Ankylosing spondylitis (AS) is a type of inflammatory arthritis that targets the joints of the spine. It first affects the sacroiliac (SI) joint, where the spine attaches to the pelvis, and then starts to affect other areas of the spine. The hips and shoulders can be affected, and so can the eyes, skin, bowel and lungs. Symptoms of AS include back pain, stiffness and reduced mobility in the spine.
Ankylosing spondylitis affects men more often than women. The condition usually appears between the ages of 15 and 45 years. There is no cure for AS, however, there are things you can do to help control your symptoms.
Effects of ankylosing spondylitis
Inflammation occurs as part of the disease. New bone may grow around the joints in the spine in response to the inflammation. This leads to permanent stiffness in the back and neck of some people with AS. In severe cases, this extra bone can fuse the bones of the spine together. This used to be common, but now can usually be prevented by starting proper treatment as early as possible.
Most people with AS can lead full and active lives, because the condition can be well controlled. There are times when symptoms may become worse (known as a flare) and times when the symptoms become better. It is important that you learn about your condition and play an active role in managing your AS.
Causes of ankylosing spondylitis
The exact cause of ankylosing spondylitis is unknown, but genes are thought to play a part. You are more likely to get AS if you have a history of it in your family. Studies show that almost nine out of ten people with AS have the gene called HLA-B27. However, this gene is present in eight per cent of the general population, including people without AS.
Since the presence of this gene does not automatically lead to the development of AS, other factors are thought to be involved. Researchers currently think that exposure to certain environmental triggers can lead to the development of AS in people with the gene. But these triggers are unknown.
Symptoms of ankylosing spondylitis
The symptoms of AS vary from one person to the next, but they are usually worse after rest and relieved with exercise. The most common symptoms are:
- pain and stiffness in the back, buttocks or neck, often waking with early morning stiffness and pain
- pain in tendons (which connect muscles to bones) and ligaments (which connect bones to each other), often felt as pain at the front of the chest, back of the heel or underneath the foot.
Diagnosis of ankylosing spondylitis
Early diagnosis is important so that treatment can be commenced to prevent damage to the spine.
Investigation and diagnosis of AS may include:
- medical history
- physical examination
- scanning procedures such as CT or MRI
- blood test
- genetic testing.
These tests are generally organised by a rheumatologist or doctor who can explain the results.
Treatment for ankylosing spondylitis
There is no cure for ankylosing spondylitis. Medical treatment aims to manage pain, reduce the risk of complications and improve quality of life. Treatment will be tailored to your specific symptoms and the severity of your condition.
Medication for ankylosing spondylitis
Medications for the treatment of ankylosing spondylitis include:
- non-steroidal anti-inflammatory drugs (NSAIDs)
- disease-modifying anti-rheumatic drugs (DMARDs)
- biological disease-modifying anti-rheumatic drugs (bDMARDs) – new drugs that work by targeting certain overproduced proteins that cause inflammation and damage to bones, cartilage and tissue
- corticosteroid medication
- analgesics (pain-relieving medication).
Exercise for ankylosing spondylitis
Although exercise is important for general wellbeing, it is especially important in managing AS. Exercise can be used to relieve pain, but is also important in maintaining mobility in the spine.
Specific strengthening exercises should be performed to maintain strength through the spine. Exercises performed in warm water (hydrotherapy) can be beneficial.
For overall wellbeing, general strengthening and aerobic exercises should also be performed. If you have AS, you may benefit from seeing a health professional to get an exercise program for your specific needs. Consider seeing a physiotherapist or exercise physiologist who specialises in the treatment of AS.
Where to get help
- Your doctor
- Exercise and Sports Science Australia Tel. (07) 3862 4122
- Arthritis and Osteoporosis Victoria Tel. (03) 8531 8000 or 1800 263 265
Things to remember
- Ankylosing spondylitis (AS) is a type of inflammatory arthritis that targets the joints of the spine, particularly the sacroiliac (SI) joint where the spine attaches to the pelvis.
- There is no cure for AS – medical treatment aims to manage pain, reduce the risk of complications and improve quality of life.
- The most important management tool is regular exercise, which helps to keep the spine mobile and flexible.
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MOVE muscle, bone & joint health
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