Ankylosing Spondilytis

Ankylosing Spondylitis
Overview
Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the
small bones in our spine (vertebrae) to fuse. This fusing makes the spine less flexible and can
result in a hunched-forward posture. If ribs are affected, it can be difficult to breathe deeply.
Ankylosing spondylitis affects men more often than women. Signs and symptoms typically
begin in early adulthood. Inflammation also can occur in other parts of our body — most
commonly, our eyes.
There is no cure for ankylosing spondylitis, but treatments can lessen our symptoms and
possibly slow progression of the disease.
Symptoms
Early signs and symptoms of ankylosing spondylitis might include pain and stiffness in our
lower back and hips, especially in the morning and after periods of inactivity. Neck pain and
fatigue also are common. Over time, symptoms might worsen, improve or stop at irregular
intervals.
The areas most commonly affected are:
 The joint between the base of our spine and our pelvis

 The vertebrae in our lower back
 The places where our tendons and ligaments attach to bones, mainly in our spine,
but sometimes along the back of our heel
 The cartilage between our breastbone and ribs
 Our hip and shoulder joints
Causes
Ankylosing spondylitis has no known specific cause, though genetic factors seem to be
involved. In particular, people who have a gene called HLA-B27 are at a greatly increased
risk of developing ankylosing spondylitis. However, only some people with the gene develop
the condition.
Risk factors
 Sex. Men are more likely to develop ankylosing spondylitis than are women.
 Age. Onset generally occurs in late adolescence or early adulthood.
 Heredity. Most people who have ankylosing spondylitis have the HLA-B27 gene.
But many people who have this gene never develop ankylosing spondylitis.
Complications
In severe ankylosing spondylitis, new bone forms as part of the body's attempt to heal. This
new bone gradually bridges the gap between vertebrae and eventually fuses sections of
vertebrae. Those parts of our spine become stiff and inflexible. Fusion can also stiffen our rib
cage, restricting our lung capacity and function.
Other complications might include:
 Eye inflammation (uveitis). One of the most common complications of ankylosing

spondylitis, uveitis can cause rapid-onset eye pain, sensitivity to light and blurred
vision. See our doctor right away if we develop these symptoms.
 Compression fractures. Some people's bones thin during the early stages of
ankylosing spondylitis. Weakened vertebrae can crumble, increasing the severity of
our stooped posture. Vertebral fractures can put pressure on and possibly injure the
spinal cord and the nerves that pass through the spine.
 Heart problems. Ankylosing spondylitis can cause problems with our aorta, the
largest artery in our body. The inflamed aorta can enlarge to the point that it distorts
the shape of the aortic valve in the heart, which impairs its function.
Diagnosis
During the physical exam, the doctor might ask us to bend in different directions to test the
range of motion in our spine. We might try to reproduce our pain by pressing on specific
portions of our pelvis or by moving our legs into a particular position. Also, our doctor might
ask us to take a deep breath to see if we have difficulty expanding our chest.
Imaging tests
X-rays allow our doctor to check for changes in our joints and bones, though the visible signs
of ankylosing spondylitis might not be evident early in the disease.
An MRI uses radio waves and a strong magnetic field to provide more-detailed images of
bones and soft tissues. MRI scans can reveal evidence of ankylosing spondylitis earlier in the
disease process, but are much more expensive.
Lab tests
There are no specific lab tests to identify ankylosing spondylitis. Certain blood tests can
check for markers of inflammation, but inflammation can be caused by many different health
problems.
Our blood can be tested for the HLA-B27 gene. But most people who have that gene don't
have ankylosing spondylitis and we can have the disease without having the gene.
Treatment
The goal of treatment is to relieve our pain and stiffness and prevent or delay complications
and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease
causes irreversible damage to our joints.
Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as naproxen (Naprosyn) and

indomethacin (Indocin, Tivorbex) — are the medications doctors most commonly use to treat
ankylosing spondylitis. They can relieve our inflammation, pain and stiffness. However, these
medications might cause gastrointestinal bleeding.
If NSAIDs aren't helpful, our doctor might suggest starting a biologic medication, such as a
tumor necrosis factor (TNF) blocker or an interleukin-17 (IL-17) inhibitor. TNF blockers
target a cell protein that causes inflammation in the body. IL-17 plays a role in the body's
defense against infection and also has a role in inflammation.
TNF blockers help reduce pain, stiffness, and tender or swollen joints. They are administered
by injecting the medication under the skin or through an intravenous line.
The five TNF blockers approved by the Food and Drug Administration (FDA) to treat
ankylosing spondylitis are:
 Adalimumab (Humira)
 Certolizumab pegol (Cimzia)
 Etanercept (Enbrel)
 Golimumab (Simponi)
 Infliximab (Remicade)
IL-17 inhibitors approved by the FDA to treat ankylosing spondylitis include secukinumab

(Cosentyx) and ixekizumab (Taltz).
TNF blockers and IL-17 inhibitors can reactivate untreated tuberculosis and make us more
prone to infection.
If we're unable to take TNF blockers or IL-17 inhibitors because of other health conditions,

our doctor may recommend the Janus kinase inhibitor tofacitinib (Xeljanz). This drug has
been approved for psoriatic arthritis and rheumatoid arthritis. Research is being done on its
effectiveness for people with ankylosing spondylitis.
Therapy
Physical therapy is an important part of treatment and can provide a number of benefits, from
pain relief to improved strength and flexibility. A physical therapist can design specific
exercises for our needs.
Range-of-motion and stretching exercises can help maintain flexibility in our joints and
preserve good posture. Proper sleeping and walking positions and abdominal and back
exercises can help maintain our upright posture.
Surgery
Most people with ankylosing spondylitis don't need surgery. However, our doctor might
recommend surgery if we have severe pain or joint damage, or if our hip joint is so damaged
that it needs to be replaced.
Lifestyle and home remedies
Besides seeing our doctor regularly and taking our medications as prescribed, here are some
things we can do to help our condition.
 Stay active. Exercise can help ease pain, maintain flexibility and improve our
posture.
 Apply heat and cold. Heat applied to stiff joints and tight muscles can ease pain
and stiffness. Try heating pads and hot baths and showers. Ice on inflamed areas can
help reduce swelling.
 Don't smoke. If we smoke, quit. Smoking is generally bad for our health, but it
creates additional problems for people with ankylosing spondylitis, including further
hampering breathing.
Practice good posture. Practicing standing straight in front of a mirror can help us avoid
some of the problems associated with ankylosing spondylitis.

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Ankylosing Spondylitis

The areas most commonly affected are:

 The joint between the base of our spine and our pelvis

Other complications might include:

 Eye inflammation (uveitis). One of the most common complications of ankylosing

Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as naproxen (Naprosyn) and

IL-17 inhibitors approved by the FDA to treat ankylosing spondylitis include secukinumab

If we're unable to take TNF blockers or IL-17 inhibitors because of other health conditions,

Lifestyle and home remedies

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