What is Ankylosing Spondylitis?

Ankylosing spondylitis is a long term chronic inflammatory disorder that primarily affects the spine but joints of the legs and arms can also be affected leading to inflammation in the joints and eventual fibrosis and ankylosis if not treated. The term, Ankylosing spondylitis comes from the Greek word of "ankylos" meaning "bent" and from Latin "spondy" meaning "spine". In the untreated forms of this condition they eventually develop a bent spine. This affects up to 1% of population. The actual cause of this is unknown, but it is clear that genetic factors play a role and there may be an infective agent that may initiate immune responses in those with specific genetic factors

The initial onset of the symptoms is typically intermittent with mild hip, buttock or back pain that may be associated with decreased mobility. As the onset is so slow, this often leads to delay in diagnosis. Typically, this is worse in morning and in middle of night and the age of onset is usually 15-35 years. The stiffness will usually improve with movement and exercise. The pain gets increasing worse. About a quarter will develop an eye irritation and half will have a peripheral arthritis at some stage during disease. Some might develop cardiac issues and in some there may be breathing issues due to the restriction in mobility of the ribs. Ankylosing spondylitis can cause heel pain, tendonitis and cause foot disability. There may be issues with the fine movements of the fingers, such as doing up buttons on clothing. The course and progression of the condition is highly variable. It is characterised by exacerbations and remissions with flare-ups. Now with treatments less then 20% will go on to any type of significant disability and life expectancy appears not to be reduced. The disability may be as minor as not being able to reach the feet due to stiffness in the spine or as bad as quite a severe disabling inflammation of many joints affecting most activities of daily living.

The treatment of ankylosing spondylitis will involve a number of different approaches and different professions. In a lot of cases the disease activity is relatively mild with a reasonable prognosis, so a not a lot of treatment is needed. The aim of the management is to offer pain relief and to prevent the development of any deformity. This is why an early diagnosis is so important. Those who have been diagnosed will get a lot of education on issues such as to sleep on foam mattress, to get as much exercise as possible, to avoid smoking and reach out to patient support groups. NSAID drugs are often used for the pain and inflammation in the early stages. Later sulfasalazine may be trailed and then methotrexate if sulfasalazine is ineffective. Biologic agents are also often now being used. Physiotherapy is crucial and will consist of postural exercises, increasing joint mobility with lots of activity and range of motion exercises to prevent spinal rigidity from developing. Swimming is often helpful for this. There may also be breathing exercises if the upper spine and ribs become stiffer.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.