Ankylosing Spondylitis – Causes, Symptoms, and Treatment

Ankylosing spondylitis is a chronic inflammatory joint disease that causes pain and significantly affects the daily lives of those who suffer from it. This article will provide readers with information about ankylosing spondylitis.

What is Ankylosing spondylitis?

Ankylosing spondylitis is a chronic inflammatory joint disease characterized by pain and stiffness in the spine, pelvis, and lower limb joints. Men are more likely to develop this disease than women, with men being two to three times more likely to be affected.

If left untreated or improperly treated, the disease can progress over time, leading to a stiff and immobile spine, inflamed and fused spinal and peripheral joints, a hunched back, loss of function, and in severe cases, paralysis.

In some cases, the disease may also affect other joints in the body, such as the hips, knees, feet, tendons, and even organs such as the heart, liver, and lungs.

Causes of Ankylosing Spondylitis

The exact cause of Ankylosing Spondylitis is still unclear. However, recent studies have shown that the majority of cases are related to genetic factors. Research has indicated that most people with the disease carry the HLA-B27 gene, which codes for a human leukocyte antigen. About 90% of people with Ankylosing Spondylitis have the HLA-B27 gene.

There is a difference in the distribution of HLA-B27 between different ethnic groups. About 90% of white people with Ankylosing Spondylitis have the HLA-B27 gene, while there are almost no reported cases in African or Japanese populations with the gene (B27 <1%). In African Americans, due to the mixing of ethnicities with white people, about 2% have the HLA-B27 gene, but only about 50% of black patients with Ankylosing Spondylitis have the gene. This leads to the consequence that African Americans are much less frequently affected by the disease than white Americans.

If there are family members (parents, siblings, children) with the disease, the likelihood of developing Ankylosing Spondylitis increases significantly.

Subject susceptible to Ankylosing Spondylitis

Ankylosing Spondylitis is a common disease worldwide. The disease is most commonly found in males and usually appears before the age of 35, with only a few cases appearing after the age of 45.

Risk factors Gender

As mentioned above, males are more likely to develop Ankylosing Spondylitis than females.

Age: Onset typically occurs in adolescence, sometimes appearing early in adulthood.

Genetics: Most people with Ankylosing Spondylitis have the HLA-B27 gene.

Symptoms of Ankylosing Spondylitis

The following are typically the earliest signs of Ankylosing Spondylitis:

• Chronic back pain lasting over 3 months, may be accompanied by mild to severe joint stiffness.
• Onset usually occurs in young people, with males being the primary target.
• Pain in the morning and during periods of inactivity, with more pain occurring from night to morning. Pain in the lumbar spine, lower back, hip joints, and pelvic bones. The pain may be localized or radiate along the spine, spreading to the buttocks and may occur in one or both hips.
• Pain or inflammation in the hips, causing high fever that lasts continuously, fatigue, or sometimes pain where tendons and ligaments attach to bones.
• Other parts of the body may also experience pain and discomfort, such as the cartilage between the ribs and sternum, causing difficulty breathing or pain when taking deep breaths. Pain in the shoulder and hip joints. Redness or pain in one or both eyes.
• In some special cases, only the peripheral joints may be inflamed. The patients are usually young and have swelling and pain in one or a few large joints such as the hip, knee, or ankle, but no other diagnosis can be found. In such cases, doctors should also consider the diagnosis of ankylosing spondylitis.
• Over time, these symptoms will worsen and affect the patient’s daily life. Patients with these symptoms will feel tired, lose their appetite, have trouble sleeping, feel uncomfortable, and lose weight without trying. If left untreated, it can cause extremely dangerous complications.

Diagnosis of Ankylosing Spondylitis

Medical history of Ankylosing Spondylitis

Clinical examination

Patients with a history of or current lower back pain and stiffness lasting for more than 3 months.

Limitation of lumbar spine movements in both flexion and extension, as well as lateral flexion and rotation.

Reduced chest expansion and limited chest mobility compared to age and gender.

Diagnosis of Ankylosing Spondylitis by X-ray

Diagnostic imaging criteria:

Bilateral sacroiliitis of grade II or above.

Unilateral sacroiliitis of grade III or IV.

Diagnosis of ankylosing spondylitis is made when one imaging criterion and at least one clinical criterion are present.

Diagnosis of Ankylosing Spondylitis by MRI

Recent studies have shown that MRI is a more sensitive diagnostic tool for early diagnosis of ankylosing spondylitis than X-ray. The gold standard for diagnosing ankylosing spondylitis is the presence of bilateral sacroiliitis on MRI.

Sacroiliitis on MRI occurs earlier than the changes seen on X-ray.

Therefore, early signs of ankylosing spondylitis for diagnostic orientation include: MRI changes showing bilateral sacroiliitis, positive HLA-B27 test (in more than 80% of cases), chronic lower back pain. Additionally, family history of spinal diseases such as ankylosing spondylitis or reactive arthritis should also be considered.

Is Ankylosing spondylitis dangerous?

Ankylosing spondylitis is a disease that occurs in many parts of the world. If left undetected and untreated, AS can lead to severe and difficult-to-treat complications, including:

• Spinal joint fusion causing the patient to become hunched over, with a deformed and twisted spine, and limited daily activities.
• Fusion of the spinal joints with peripheral joints, such as the hip and knee joints, which can cause difficulty in walking, resulting in a shuffling gait, pain, and stiffness when moving, and impeding normal daily activities.
• Fractures and increased bone loss. AS can cause severe bone loss, making bones brittle and increasing the risk of fractures. Weak vertebrae may collapse or compress, resulting in pressure and potential damage to the spinal cord and nerves passing through the spine.
• Inflammation of the eyes (uveitis): This is the most common complication of AS, which can cause eye pain, unilateral or bilateral pain, increased sensitivity to light, and gradual loss of vision, affecting vision severely.
• Heart issues: AS can affect the aorta, which can become inflamed. When inflamed, the aorta can bulge, causing severe deformation of the aortic valve, weakening the function of the heart valve, and affecting blood flow.
• Chest: Bone fusion in the ribcage makes the bones stiff and inflexible, stiffening the ribcage, limiting chest movement, reducing lung capacity, decreasing respiratory function, causing shortness of breath, and chest pain when breathing deeply.
• Nerves: Due to the fusion of the vertebrae, scars can form in the nerve bundles in the spine. If left untreated, it can cause paralysis of half or the entire body.

Does ankylosing spondylitis affect reproduction?

Both males and females with ankylosing spondylitis experience impacts on reproductive function and sexual life.

For males: the disease reduces both the quantity and quality of sperm. In addition, complications resulting from nervous system involvement can cause sexual dysfunction, affect mental health, and decrease the chances of fertility.

For females: the disease has significant effects on pregnancy due to symptoms such as back pain, hip fatigue, and exhaustion.

Drugs for ankylosing spondylitis?

Treatment for ankylosing spondylitis typically involves nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. Disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine and methotrexate can also be used to slow the progression of the disease. In more severe cases, biologic medications such as tumor necrosis factor (TNF) inhibitors may be prescribed to target the underlying inflammation. Physical therapy and regular exercise are also important components of treatment to improve flexibility and reduce stiffness.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs are used to reduce pain and inflammation in the affected joints. Examples include ibuprofen (Advil, Motrin), naproxen (Aleve), and celecoxib (Celebrex).
• Disease-modifying antirheumatic drugs (DMARDs): DMARDs work by slowing down or stopping the progression of the disease. Examples include sulfasalazine (Azulfidine) and methotrexate (Trexall).
• Biologic agents: These drugs target specific components of the immune system that are responsible for inflammation. Examples include adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade).
• Janus kinase (JAK) inhibitors: These drugs block the action of a family of enzymes called JAKs, which play a role in the immune system’s response. Examples include tofacitinib (Xeljanz) and baricitinib (Olumiant).

It’s important to note that the choice of medication will depend on the severity of the disease, the patient’s medical history, and other factors. A healthcare provider will be able to recommend the most appropriate treatment plan for each individual case.

What to avoid eating for Ankylosing Spondylitis?

For patients with Ankylosing Spondylitis, diet plays a crucial role in the treatment process. It is important to limit the consumption of certain foods and beverages:

Alcohol: This is a type of food that is highly recommended not to be used. Consuming alcohol can damage the liver, hinder the absorption of nutrients such as Vitamin B1, minerals, trace elements, etc., and cause damage to the gastric mucosa.

More importantly, most people with Ankylosing Spondylitis use a lot of medication to treat their condition. The use of alcohol can also cause harmful interactions with medications, reduce the effectiveness of treatment.

Tobacco: Smoking can affect the respiratory system, especially the lungs, and increase complications of the disease in the lungs. Quit smoking while treating the disease.

Coffee: Consuming too much coffee can reduce calcium absorption, leading to calcium deficiency in bones, making the disease more severe.

Carbonated drinks: The phosphoric acid in carbonated drinks is the main cause of harm. This substance increases calcium excretion from the body through the urinary tract. This increases the risk of calcium deficiency, increases the risk of osteoporosis, and makes the disease worse.

Foods high in salt and sugar: Foods high in salt contain a lot of sodium, which increases calcium excretion. Foods high in sugar increase inflammatory reactions, making patients more painful.

Foods high in omega-6 and fat: such as egg yolks, red meat, animal liver, etc. Scientific research by Harvard Medical School has shown that omega-6 can make patients more painful, with longer-lasting pain.

What to eat for ankylosing spondylitis?

• Foods rich in omega-3 fatty acids such as cereal powder, flaxseed, walnuts, seafood, etc. are recommended for people with ankylosing spondylitis. They have anti-inflammatory and anti-bacterial properties which help reduce inflammation and swelling.
• Research has shown that omega-3 stabilizes the nucleus pulposus of the intervertebral disc. Omega-3 also has antioxidant properties that slow down degeneration and help in the regeneration of damaged cells, increasing flexibility and elasticity.
• Foods rich in calcium such as salmon, sardines, cheese, broccoli, etc. are good for bones as they provide calcium which makes them stronger.
• Foods rich in Vitamin D such as kale, almonds, various types of milk, etc. enhance the absorption of calcium, thereby improving bone health.
• Drinking plenty of water helps to detoxify the body, reduce inflammation and pain.
• Supplementing with vitamins and minerals strengthens the immune system, improves overall health and increases joint cartilage regeneration.
• Probiotics such as yogurt and kefir help balance gut bacteria and aid in the absorption of essential nutrients during treatment, as the body may lose balance in the gut microflora due to high medication usage.

Exercises for people with ankylosing spondylitis

Attend physical therapy sessions to learn and practice exercises that help maintain flexibility in your back and other joints, reduce pain, and improve your ability to perform daily activities. You can also learn deep breathing exercises to help expand your chest when you breathe.

Maintain good posture, including sitting and standing up straight. Sit on straight-backed chairs and keep your back against the chair. If you work at a computer or desk, do not slouch or jut your head and neck forward.

Sleep in the correct position: lie on your back, limit sleeping on your side, and avoid curling up or sleeping on one side. A firm mattress without a pillow under your head is best.

Regular exercise is important. Swimming is one of the most effective forms of exercise, as it helps to keep your joints mobile, reduce pain, and increase overall joint flexibility.

Avoid heavy lifting or overexertion, which can strain your back muscles. Avoid high-impact sports such as running and jumping.

Ways to prevent Ankylosing Spondylitis

• Think positively. Over-worrying can lead to stress, fatigue, and exhaustion, which can exacerbate pain and discomfort.
• Avoid harmful postures that strain your back, and avoid lifting heavy objects.
• Maintain good personal hygiene.
• Apply heat and cold to reduce pain
• If you experience joint stiffness and muscle tension, use a warm pillow to massage the affected area.
• If you experience pain due to inflammation, apply a clean ice pack to the affected area to alleviate the pain.
• Maintain a healthy eating habit: eat plenty of vegetables, drink plenty of water, limit fat and fast food.
• Quit smoking: if you smoke, quit immediately. Smoking increases lung complications, exacerbates breathing difficulties and pain.
• Have a general check-up at a medical facility at least every 6 months, and closely monitor any signs such as back pain, hip pain, or groin pain to detect and treat the disease early.
• Regularly exercise using the exercises mentioned above. Regular exercise helps keep your body flexible, maintains joint flexibility, reduces stiffness and pain, and improves posture.

We hope that this article has provided readers with the necessary information to understand more about Ankylosing Spondylitis.