What is Ankylosing Spondylitis?

By Dr Ananya Mandal, MD

Ankylosing spondylitis is a long term painful disease that affects the spine, bones, muscles and ligaments that connect bones. There is presence of joint pain and inflammation akin to arthritis in this condition.

Causes of ankylosing spondylitis

This condition is caused when there is inflammation of the joints between the vertebrae in the spine, or in the ligaments and the joints at the base of the spine.

The inflammation leads to pain and stiffness in the neck and back and inflammation of the joints at the base of the spine or sacroiliac joints leads to pain in the lower back.

There is a genetic link that is associated with this condition. A gene known as HLA-B27 has been found to be associated with ankylosing spondylitis.

Symptoms of ankylosing spondylitis

The condition is characterized by pain and inflammation of the spine, surrounding muscles, ligaments and sacroiliac joints. The inflammation may affect the ankles, knees, and other organs such as eyes as well.

Ankylosing spondylitis epidemiology

Ankylosing spondylitis may affect people at any age beyond adolescence. It usually begins between ages 15 and 35 years (average 26 years).

About 80% of patients develop the condition before they are 30 years of age and less than 5% present with the symptoms at an age above 45 years.

Men are around two to three times more likely to suffer from this condition.

HLA B27 is the genetic link with the disease and is seen mostly among northern countries and some tribes. It is highest in Inuit populations and Haida Indians.

Overall, the prevalence of ankylosing spondylitis is between 0.1% and 1.4%. In mid-Europe the prevalence is 0.3–0.5%. The incidence of new cases of ankylosing spondylitis is between 0.5 and 14 per 100 000 people per year worldwide.

Treatment of ankylosing spondylitis

There is no cure for ankylosing spondylitis. Treatment aims at relief of pain and stiffness.

Long term treatment goals include maintaining optimum flexibility and movement of the spine in order to retain functioning.

Treatment involves regular physiotherapy that includes physical methods, such as massage and manipulation.

Medications including pain medications and those that relieve inflammation may help. Several lifestyle changes that improve the symptoms also help in treatment of this debilitating condition.

Eye involvement including inflammation of the uvea or uveitis is a complication sometimes associated with ankylosing spondylitis. This needs urgent attention failing which vision may be lost.

Reviewed by April Cashin-Garbutt, BA Hons (Cantab)

Sources

  1. http://www.nhs.uk/conditions/Ankylosing-spondylitis/Pages/Introduction.aspx
  2. http://ard.bmj.com/content/61/suppl_3/iii8.full.pdf
  3. http://www2.courses.vcu.edu/ptxed/as/download/Lancet%202007%20AS.pdf
  4. http://www.azermds.org/upload-files/e-books/Attachments_2012_06_6%20(5)/15_ankylosing_spondylitis.pdf
  5. http://www.arthritis.org.nz/wp-content/uploads/2011/07/4506_art_AS_newImages_4-0.pdf
  6. https://www.orpha.net/data/patho/Pro/en/AnkylosingSpondylarthritis-FRenPro41.pdf

Further Reading

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