ANKYLOSING

SPONDYLITIS
Sana kiani
Ankylosing spondylitis is a type of arthritis that causes lower back pain.

Symptoms, including hip pain and a stiff back that may come and go. Over time,

vertebrae in the spinal column may fuse and become rigid (ankylosis).

Exercise is one of the best ways to ease pain and maintain flexibility. Pain

relievers and other medications also help.

What is ankylosing spondylitis (AS)?

Ankylosing spondylitis (pronounced ankle-oh-sing spon-dill-eye-tiss) is a form of arthritis

that causes chronic (long-term) spine inflammation. Ankylosing spondylitis (AS) inflames
the sacroiliac joints located between the base of the spine and pelvis. This inflammation,
called sacroiliitis, is one of the first signs of AS. Inflammation often spreads to joints
between the vertebrae, the bones that make up the spinal column. This condition is known
as spondylitis.

Some people with AS experience severe, persistent back and hip pain and stiffness. Others
have milder symptoms that come and go. Over time, new bone formations may fuse
vertebrae sections together, making the spine rigid. This condition is called ankylosis.
How common is ankylosing spondylitis (AS)?

Ankylosing spondylitis belongs to a group of diseases known as spondyloarthropathies.

Between three and 13 out of 1,000 Americans have one of these diseases.

Who might have ankylosing spondylitis (AS)?

Anyone can get AS, although it affects more men than women. Symptoms usually appear
in people between the ages of 17 and 45. Ankylosing spondylitis has a genetic link and
may run in families.
SYMPTOMS AND CAUSES

What causes ankylosing spondylitis (AS)?

About 95% of people who have AS have a variation of the human leukocyte antigen-B gene
(HLA-B). This changed, or mutated, gene produces a protein called HLA-B27 that increases
disease risk. However, most people with a mutated HLA-B gene don’t get AS. In fact, 80% of
children who inherit the mutated gene from a parent with AS don’t develop the disease. More
than 60 genes have been linked to the condition.

Having one of these conditions may also increase your risk:

Crohn’s disease.

Ulcerative colitis.

Psoriasis.
What are the symptoms of ankylosing spondylitis (AS)?
Symptoms typically appear between the ages of 17 and 45 but may develop in younger children or older
adults. Some people have persistent pain, while others experience milder symptoms. Symptoms may flare
up (worsen) and improve (go into remission) off and on. If you have ankylosing spondylitis, you may
experience:

Lower back pain and stiffness.

Hip pain.
Joint pain.
Neck pain.
Difficulty breathing.
Fatigue.
Loss of appetite and unexplained weight loss.
Abdominal pain and diarrhea.
Skin rash.
Vision problems.
DIAGNOSIS AND TESTS

How is ankylosing spondylitis (AS) diagnosed?

There isn’t a test that definitively diagnoses ankylosing spondylitis. After reviewing your
symptoms and family history, your healthcare provider will perform a physical exam. Your
provider may order one or more of these tests to help guide diagnosis:

Imaging scans: Magnetic resonance imaging (MRI) scans can detect spine problems
earlier than traditional X-rays. Still, your provider may order spine X-rays to check for
arthritis or rule out other problems.

Blood tests: Blood tests can check for the presence of the HLA-B27 gene. About 8% of
people of European descent have this gene, but only a quarter of them develop ankylosing
spondylitis.
MANAGEMENT AND TREATMENT
What are the complications of ankylosing spondylitis (AS)?
Ankylosing spondylitis may affect more than the spine. The disease may inflame joints in
the pelvis, shoulders, hips and knees, and between the spine and ribs. People with AS are
more prone to spinal fractures (broken vertebrae). Other complications include:

Fused vertebrae (ankylosis).

Kyphosis (forward curvature of the spine).
Osteoporosis.
Painful eye inflammation (iritis or uveitis) and sensitivity to light (photophobia).
Heart disease, including aortitis, arrhythmia and cardiomyopathy.
Chest pain that affects breathing.
Jaw inflammation.
Cauda equina syndrome (nerve scarring and inflammation).
How is ankylosing spondylitis (AS) managed or treated?

Ankylosing spondylitis is a lifelong condition. While there’s no cure, treatments can

prevent long-term complications, reduce joint damage and ease pain. Treatments include:

Exercise: Regular physical activity can slow or stop disease progression. Many people
experience worse pain when they’re inactive. Movement seems to lessen pain. Your
healthcare provider can recommend safe exercises.

Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, including ibuprofen and

naproxen ease pain and inflammation.
Disease-modifying anti-rheumatic drugs (DMARDs):

Medications such as sulfasalazine reduce pain and joint swelling. The drugs also treat
lesions caused by inflammatory bowel disease. Newer DMARDs called biologics help
control inflammation by changing the immune system. Biologics include tumor necrosis
factor (TNF) and interleukin inhibitors (IL-17).

Corticosteroids: Injectable corticosteroids temporarily ease joint pain and inflammation.

Surgery:

A small number of people with ankylosing spondylitis may need surgery. Joint
replacement surgery implants an artificial joint. Kyphoplasty corrects a curved
spine.

What other steps can I take to manage or treat ankylosing spondylitis (AS)?

In addition to standard AS treatments, these steps may also help ease

inflammation and pain:
Eat a nutritious diet: Fried foods, processed meats and foods high in fat and sugar can have
an inflammatory effect. Anti-inflammatory diets, such as the Mediterranean diet, may help
fight inflammation.

Maintain a healthy weight: Obesity and excess weight puts pressure on joints and bones.

Limit alcohol consumption: Drinking too much alcohol can weaken bones and increase the
risk of osteoporosis.

Stop smoking: Tobacco use accelerates spinal damage and intensifies pain. Your provider
can help you quit smoking.

PREVENTION

How can I prevent ankylosing spondylitis (AS)?

Because ankylosing spondylitis has no known cause, there isn’t any way to prevent it.
OUTLOOK / PROGNOSIS

What is the prognosis (outlook) for people who have ankylosing spondylitis (AS)?

Ankylosing spondylitis symptoms may gradually worsen as you age. The condition is

rarely disabling or life-threatening. Still, symptoms like joint pain may interfere with your

ability to do the things you love. Early interventions can ease inflammation and pain. A

combination of physical activity and medications can help.

LIVING WITH

When should I call the doctor?

You should call your healthcare provider if you have AS and experience:

Chest pain.

Difficulty breathing.

Vision problems.

Severe back pain or other joint pain.

Spine rigidity.

Unexplained weight loss.

RHEUMATOID ARTHRITIS
Rheumatoid arthritis is a disease that causes destruction of joints in the body. The disease

can occur in any joint in the body and is most commonly symptomatic in the small joints

in the hands and feet. When rheumatoid arthritis affects the joints in the spine, it is far

more common for the neck (cervical spine) to be affected than for the lower back.
Rheumatoid Arthritis Symptoms in the Spine

The symptoms of rheumatoid arthritis in the spine are generally similar to the symptoms
of osteoarthritis (also called degenerative arthritis). The range of symptoms is broad and
can include any combination of the following:

 Pain is the most common symptom, especially pain at the base of the skull as
rheumatoid arthritis most commonly affects the joints connected to the upper 
cervical vertebrae

 Swelling and warmth in one or more joints, may even be described as burning
 A feeling of local tenderness when the joint of the affected area of the spine is pressed
 Loss of flexibility of the joint(s) in the affected area of the spine

 A crunching feeling when the joint is moved (called crepitus), particularly notable in the

neck (although this crunching also happens in normal joints)

 Headaches, related to cervical rheumatoid arthritis

 Pain that radiates down one or both arms, indicating that a cervical spinal nerve root is

affected
 Pain that radiates down one or both legs, indicating that a lumbar nerve root is affected.

 A change in the ability to walk can signal increasing pressure on the spinal cord.

 Sensations of tingling and/or weakness in the arms or legs, or a loss of coordination or

ability to walk, which may be an indication that the spinal cord is affected.

Any type of difficulty with bowel or bladder control, such as incontinence or inability to

urinate, or lack of ability to control the bowels

Rheumatoid Arthritis Treatment

The goals of treatment for rheumatoid arthritis in the spine are primarily to:

Reduce or eliminate the pain

Maintain the ability to function in everyday life

Reduce or slow the progression of the disease.

For the vast majority of people, treatment is nonsurgical and will include one or a
combination of physical therapy and exercise, medications, diet and nutrition, and possibly
alternative or complementary forms of care. Surgery for rheumatoid arthritis in the spine is
rare.
The End