Ankylosing Spondylitis


Ankylosing Spondylitis (AS) is a rheumatic disease that causes arthritis of the spine and sacroiliac joints. The sacroiliac joints are located in the lower back where the bone above the tailbone (sacrum) meets the bones on either side of the upper buttocks (iliac bones).

The term ‘Ankylosing’ means fusing together, while Spondylitis refers to the inflammation of vertebrae. AS is typically a painful, progressive and rheumatic disease. It primarily affects the spine, but can also affect other joints, tendons and ligaments. Sometimes, other areas like the eyes, lungs, bowel and heart can also get affected.

AS is also known as Bechterew’s disease, Bechterew syndrome and Marie Struempell disease.

Incidence and Prevalence

Ankylosing Spondylitis is three times more common in men than in women. The condition can affect all age groups including children. However, the most common age group includes those in late teens or early adulthood.

Sometimes, the disease might also begin before the age of 10.

Symptoms of Ankylosing Spondylitis

The typical symptoms of AS include:

• Slow or gradual onset of back pain and stiffness

• Limited expansion of the chest

• Hip pain and stiffness

• Eye inflammation

• Early morning stiffness and pain

• Persistent pain for more than three months

• Relief from pain after exercise and recurrence after rest

• Fatigue and feeling feverish

• Experiencing night sweats

Causes of Ankylosing Spondylitis

The occurrence of ankylosing spondylitis is normally traced to genetic inheritance. Research shows that a majority of patients (almost 90%) are born with the HLA-B27 gene, which is also reflected in a blood test.

In addition, the initial inflammation is thought to be a result of an activation of body’s immune system by a bacterial infection. Once activated, the body’s immune system becomes unable to turn itself off, even after the initial bacterial infection has subsided.

Diagnostic Tools

A physical examination might reveal limited spine motion, chest expansion or other characteristic symptoms. Following tests may be carried out:

• HLA-B27 antigen test

• Spine x-ray or pelvis x-ray

• CSC, showing mild anemia

Treatment Options

The treatment plan for ankylosing spondylitis normally comprises of two elements:

A) Medications

Variety of medications are prescribed to lessen pain and stiffness and make movement easier. The main medications include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), including Aspirin and Advil

• Disease modifying anti-rheumatic drugs (DMARDs), such as methotrexate and sulfasalazine

• Corticosteroids, such as a cortisone injection into the affected joint

• Biologics (Biologic Response Modifiers), such as Enbrel, Humira, and Remicade

B) Physiotherapy

Exercises can help in improving posture and breathing. Lying flat on the back at night can help maintain normal posture.

If left untreated, the disease can cause progressive stiffening of the spine, eventually leading to inability.