriatic arthritis, colitic arthritis and reactive arthritis. Some of these other disorders may occur prior to AS developing or they may occur alongside it.

AS is characterised by inflammation of joints and ligaments in the back. As the inflammation resolves, bone material grows at the site of inflammation and this causes the vertebra to fuse together resulting in pain and stiffness. This process is known as ankylosis. Although it mainly affects the back, sufferers may experience pain in the buttocks, thighs and other joints including the hips, knees, shoulders and neck. If the inflammation remains untreated, the neck and back may become rigid resulting in restricted movement.

Symptoms
Symptoms of AS usually begin with stiffness and an ache in the lower back. The pain may spread to the back of the thighs and buttocks and then possibly move to other joints. In children pain may first appear in the hips and knees as opposed to the back. AS may also cause a visible physical deformity such as a hunchback in the upper back or a swayback in the lower back. In some patients after the initial inflammation, the back may become stiff and painful but then the disease may become ‘inactive’ or completely disappear. In others the disorder continues to remain ‘active’ resulting in more stiffness and pain.

Diagnosis
AS often remains undiagnosed for a long time as it is often wrongly diagnosed as non specific back pain. Diagnosis usually involves a blood test which may show abnormalities linked with the inflammation associated with the disease. There are three commonly used blood tests. The first, the CRP test measures a protein known as the C Reactive protein and increased levels of this indicates the presence of inflammation. The second test measures the Erythrocyte Sedimentation Rate (ESR) which looks at how long blood cells take to fall to the bottom of a test tube. An increased ESR also indicates inflammation. The third test measures plasma viscosity (a measure of protein changes in the blood) and an elevated plasma viscosity is associated with inflammation.

Diagnostic methods including x-rays, CT scans and MRI scans which can visualise spinal changes caused by AS may also be used to help diagnose the condition. However, the usefulness of these methods is still unclear and they would never be used as a standalone diagnostic tool.

Living with AS
AS affects the lives of sufferers in many ways and although there is currently no cure, there are ways to ensure that it does not become debilitating. Firstly as the lower back and neck become stiff it is important to maintain good posture as this helps ease pain and reduce stiffness. As exercise helps improve posture and muscle strength it is also recommended that those with AS do their best to remain active. On occasion symptoms can be aggravated by extreme exertion but if exercise is carried out moderately it can provide great benefit. Maintaining a healthy weight is also advised as carrying extra weight can result in more pressure being put on joints which can make pain worse.

It has been shown that manipulation techniques have only minimal effect for AS sufferers but there are many other actions that can be taken to ease pain. For example practising certain methods of lying, purchasing a good bed and changing your diet (relief in symptoms attributed to a vegan diet has been seen in some) can all be effective. In some cases physical therapy may prove useful and other treatment options such as TENS, massage, hot and cold treatments and other complementary treatments may benefit some. Interventions such as pain management programmes and counselling may also help with some of the psychological aspects of the condition.

Medication
There are many medications used to help manage pain caused by AS. Analgesics (pain killers) particularly Non-steroidal Anti inflammatory drugs (NSAIDs) such as Ibuprofen, which help to reduce inflammation, are often used. Other medications include a group of drugs known as Disease Modifying Anti-rheumatic Drugs (DMARDs). Examples including methotrexate and corticosteroids slow down the progression of the disease by reducing damage to bones and cartilage. Another newly developed class of drugs known as TNF blockers also appears to be effective for some sufferers. In severe cases of AS where hip or knee joints are greatly affected, or in order to correct a bent spine caused by the condition, surgery may be required.

In order to better treat disorders such as AS their cause must first be understood. As research continues to try and unravel this mystery new drugs and treatment methods for arthritic conditions are being developed and tested. Hopefully these can offer greater relief to patients until the cause of these conditions can be established and used to inform treatments or even a possible cure.