Spondylitis involves inflammation of one or more vertebrae. Ankylosing spondylitis is a chronic inflammatory disease that affects the joints between the vertebrae of the spine, and the joints between the spine and the pelvis. It eventually causes the affected vertebrae to fuse or grow together.
Rheumatoid spondylitis; Spondylitis, spondylarthropathy
Causes, incidences, and risk factors
The specific cause for this disease is unknown, but genetic factors seem to play a role. The disease starts with intermittent hip and/or lower back and buttock pain that are worse particularly in the morning and night or periods of inactivity. Inflammation and back pain begins in the sacroiliac joint (joint between the pelvis and the spine) and may progress to include the lumbosacral spine and the thoracic spine (chest portion of the spine). Pain may be eased by assuming a bent posture. Typically disease activity is a progressive waxing and waning which over time may worsen, go into remission, or stop at any stage.
The disease most frequently begins between the ages of 20 and 45 but may begin before 10 years of age. Males are more frequent affected than females. Risk factors include a family history of ankylosing spondylitis, male gender and the HLA-B27 gene marker. About 0.2% of Americans over age 15 are affected. Due to the predominant symptom being back pain, there is often a long lag time between symptom onset and diagnosis. This can lead to unwanted long-term joint outcomes.
With progressive disease, deterioration of bone and cartilage can lead to fusion in the spine or progressive arthritis in peripheral joints affecting mobility. It can be extremely painful and crippling. Ankylosing Spondylitis sometimes causes aching, pain and swelling in the hips, knees and ankles. Indeed, any joint can be affected.
The heel bone can become particularly troublesome causing pain at the plantar fascia or Achilles tendon.The heart, the lungs, and the eyes may also become affected.
- Gradual onset of low back or buttock pain
- Symptoms greater than 3 months
- Pain that is worse in the morning and night or after periods of inactivity
- Symptoms that improve over the course of the day or with exercise
- stiffness and limited motion in the low back
- hip pain and stiffness
- limited range of motion, especially involving spine and hips
- joint pain and joint swelling in the shoulders, knees, and ankles
- neck pain
- heel pain
- limited expansion of the chest
- chronic stooping to relieve symptoms
- fever, low grade
- loss of appetite
- weight loss
- eye inflammation
Signs and diagnostic testing
Physical examination and characteristic symptoms are indicative of limited spine motion or chest expansion.
Tests may include:
- HLA-B27 antigen test is positive.
- X-rays of the spine or pelvis may shows characteristic findings.
- ESR may or may not be elevated.
- CBC may show mild anemia.
There are several other conditions associated with ankylosing spondylitis.
- Psoriasis, a skin condition which causes scaly patches on the skin and scalp. It can also lead to a slightly different form of arthritis.
- Non-Specific Urethritis (NSU), a sexually acquired infection, can lead to a syndrome called Reactive Arthritis.
- Ulcerative colitis or Crohn’s disease are also related to Ankylosing Spondylitis but are not caused by it. The symptoms are bouts of crampy abdominal pain and bloody diarrhea, often with fever, weight loss, and an associated peripheral arthritis in some cases.
What actually happens?
Inflammation occurs at the site where certain ligaments or tendons attach to bone (enthesis). This is followed by some erosion of bone at the site of the attachment (enthesopathy). As the inflammation subsides, a healing process takes place and new bone develops. Movement becomes restricted where bone replaces the elastic tissue of ligaments or tendons. Repeated cycles of this inflammatory process of erosion and new bone formation can lead to progressive fusion of the vertebrae. The jont between the spine and pelvis is commonly affected first. The lower back, chest wall and neck may become affected with more advanced disease
Unfortunately, there is no known cure, however the objective of treatment is to relieve the joint pain and stiffness and to prevent, delay, or correct joint damage.
Medications – Treatment strategies aim to reduce inflammation. Non-steroidal anti-inflammatory medications (NSAIDs) such as aspirin, naproxen or ibuprofen are used to reduce inflammation and pain associated with the condition. These medications enable the use of exercise programs that include exercises to improve posture and breathing. (Note: DO NOT give aspirin or other NSAIDs to children unless advised to do so by a health care provider!)
If more aggressive therapy is required, biologic medications used to suppress specific drives of inflammation may be used.
Corticosteroid therapy or medications to suppress the immune system may be prescribed to control the various manifestations of severe disease.
Ask our physicians about the latest in ankylosing spondylitis research and new therapeutic techniques!
Surgery – Surgery is done if pain or joint damage is severe. Only about 6% of people with Ankylosing Spondylitis need to have a hip replaced. This will successfully restore mobility and eliminate pain of the damaged joint.
Lifestyle changes – Exercises to improve posture and breathing. Use of devices to help with activities of daily living.
Ankylosing Spondylitis seems to affect everybody slightly differently with an unpredictable disease course. Remissions and relapses may occur at any stage. In general, though, you will probably find that the symptoms come and go over many years. In the classic case, the lumbar spine can become stiff, caused by the growth of additional bone, as can the upper spine and neck. If you pay attention to your posture, exercise regularly and avoid the stoop associated with the condition, you can prevent this from becoming too serious.
Please contact you physician immediately with the development
- Eye inflammation (uveitis, iridocyclitis – red eyes, slight blurring of vision, light sensitivity)
- Heart valve disease, typically aortic valve stenosis
- Pulmonary fibrosis
Ankylosing spondylitis versus Spondylosis?
They sound similar but they are different. Spondylosis is a term relating to “wear and tear” and is more common in older people. Ankylosing Spondylitis relates to an inflammatory condition which produces new bone and leads to fusion. The vigorous exercise therapy designed for people with Ankylosing Spondylitis might be harmful to those suffering from spondylosis.