Ankylosing spondylitis

Description

Ankylosing spondylitis is a form of arthritis in which the immune system attacks the joints, leading to inflammation and pain. The joints most commonly affected are located in the spine, mainly the low back area. As the inflammation persists, the body tries to repair the damage by producing new bone tissue, causing some of the bones in the spine to grow closer and even fuse together.

Ankylosing spondylitis affects about 1 in every 100 people. Of those affected, men are 3 to 4 times more likely to develop this disease. The disease usually appears between the ages of 15 and 40. The physical profile of patients with ankylosing spondylitis is as follows: they are usually of medium height with a slim build, and have a long, narrow face.

Cause

The exact cause of the disease has not yet been established. However, a genetic component is thought to be involved. That being said, a person's risk of developing ankylosing spondylitis increases if a family member has been diagnosed with the disease. In fact, about 90% of those with ankylosing spondylitis carry a gene known as HLA-B27. The disease however, does not necessarily develop in every person who has this gene, which leads us to believe that other factors are involved in triggering the disease.

Symptoms

• Pain so severe it prevents individuals from moving or sleeping. The pain is not constant but rather dull and diffuse.
• Stiffness that is often worse in the morning or after periods of inactivity
• Inflammation of the tendons surrounding the joints (back of the heel, sole of the foot, outside of the hips, sternum...)
• Fatigue
• Fever
• Weight loss
• Loss of appetite
• Night sweats
• Uveitis (eye inflammation)

Apart from the joints in the spine, the hips, shoulders and knees can also be affected, although more rarely.

Complications

In an effort to ease their pain, people with ankylosing spondylitis tend to modify their posture by bending forward and, with time, this may cause changes in their overall posture. Since the vertebrae have a tendency to fuse, the skeleton can be similarly affected and the bones can freeze in this bent-over posture, resulting in reduced mobility. Furthermore, the vertebrae in persons with ankylosing spondylitis are more fragile, which increases the risk of fracture. Other organs such as the eyes (eye inflammation) and the respiratory system may also be affected. Ankylosing spondylitis may, on very rare occasions, cause heart problems.

Diagnosis

Diagnosis is based on the patient's symptoms (type of pain, location of the pain, time of day at which pain is present), x-rays and various examinations including certain imaging methods. Blood tests can also be used to diagnose the disease.

Treatment

There is no cure for ankylosing spondylitis. It is possible however, to relieve symptoms and improve the quality of life of those affected. Early treatment may also help slow the progression of the disease.

Given the positive effect of exercise, physiotherapy is another important part of managing the disease. Adapted physical exercise can help reduce pain and fatigue, as well as improve mobility. Overexertion however, can lead to joint damage. It is therefore recommended that persons with ankylosing spondylitis consult with a physiotherapist and an occupational therapist.

There are several drug treatments that can help reduce pain and maintain mobility. These include anti-inflammatories, corticosteroids and injections, which modify the biological response.

Adopting certain lifestyle habits can also help improve one's overall condition:

• Maintain a healthy weight
• Apply heat
• Alternate sleeping on your back and stomach (avoid sleeping on your side)
• Avoid carrying heavy loads
• Sleep on a firm mattress

Surgery is only considered in very rare cases.

If you have any questions, do not hesitate to speak to your pharmacist.

For more information or for support:

• Arthritis.ca