Ankylosing spondylitis is a type of arthritis of the spine. It is a form of inflammatory arthritis (rheumatoid arthritis is another form), that affects the joints of the lower back, bones, muscles and ligaments. ‘Ankylosing’ means stiffening, and ‘spondylitis’ means inflammation of the spine. It causes swelling between your vertebrae, which are the disks that make up your spine, and in the joints between your spine and pelvis. Ankylosing spondylitis is an immune disease. The disease is more common and more severe in men, and it often runs in families.
In ankylosing spondylitis, the sacroiliac joints (which join the base of the spine to the pelvis), become inflamed. This is why your lower back may feel sore first thing in the morning, or after periods of inactivity. The list below tells you what happens.
- Inflammation occurs.
- Scar tissue forms in the spaces between vertebrae (the chain of bones that make up the spine).
- Scar tissue may turn into bone and fill the space between the vertebrae.
- The joint is effectively fused and movement of the spine is limited.
What causes it?
In ankylosing spondylitis, the spinal joints, ligaments and the sacroiliac joints (the joints at the base of the spine) become inflamed. This inflammation causes pain and stiffness in the neck and back. Sacroiliitis, (inflammation of the sacroiliac joints), leads to pain in the lower back and buttocks.
It is not known what causes the condition, but there is thought to be a link with a particular gene known as HLA-B27.
How will it affect me?
The symptoms of ankylosing spondylitis can vary, but most people experience back pain and stiffness. The condition can be severe, with around one in 10 people at risk of long-term disability.
The initial symptoms are pain, aching and stiffness in the lower back. You may also feel pain further up the back and restricted movement of the chest.
It can develop at any time from teenage years onwards, although it usually occurs between 15 and 35 years of age, and rarely starts in old age. It is around three times more common in men than in women.
Some people will experience pain and discomfort on and off for a number of years until the inflammation ceases, but most will be able to lead a full and active life. In others, movement of the spine may be severely limited.
Complications are situational with wide variations. These are dependent on the symptoms persons experience and could include:
- Eye inflammation (uveitis) – A common complication that can cause rapid-onset eye pain, sensitivity to light and blurred vision. See your doctor right away if you develop these symptoms.
- Compression fractures – Some people experience a thinning of their bones during the early stages of the disease. Weakened vertebrae may crumble, increasing the severity of your stooped posture. Vertebral fractures sometimes can damage the spinal cord and the nerves that pass through the spine.
- Difficulty breathing – If your ribs are affected, the fused bones can’t move when you breathe — making it difficult to fully inflate your lungs.
- Heart problems – Could develop with your aorta, the largest artery in your body. The inflamed aorta can enlarge to the point that it distorts the shape of the aortic valve in the heart, impairing its function.
- Bowel Problems – Your bowels can also be affected.
How is it treated?
Symptoms can worsen, improve, or stop altogether. The disease has no cure, but medicines can relieve the pain, swelling and other symptoms. Exercise can also help. The overall aim of treatment is to ease the pain and stiffness and to keep the spine flexible.
It is very important that you get diagnosed early to minimise the damage to your joints, and there are a number of ways to manage your condition:
- Exercise – to maintain mobility; prevent the joints from being fused into a bad position; and to help relieve pain.
- Use of non-steroidal anti-inflammatory drugs (NSAIDs), to reduce inflammation.
- Use of disease-modifying anti-rheumatic drugs (DMARDs), to control your arthritis if it lasts more than a few months.
- Use of anti-TNF drugs (or biologics), which can be very good at controlling severe ankylosing spondylitis.
- Do physiotherapy – where physical methods, such as massage and manipulation, are used to improve comfort and spinal flexibility. It is important to note though that only the muscles and soft tissue should be manipulated and never the bones of the spine. Manipulating bones in people with ankylosing spondylitis can cause injury.
- Make lifestyle changes to minimise the risk of other health conditions and improve symptoms.
- Surgery – If the hip joints are badly affected, hip replacement may be suggested. Most people, however, don’t need surgery.
It is critical to follow the advice given to ensure as healthy a lifestyle as possible. Nobody enjoys having restricted mobility. Proper sleep, walking positions, abdominal and back exercises can help maintain your upright posture. Even if portions of your spine eventually fuse, you’ll be able to get around and perform daily functions more easily if your spine fuses in an upright position.