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Ankylosing Spondylitis (AS)

Introduction:

 

Ankylosing Spondylitis (AS) belongs to a family of inflammatory arthritis conditions involving the spine called Axial Spondyloarthritis (SpA). Many times (but not always) these patients carry a genetic marker called HLA-B27.

 

AS commonly affects young people in their twenties and can lead to progressively debilitating back pain and stiffness. Over time, this can deform the spine, leading to fusion of the vertebrae and permanent loss of flexion in the spine, hunching the neck and upper back.

 

AS affects men more than women but we now appreciate that its impact on women has been historically underestimated.

 

Symptoms:

 

Hallmarks of AS include ‘inflammatory back pain’, which is characterized by

 

  • Intractable back pain or stiffness, especially in patients who are less than forty-five years of age, often in their twenties

  • Low back stiffness especially in the morning that can last for several hours

  • Low back and buttock pain in the second half of the night

  • Nocturnal pacing (patient gets up and walks around at night to relieve the back pain)

 

and often accompanied by:

 

  • Fatigue, and, sometimes, fever and weight loss

  • Eye inflammation, redness, and pain (uveitis)

 

Importance of Treatment:

 

The diagnosis of AS is often missed for years and can have devastating consequences on a patient’s life. For that reason, general practitioners and orthopedic surgeons are often encouraged to screen patients with chronic intractable back pain and refer to a rheumatologist if there is any suspicion for inflammatory back pain.

 

AS can cause bone thinning and lead to compression fractures.

 

It can also cause enlargement of the aorta, the largest blood vessel in the body, and cause distortion of the aortic valve in the heart, causing impaired heart function.

Historically, rheumatologists didn’t have a lot of options for treating AS. Medications that work in rheumatoid arthritis were often used without a lot of benefit.

 

Fortunately, now there are excellent medications for treating AS, which can halt the disease and improve a patient’s function and quality of life tremendously. Please ask you rheumatologist for details.

 

Besides medications, other things that have been shown to help AS patients  include:

 

  • Physiotherapy

  • Regular neck and back flexibility exercises

  • Aerobic and strength-building exercises

  • Avoiding smoking

  • An active lifestyle

 

Note: None of these is a substitute for newer medications for patients whose disease is progressing quickly.