Ankylosing Spondylitis
Understanding Ankylosing Spondylitis
Axial spondyloarthritis is an inflammatory condition that primarily affects the spine and has two main types. When the disease causes visible changes on X-rays, it is called ankylosing spondylitis. If these changes are not seen on X-ray but the condition is diagnosed based on symptoms, blood tests, or MRI scans, it is referred to as nonradiographic axial spondyloarthritis. Symptoms usually begin in early adulthood, often presenting as persistent back pain and stiffness.
Ankylosing Spondylitis Symptoms
Early signs of ankylosing spondylitis often involve stiffness and pain, especially in the lower back and hips.Inflammation can also occur in other areas of the body, especially the eyes, leading to conditions such as uveitis. Although there is no cure for ankylosing spondylitis, treatments are available to help manage symptoms and may slow the progression of the disease.
- Pain and stiffness in the joint between the base of the spine and the pelvis
- Discomfort in the vertebrae of the lower back.
- Inflammation where tendons and ligaments attach to bones, especially in the spine and back of the heel.
- Chest pain due to inflammation of the cartilage between the breastbone and ribs.
- Pain or limited movement in the hip and shoulder joints.
Diagnosis
To diagnose ankylosing spondylitis, your healthcare provider will begin with a physical examination. The provider might also press on specific areas of your pelvis or move your legs to identify points of pain. A deep breathing test may be conducted to evaluate chest expansion.
- Imaging tests play a crucial role. X-rays can reveal changes in bones and joints typical of radiographic axial spondyloarthritis, though these signs might not appear early in the disease.
- Magnetic Resonance Imaging (MRI) offers more detailed images of bones and soft tissues and can detect signs of nonradiographic axial spondyloarthritis earlier, though it is costlier.
- Lab tests are also part of the evaluation. While no lab test can definitively diagnose the condition, blood tests can check for inflammation markers.
Treatment Options
The primary goals of treatment are to relieve pain and stiffness, reduce inflammation, and prevent or delay complications such as spinal deformity. Early treatment is key to avoiding irreversible joint damage.
- Medications are the first line of treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen sodium (Aleve), are commonly used to reduce pain and inflammation.
- If NSAIDs are not effective, your doctor may prescribe tumor necrosis factor (TNF) blockers or interleukin-17 (IL-17) inhibitors, which are administered by injection or IV.
- TNF blockers include adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi), and infliximab (Remicade). IL-17 inhibitors like secukinumab (Cosentyx) and ixekizumab (Taltz) are also effective.
Therapy & Surgery
- A physical therapist will create exercises tailored to your condition, focusing on pain relief, improving flexibility, and strengthening your back and abdominal muscles.
- Therapy includes training in proper walking and sleeping positions, along with range-of-motion and stretching routines to help maintain spinal alignment and mobility.
- While surgery is rarely needed, it may be considered in cases of severe pain or when joints like the hip are severely damaged and require replacement.
