Ankylosing Spondylitis: What It Is, Causes, Symptoms, and Treatment

Ankylosing spondylitis is a type of rheumatic arthritis (joint inflammation) that primarily affects the spine but can also involve various bones, joints, and ligaments in the body. It results from long-term inflammation and is more commonly seen in men than in women.

What is Ankylosing Spondylitis?

The term “ankylosing” refers to the fusion of bones with other hard tissues, while “spondylitis” refers to the inflammation of the vertebrae (spinal bones).

Ankylosing spondylitis causes long-term inflammation in certain joints, leading to damage. The disease primarily affects the bones of the spine, where the formation of new small bones occurs. These new small bones can cause the spinal bones to fuse together. As a result, the spine becomes less flexible and deformities develop.

In addition to the spine, ankylosing spondylitis can also affect major joints such as the shoulders, hips, and knees. Issues such as stiffness and pain may arise in these joints as well.

What Are the Symptoms of Ankylosing Spondylitis?

In the early stages of ankylosing spondylitis, pain and stiffness, especially in the lower back and hips, are more noticeable in the mornings. This can also become apparent after prolonged inactivity. Common symptoms in ankylosing spondylitis patients include neck, back, and lower back pain, as well as fatigue.

Ankylosing spondylitis can affect the lower part of the spine, pelvic joints, and patients may experience pain in the lower back region in these joints. Rib bones may also be affected by ankylosing spondylitis. Additionally, the tendons where muscles attach to bones can be impacted, causing pain in these structures and leading to joint stiffness.

The symptoms of ankylosing spondylitis can improve, worsen, or remain stable over time. Symptoms may appear intermittently, disappear, and flare up again, making the condition fluctuate.

What Causes Ankylosing Spondylitis?

The exact mechanisms behind ankylosing spondylitis are not fully understood, but it is believed that genetic factors may play a role in the disease's development. People with the HLA-B27 gene have a higher risk of developing ankylosing spondylitis. However, not everyone carrying the HLA-B27 gene will develop the disease—there are individuals with this gene who do not have ankylosing spondylitis.

Risk factors for ankylosing spondylitis include:

• Gender: Ankylosing spondylitis is more common in men than in women.
• Age: The disease typically manifests during adolescence or early adulthood.
• Genetics: Individuals with a family history of ankylosing spondylitis or those carrying the HLA-B27 gene are at increased risk.

How is Ankylosing Spondylitis Diagnosed?

A thorough examination is crucial for diagnosing ankylosing spondylitis. The doctor may ask the patient to bend forward, backward, and sideways to check the flexibility of the spine. Pressure may be applied to the pelvis, or the legs may be moved in certain ways to trigger pain. If the patient experiences pain during these movements, it may indicate that the affected joints are involved in ankylosing spondylitis. Additionally, the patient's ability to expand their chest by taking a deep breath may also be assessed.

Imaging techniques can assist in diagnosing ankylosing spondylitis. X-rays may be taken to evaluate changes in the bones and joints caused by the disease. However, in the early stages, X-rays may not reveal enough changes in the bones and joints. MRI imaging is often a better option for identifying early-stage bone and joint damage. Blood tests are also used to track flare-ups.

There is no specific laboratory test to detect ankylosing spondylitis. Since it is an inflammatory disease, inflammatory markers may be elevated in the blood test. However, these markers can be elevated in other inflammatory conditions as well, so the test results may not be sufficient for diagnosis. While the HLA-B27 gene is closely associated with ankylosing spondylitis, not everyone with this gene will develop the disease, meaning that genetic tests cannot provide a definitive diagnosis.

What Are the Symptoms Associated with Ankylosing Spondylitis?

In severe cases of ankylosing spondylitis, new bone fragments may form as a result of the body attempting to repair itself. These fragments gradually fill the gaps between the vertebrae, leading to fusion of the spinal bones. This fusion causes the spine to lose its flexibility and become stiff. The fusion may also affect the rib bones, leading to reduced lung capacity and function.

Other complications that can occur due to ankylosing spondylitis include:

• Eye Inflammation (Uveitis): Uveitis is one of the most common complications of ankylosing spondylitis. Symptoms include sudden eye pain, sensitivity to light, and blurred vision.
• Compression Fractures: Some people have fragile bones early in the disease, and the weakened vertebrae can break, worsening spinal curvature. Fractures in the spinal bones may compress the spinal cord nerves, causing damage.
• Heart-related Issues: Ankylosing spondylitis can lead to problems with the aorta, the body's largest artery. Inflammation of the aorta may cause it to enlarge, affecting the function of the heart valves.

How is Ankylosing Spondylitis Treated?

It is not possible to completely eliminate ankylosing spondylitis. The main goal of treatment is to relieve the patient's pain and joint stiffness, and to delay the development of deformities that may arise due to the disease.

Starting treatment before ankylosing spondylitis causes permanent damage to the joints helps achieve better outcomes.

The most commonly used treatment method for ankylosing spondylitis is medication. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as naproxen and indomethacin can be used to relieve symptoms such as pain and stiffness. If these medications are insufficient in alleviating the symptoms, biological drugs may be used as an alternative. Tumor Necrosis Factor (TNF) blockers and Interleukin-17 (IL-17) inhibitors can be used in the treatment of ankylosing spondylitis. TNF blockers stop the cells that cause inflammation in the body, while IL-17 is a protein that plays a role in inflammation. IL-17 inhibitors aim to reduce inflammation by blocking the function of this protein.

TNF blockers alleviate pain and stiffness symptoms, and reduce joint sensitivity and swelling.

Adalimumab, certolizumab, etanercept, golimumab, and infliximab are TNF blockers that may be prescribed in the treatment of ankylosing spondylitis.

Physical therapy and rehabilitation are some of the most important components of ankylosing spondylitis treatment. Physical therapy helps reduce joint pain and increase the flexibility and strength of the joints. The therapist prepares specific exercise programs tailored to the patient's needs, aiming for maximum benefit from the treatment.

Stretching exercises aimed at improving joint flexibility help maintain a proper posture. Maintaining correct positioning while sleeping and walking, as well as abdominal and back exercises, ensure that the patient stays in an upright and proper position.

Swimming is also an effective exercise for addressing issues related to ankylosing spondylitis.

Surgery is generally not required in the treatment of ankylosing spondylitis. However, if the patient experiences severe pain or significant joint damage, surgical procedures may be considered. For example, patients with severe hip joint damage may undergo hip replacement surgery.

Some home-based treatments can also help alleviate pain and stiffness caused by ankylosing spondylitis. These include:

• Exercising
• Applying heat or cold to the affected area
• Practicing proper posture throughout the day

As ankylosing spondylitis can reduce lung capacity, it is beneficial for patients who smoke to quit.

Ankylosing spondylitis is a disease that cannot be completely cured. However, if the disease is detected early and treatment is started, promising results can be achieved. Therefore, individuals experiencing pain in the spine, hips, knees, or shoulders should seek medical attention at a well-equipped health center. These individuals should undergo the necessary tests for ankylosing spondylitis and other types of joint inflammation at the appropriate facility.