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, as 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.
Ankylosing spondylitis is an autoimmune disease. That means that your body’s immune system, for unknown reasons, becomes confused. It attacks your healthy tissue, including your joints, instead of targeting foreign bodies like viruses and bacteria. This causes pain and inflammation.
For people with AS, a result of this inflammation is that new bone may grow around the joints in the spine. This can lead 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 appropriate 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’s important that you learn about your condition and play an active role in managing it.
Causes of ankylosing spondylitis
The exact cause of ankylosing spondylitis is unknown.
Genes are thought to play a role. 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 doesn’t 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. 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, especially in the morning or if you’ve been inactive for a period of time
- 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
- fatigue (extreme tiredness).
Diagnosing ankylosing spondylitis
Early diagnosis is important so that treatment can be started as soon as possible to prevent damage to the spine.
Investigation and diagnosis of AS may include:
- medical history
- physical examination
- scanning procedures such as CT (computed tomography) or MRI (magnetic resonance imaging)
- blood test
- genetic testing.
These tests are generally organised by a rheumatologist or doctor who can explain the results.
Treating ankylosing spondylitis
There is no cure for ankylosing spondylitis. Treatment aims to manage your pain, reduce the risk of complications and improve your quality of life. It will be tailored to your specific symptoms and the severity of your condition.
Medications for the treatment of ankylosing spondylitis include:
- analgesics (pain-relieving medications) – to provide temporary pain relief
- non-steroidal anti-inflammatory drugs (NSAIDs) – to help control inflammation and provide temporary pain relief
- corticosteroids – this group of medications has a strong anti-inflammatory effect and can be taken as tablets or injections
- disease-modifying anti-rheumatic drugs (DMARDs) – this group of medications works on controlling your overactive immune system. They help relieve pain and inflammation, and can also reduce or prevent joint damage
- biological disease-modifying anti-rheumatic drugs (bDMARDs or biologics) – these newer medications also work on controlling your immune system. However, unlike other disease-modifying drugs, biologics target specific cells and proteins that are causing this inflammation and damage, rather than suppressing your entire immune system.
Although exercise is important for general wellbeing, it’s 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 help to maintain strength through the spine. Exercises performed in warm water (hydrotherapy) can also be beneficial.
For overall wellbeing, general strengthening and aerobic exercises are also recommended. 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.
There are many things you can do to help yourself, including:
- learn more about your condition – knowing as much as possible about your AS means that you can make informed decisions about your healthcare and play an active role in the management of your condition
- exercise and stay active as much as possible – talk with a physiotherapist or an exercise physiologist for specific advice
- manage your stress – stress can aggravate your symptoms and make you feel worse
- get up and move if you’ve been sitting or standing in one position for long periods at a time (for example at work or while travelling)
- stay involved in your usual home activities, as well as work, leisure and social activities. Social connections are extremely important
- eat a healthy, well balanced diet for overall good health
- be aware of your posture.
Where to get help
This page has been produced in consultation with and approved by:
MOVE muscle, bone & joint health
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