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RA CD UC AS PsO PsA

Ankylosing Spondylitis (AS)

  • About AS

    What is Ankylosing Spondylitis ?

    Spondyloarthritis (SpA) refers to a group of chronic inflammatory diseases that share common clinical and genetic features. These include inflammation of the axial skeleton including sacroiliac(SI) joints and spine, peripheral arthritis commonly occurring in a characteristic pattern, and association with the HLA-B27 gene. Some diseases within the SpA group affect the axial skeleton predominantly, while others primarily involve the peripheral skeleton.

    In its current understanding, SpA encompasses Axial Spondyloarthritis (axSpA) including non-radiographic Axial Spondyloarthritis (nr-axSpA) and Ankylosing Spondylitis (AS), plus Peripheral Spondyloarthritis (pSpA) including psoriatic arthritis (PsA), reactive arthritis (ReA), and enteropathic spondyloarthritis.

    • Ankylosing Spondylitis (AS)

      AS affects the vertebrae in the spine, causing inflammation leading to back pain, discomfort, and morning stiffness.

    • Non-radiographic Axial Spondyloarthritis (nr-axSpA)

      nr-axSpA is a type of arthritis in your spine causing inflammation, which leads to symptoms like redness, swelling, heat, stiffness, and pain. “Non-radiographic” means the disease causes symptoms, but there’s no visible damage on X-rays.
      Nr-axSpA is thought to be an early stage of AS.

    How does Ankylosing Spondylitis affect the spine? 1

    Chronic inflammation may cause new bone to form around the spine, leading to spinal fusion and ossification. This results in limited spinal mobility and a forward-stooped posture.

    What causes Ankylosing Spondylitis?

    The exact cause of Axial Spondyloarthritis remains unknown. However, a particular gene known as HLA-B27 is thought to be an important link to the disease. Other genetic or environmental triggers may also play a role in the development of the disease.

    Risk Factors 1,2

    Your sex:

    Men are more likely than women to have AS, and it strikes them earlier and harder. Women tend to have a milder form of AS called non-radiographic Axial Spondyloarthritis.

    Your age:

    AS often starts in your teens and young adulthood. About 80% of cases begin in 20s, and 95% before 40s.

    Your heredity:

    Most people who have Ankylosing Spondylitis have the HLA-B27 gene. But many people who have this gene never develop Ankylosing Spondylitis.

    What is the difference between Ankylosing Spondylitis and non-radiographic Axial Spondyloarthritis? 1,3

    The presence or absence of structural damage to the sacroiliac joints on X-ray differentiates nr-axSpA and AS.

  • Symptoms

    What are the symptoms of Ankylosing Spondylitis? 1,2,4,5

    Early symptoms of AS mainly include pain and stiffness in your lower back and hips.

    Over time, symptoms might worsen, improve or stop at irregular intervals.

    • Symptoms of Ankylosing Spondylitis:

      Urgent need to move bowels and sensation of incomplete evacuation are other symptoms related to inflammation of the Gl tract. 6

    • Characteristics of Ankylosing Spondylitis:

      Weight loss, night sweats and loss of normal menstrual cycle are general symptoms that may be associated with CD. 6

  • Diagnosis

    How is Ankylosing Spondylitis diagnosed? 6

    During the physical exam, your doctor might ask you to bend in different directions to test the range of motion in your spine. A comprehensive medical examination covering medical and family history, blood tests, X-ray, and MRI scans is important in making a diagnosis.

    • Medical History

      Personal and family medical history is used to assess if you are at a higher risk of developing Ankylosing Spondylitis.

    • Physical Exam

      Your physician will check for symptoms such as:

      • Chronic pain lasting for more than 3 months.
      • Back pain and stiffness that improve with exercise and worsen with rest.
      • Limited mobility in the spine and ribs.
    • Blood Test

      Blood samples are tested for HLA-B27 and signs of inflammation.

    • Radiology Test

      While physical changes due to Ankylosing Spondylitis may be visible in X-rays, non-radiographic Axial Spondyloarthritis can only be diagnosed by MRI.

  • Treatment

    How is Ankylosing Spondylitis treated? 7-10

    Goal

    Ankylosing Spondylitis cannot be cured completely. Treatment for Ankylosing Spondylitis aims to relieve symptoms and delay the process of spinal fusion.

    Medication

    Biologies
    • Currently the most effective treatment for AS.
    • Help reduce joint pain, stiffness, and swelling by blocking tumor necrosis factors (TNFs) that trigger inflammation.
    Non-steroidal anti-inflammatory drugs(NSAIDs)
    • Reduce pain and stiffness of the joints.
    • Most commonly include ibuprofen, indomethacin, and naproxen.
    • High doses may cause side effects in the cardiovascular, gastrointestinal, and renal systems.
      Glucocorticoids
    • Prescribed to relieve more severe symptoms when non-steroidal anti-inflammatory drugs (NSAIDs) are not effective.
    • Include corticosteroid injections (cortisone) and oral corticosteroids (prednisone and prednisolone).
    • Taken for a short period of time to avoid side effects.
    Non-steroidal anti-inflammatory drugs(NSAIDs)
    • Prescribed as an alternative treatment option in severe cases of Ankylosing Spondylitis.
    • Help manage joint symptoms as well as gastrointestinal inflammation.
    • Include sulfasalazine and methotrexate.
  • Tips & FAQs

    Frequently asked Questions

    1. Will smoking worsen Ankylosing Spondylitis?11

    Smoking is a major risk factor for Ankylosing Spondylitis, and continuing your smoking habits can result in more joint and spinal damages. Smoking can also further limit your ability to breathe. For treatment to be effective, smoking should be avoided.

    2. Can I exercise while diagnosed with Ankylosing Spondylitis? 11

    Although Ankylosing Spondylitis results in reduced mobility, regular exercise is important for reducing pain and stiffness. Spinal stretch exercises and breathing exercises can help slow down the progression of Ankylosing Spondylitis. Other exercises that help build a good posture are also recommended.

    3. Can Ankylosing Spondylitis be cured? 12

    Currently, Ankylosing Spondylitis remains an incurable disease. However, some treatments are successful in relieving symptoms and preventing the progression of the disease. Treatment generally involves various combinations of medication, exercise, lifestyle modifications, and surgery in severe cases.

    4. Should I watch my diet? 12

    There is no specific diet for patients with Ankylosing Spondylitis. However, a healthy and nutritious diet, along with regular exercise, may help reduce pain and swelling of the joints.

References

1. Ankylosing spondylitis. Mayo clinic. Available at https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808 Accessed June 2020.

2. Ankylosing spondylitis. WebMD. Available at https://www.webmd.com/arthritis/ankylosing-spondylitis-17/basics/what-is-as Accessed June 2020

3. AnkylosingSpondylitis, Arthritis victoria. Available at https://www.msk.org.au/ankylosing-spondylitis/ Accessed June 2020.

4. Ankylosing spondylitis. Spondylitis Association of America. Available at https://spondylitis.org/about-spondylitis/types-of-spondylitis/ankylsoing-spondylitis/ Accessed June 2020.

5. What we need to know about Spondyloarthritis. Available at https://www.healthline.com/health/spondyloarthritis Accessed June 2020.

6. Global prevalence of ankylosing spondylitis. Dean LE et al, Rehtumatology (Oxford). 2014;53; 650-7

7. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis, Braun J et al, Ann Rheum Dis, 2011;70:896-904

8. Treatment for Ankylosing Spondylitis. Available at https://www.healthline.com/health/ankylosing-spondylitis/treatment#2 Accessed June 2020.

9. Biosimilars. FDA. Available at http://www.fda.gov/drugs/developmentapprovalprocess/howdrugsaredevelopedandapproved/approvalapplications/therapeuticbiologicapplilcations/biosimilars/default.htm Accessed June 2020.

10. Medications used to treat ankylosing spondylitis__SAA. Available at https://spondylitis.org/about-spondylitis/types-of-spondylitis/ankylosing-spondylitis/treatment-ankylosing-spondylitis/ Accessed June 2020.

11. "Ankylosing Spondylitis: The Facts". KhanMA. Oxford University Press. 2002.

12. Questions and Answers about Ankylosing Spondylitis, NIH. Available at http://www.niams.nih.gov/Health_Info/Ankylosing_Spondylitis/ Accessed June 2020.

Abbreviations

AS, ankylosing spondylitis; axSpA, axial spondyloarthritis; HLA-B27, human leukocyte antigen-B27; PsA, psoriatic arthritis; pSpA, peripheral spondyloarthritis; SpA, spondyloarthritis; SI, sacroiliac; TNF, tumor necrosis factor; MRI, magnetic resonance imaging; nr-axSpA, non-radiographic axial spondyloarthritis; NSAID, non-steroidal anti-inflammatory drug; ReA, reactive arthritis;