In this video I’m going to answer what is ankylosing spondylitis, its common symptoms,
progression and how it’s diagnosed.
Hey everyone, Dr. Rowe here at SpineCare in St. Joseph, MI.
If you’re unsure of what ankylosing spondylitis (or AS) is, it’s an auto-immune, rheumatic
condition that primarily affects the spine, as well as other joints throughout the body.
To help explain it a bit better, I’m going to break it down into 3 parts: causes, symptoms,
and how it’s commonly diagnosed.
So to begin with, let’s talk more about the cause of ankylosing spondylitis.
Going back to AS being a ‘rheumatic condition’, that means there’s a condition in which
your immune system has developed a fault, goes awry, and beings attacks your own tissues.
This is also referred to as an autoimmune disease.
Many of these conditions are considered idiopathic, or of unknown cause.
Sometimes it’s in the genes you’re born with, other times it’s a result of something
that affects you directly, like something that causes an infection.
As of today, doctors and researchers are stumped on what exactly causes AS.
Which also means no known cure.
However, it is known that genetics play a very important role, especially with a gene
called HLA-B27.
This is important to note: most people who have AS have a gene that produces a protein
called HLA-B27.
I want to note though, being a HLA-B27 gene carrier though does not mean a person will
develop ankylosing spondylitis.
Less than 1 in 20 people with HLA-B27 gets AS.
It’s just an important link to the development of the condition.
Also, HLA-B27 isn’t the only genetic marker linked with AS, since researchers suspect
that more than 60 different genes have been associated with AS.
Particular environmental factors (like a viral or bacterial infection) may also be needed
to activate AS.
There’s also research that may link intestinal bacteria as the trigger the disease.
Additionally, the majority of those diagnosed with ankylosing spondylitis are Caucasian
males under the age of 45.
Women can also have the disease, but men are twice as likely to get it.
Again, there is no cause or cure for AS, but research is making headway on possible triggers
and early detection signs that may help treat it with greater success.
So next, let’s go over the common symptoms of AS in better detail.
Just like any condition or disease, the development of ankylosing spondylitis, including the onset
of symptoms, can vary significantly from one person to the next.
However, most symptoms will start to develop in late adolescence or early adulthood.
In more rare cases, it’s possible to see symptoms start early in childhood.
The most common early symptoms include frequent, dull pain and stiffness around the lower back
or buttocks.
This pain will gradually become more severe and frequent over the course of weeks to months.
Initially, the discomfort is felt at first on one side, then may suddenly alternate sides.The
pain is usually spread out or diffuse, instead of pinpoint or localized.
Pain and stiffness is usually worse in the mornings and during the night, or after any
long periods of inactivity.
It’s usually relieved by heat, such as a warm shower, or with light stretches and exercises.
Other early stages of AS include mild fever, loss of appetite, and overall general discomfort.
This is because back pain and other symptoms from ankylosing spondylitis are caused by
increased inflammation in the body (that is being produced due to the autoimmune disease).
As AS progresses, the pain usually becomes more frequent and chronic, and at this point
is usually felt on both sides.
Random flare-ups of discomfort and significant pain can last for several weeks.
Over the course of months or years, the stiffness and pain may slowly work its way to the spine
and into the neck.
It’s possible the pain and tenderness may spread to the ribs, shoulder blades, hips,
and ankles.
The major, hallmark sign of ankylosing spondylitis is pain and stiffness in the sacroiliac (or
SI) joints that progressively gets worse.
The SI joints are located at the base of the spine, it’s where the spine joins the pelvis.
A classic symptom is when the SI joints start to hurt more at night, and get better when
you wake up and start to move around.
Fatigue is another common symptom, again, from the inflammation being caused by AS.The
body must spend energy to fight inflammation, which leads to fatigue.
Also, it may cause mild to moderate anemia (due to the inflammation) can lead to feeling
tired and lethargic.
Other symptoms of ankylosing spondylitis may include bowel inflammation and eye or vision
issues.
As ankylosing spondylitis progresses into its later stages, the buildup of chronic inflammation
can lead to a condition known as “ankylosis” (hence the name), which bony formations start
to appear in the spine and cause vertebrae to fuse together in a locked, fixed position.
Also, the rib cage can undergo calcification and fusion, which makes breathing difficult.
One of the most serious complications of ankylosing spondylitis in its later stages is the development
of a hyperkyphotic “hunchback” posture.
It’s commonly seen with individuals who poorly manage, or completely leave the condition
untreated.
Why this happens is because as AS progresses, the spine becomes stiff and rigid, slowly
leading into a head-forward position.
This position, not only being considered unsightly, may severely impact the range of motion of
the neck and back, leading to decreased quality of life.
Postural exercises and maintaining good posture, without a doubt, is important at this point.
So what diagnostic tests are available to detect and diagnosis ankylosing spondylitis?
The first steps are working with your doctor to have a comprehensive physical exam, blood
work (including testing for HLA-B27) and imaging (such as X-rays) performed.
Also take into account individual medical history, and any family history of AS, as
these are important factors in making a diagnosis.
Here are some key factors in helping to diagnose it:
Onset before 45 years of age.
Chronic pain that persists for more than 3 months
Back pain and stiffness made worse with inactivity, especially at night and in the morning.
Back pain and stiffness gets better with light activity and exercise
Changes in normal back and neck range of motion, inflammation and tenderness around the spine
and pelvis, and any eye or bowel issues may help give clues too.
Going back to what I mentioned earlier, since it’s a big factor: the hallmark sign of
AS is the involvement of the sacroiliac (or SI) joints.
X-rays can show sacroiliitis, or erosion of the SI joints due to chronic inflammation.
Sacroiliitis is extremely common with AS, especially during its early stages.
Sacroiliitis caused by this tends to be symmetrical, affecting both sides.
Another important sign on an x-ray is the formation of syndesmophytes, which are thin,
bony projections that stick out from the corners of the vertebrae.
As AS progresses, it can start moving up the spine, leading to spinal joints becoming inflamed
and syndesmophytes forming, eventually bridging and fusing two or more vertebrae together.
The end result of this process (seen on an x-ray) is a radiographic feature called ‘bamboo
spine’ due to its similar appearance.
A third radiographic sign is the squaring of lumbar vertebrae.
They may appear abnormally square from erosion during the inflammatory phase.
With all this, you can see how X-rays are extremely vital for doctors to help diagnose
ankylosing spondylitis.
So what’s the next step if you’ve diagnosed with AS?
Most people will end up working with a doctor that specializes in autoimmune disorders and
arthritis, called a rheumatologist.
A rheumatologist will set up a treatment plan that may include medications (such as NSAIDS
or non-steroidal anti-inflammatory drugs) and prescribing physical and occupational
therapy to help manage the symptoms.
Many patients also follow a strict anti-inflammatory diet, and find relief with chiropractic treatments,
acupuncture, massage, and yoga.
At-home exercises, especially those that focus on maintaining posture, are also beneficial.
So if you have been diagnosed with AS, make sure to consult with your rheumatologist about
treatment options, and possible ways to help limit inflammation.
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