What is Ankylosing Spondylitis? Explanation & Treatment Options
Ankylosing spondylitis, or AS, is a form of chronic inflammatory arthritis affecting the back or spine. For some patients, the condition starts between the teens and 30s. Ankylosing spondylitis is characterized by pain and stiffness in the lower back as the joints and ligaments within the spine become inflamed.
Who’s Affected by Ankylosing Spondylitis?
Ankylosing spondylitis forms during teen or young adult years. Most patients with the disease began having symptoms before age 30 and it affects patients for the rest of their lives. About twice as many men as women are diagnosed with ankylosing spondylitis.
The cause of AS is unknown. It’s likely that genes (passed from parents to children) and the environment both play a role in a patient developing an AS diagnosis. Scientists have discovered a gene called HLA-B27 that is found in about 90 percent of Caucasian patients with AS but only 8 percent of Caucasian patients without AS, suggesting a genetic link.
In some cases, it develops so gradually that you may not notice it. The symptoms may come and go, and improve or get worse, over many years. If you've had consistent low back pain for more than three months, talk to your doctor. Symptoms of ankylosing spondylitis include:
- Neck pain
- Stiffness that is worse in the morning
- A reduction in pain and stiffness with physical activity
- A hunched posture
- Difficulty taking a deep breath (if the disease has affected the ribs)
Ankylosing Spondylitis can also create inflammation in your joints (arthritis). These symptoms include:
- Pain when moving the affected joint
- Joint tenderness during an examination
- Swelling and warmth in the affected area
Fatigue is a common symptom of untreated AS. It can make you feel tired and lacking in energy.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). Over-the-counters, like Advil, Motrin, and Aleve reduce pain and inflammation. They are generally safe for consumption with other medications. Be sure to consult with your doctor or specialist on correct dosages.
TNF Blockers. TNF blockers help reduce pain, stiffness, and tender or swollen joints. These medications are injected under the skin or through an intravenous line. The five TNF blockers approved by the Food & Drug Administration to treat ankylosing spondylitis are:
- Adalimumab (Humira)
- Certolizumab pegol (Cimzia)
- Etanercept (Enbrel)
- Golimumab (Simponi; Simponi Aria)
- Infliximab (Remicade)
- Secukinumab (Cosentyx) is the first IL-17 inhibitor approved by the FDA for the treatment of ankylosing spondylitis.
TNF blockers and IL-17 inhibitors can reactivate latent tuberculosis and make you more prone to infection.
Physical therapy can help to treat chronic back pain, improve posture, build strength and increase flexibility. A physical therapist can design specific exercises for your needs. Here are some that your therapist may recommend or walk you through:
- Posture Training. This therapy is designed to help you avoid slouching or forward bending.
- Occupational Therapy. This focuses on helping you avoid fatigue and increases energy for doing your everyday activities. Your physical therapist will teach you how to move your body efficiently when performing daily activities to avoid strain and to prevent excessive bending or in some cases loss of balance.
- Back and Core Exercises. These exercises key in on your core, lower back and abdominal muscles to further ensure that you can hold proper posture for standing and walking, as well as perform your daily life activities.
- Back Stretches. More exercises designed to help with posture, flexibility, and chest expansion.
- Flexibility Exercises. These exercises focus on helping you with range of motion to prevent your spine and joints from getting stiff.
- Deep-Breathing Techniques. These help to oxygenate muscles and improve blood flow and circulation while opening your chest and strengthening your core and abdomen for walking and sitting.
Smokers who have ankylosing spondylitis (AS) have more spinal damage than non-smokers with the same level of disease activity. Having the disease is also linked to an increased risk of heart disease and stroke.
The goal of medical treatment for an ankylosing spondylitis diagnosis is to relieve chronic pain and stiffness—to help patients maintain a standard quality of life. Ankylosing spondylitis treatment is most successful before the disease causes irreversible joint damage.
Surgery is not generally recommended for people with ankylosing spondylitis unless your doctor identifies severe pain or joint damage, or damage has reached your hip warranting a hip replacement surgery.