Ankylosing spondylitis is a form of arthritis that is characterized by inflammation of joints and ligaments located in the spine. It can also affect peripheral joints such as the knee, ankle, and hip joints. The joints and ligaments within the spine are responsible for the movement and bending of the body. If an individual has ankylosing spondylitis, the inflammation of the joints and tissues within the spine can lead to stiffness. In more severe cases, the vertebrae in the spine may fuse, which can result in a stiff and rigid spine.
Causes of ankylosing spondylitis
Ankylosing spondylitis can affect anyone, however, certain factors may increase the likelihood of developing the condition. These factors include:
Genetics and family history: Ankylosing spondylitis is more likely to occur in individuals with a family history or genetic predisposition to the condition. The exact cause of ankylosing spondylitis is largely unknown, although heritability is often cited as a major contributing factor.
About 95% of individuals with ankylosing spondylitis possess a variant of the human leukocyte antigen-B (HLA-B) gene. This altered gene produces HLA-B27 protein that increases the risk of disease. However, a majority of individuals with this variant do not develop ankylosing spondylitis.
Over 60 genes, such as HLA-B60, HLA-DR1, ERAP1, IL23R, IL1A, etc. may have an influence on the heritability of ankylosing spondylitis.
Age: Most people develop the symptoms of ankylosing spondylitis before the age of 45. However, there are some individuals who may develop this condition at an earlier age, such as in childhood or adolescence.
Other conditions: Individuals with Crohn's disease, psoriasis, or ulcerative colitis may have a higher risk of developing ankylosing spondylitis.
Symptoms of ankylosing spondylitis
The most common symptom of ankylosing spondylitis is pain and stiffness in the lower back (and/or hip) and, over time, the symptoms may spread to other areas of the body. The symptoms tend to worsen during periods of relaxation or lack of activity, which may lead some individuals to experience increased pain during the night or after extended periods of sitting. Generally, movement and exercise can be beneficial in relieving pain.
The symptoms of ankylosing spondylitis differ between individuals. Some individuals may experience transient periods of pain, while others may experience chronic, intense pain. Mild or severe symptoms may become more pronounced during "flares" and improve in periods of remission. The symptoms of ankylosing spondylitis include:
• Lower back pain and stiffness
• Neck, hip, and joint pain
• Difficulty in breathing
• Tiredness
• Vision problems
• Loss of appetite
• Unexplained weight loss
• Abdominal pain
• Diarrhea
• Skin rash
Diagnosis of ankylosing spondylitis
After assessing the patient's symptoms and their family history, a physical examination may be conducted by a healthcare provider. One or more of the following tests may be ordered to assist in the diagnosis of ankylosing spondylitis.
Imaging scans: Magnetic resonance imaging (MRI) can be used to identify spine issues while X-rays may be used to rule out arthritis and other conditions.
HLA-B27 blood test: Human leukocyte antigen (HLA)-B27 is a type of protein that is found on the cell surfaces. The HLA-B27 blood test is used to determine whether a person's white blood cells (WBCs) contains the HLA-B27 protein or not.
Interpretation of the HLA-B27 blood test results
Positive test result
A positive HLA-B27 test result indicates that the individual is at a higher risk of developing ankylosing spondylitis. If the individual has symptoms of chronic pain, inflammation, and/or degenerative bone changes (as evidenced by imaging scans), then the test supports a diagnosis of ankylosing spondylitis.
Negative test result
A negative HLA-B27 test result indicates that the HLA-B27 marker has not been detected in the blood sample. However, this does not mean that the individual is not having/will not develop ankylosing spondylitis, as individuals with or without the antigen can also develop ankylosing spondylitis.
Treatment of ankylosing spondylitis
There is no cure for ankylosing spondylitis, which is a long-term condition. However, there are treatments that can help prevent complications, limit joint damage, and reduce pain. These treatments include:
Exercise: Physical activity can reduce or prevent the progression of the disease. Many individuals experience intense pain when they are not active. Movement appears to reduce pain. It is recommended that individuals seek advice from their healthcare providers regarding safe exercise practices.
Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs are often used to reduce the symptoms of pain and inflammation.
Disease-modifying anti-rheumatic drugs (DMARDs): DMARDs are used to alleviate pain and swelling in the joints. They are also used to treat lesions associated with inflammatory bowel disease (IBD). Newer types of DMARDs, known as biologics, are used to manage inflammation by modulating the immune system.
Corticosteroids: Injectable corticosteroids help to temporarily reduce pain and inflammation in the joints.
Surgery: Surgery may be necessary for a limited number of individuals with ankylosing spondylitis. Some types of surgery include joint replacement surgery, which involves the implantation of an artificial joint. Kyphoplasty is a surgical procedure used to correct curvature in the spine.
A combination of imaging scans, physical examinations, and blood tests are used to assess the effectiveness of the treatment. Healthcare providers help individuals determine how long treatment should be continued and inform individuals about side effects of medicines and plan for follow-up visits.
HLA-B27 blood tests and imaging scans help in determining whether individuals have an increased risk of developing ankylosing spondylitis, and early detection enables possible treatment. There are many treatments available to help manage symptoms of ankylosing spondylitis, such as physical therapy/activity to improve mobility and posture, as well as medications for pain relief, inflammation control, etc. Ankylosing spondylitis can be a debilitating condition, but timely detection can help lead a pain-free and active life!
