Ankylosing Spondylitis (AS) is a type of arthritis that occurs when the spine and feet become inflamed and stiff. AS is an autoimmune disease, which means the immune system attacks the body’s own tissues. It can cause chronic pain, fatigue, and difficulty with daily activities.
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What is Ankylosing Spondylitis?
Ankylosing spondylitis is chronic inflammatory arthritis that primarily affects the joints, ligaments, and tendons of the spine. Specifically, ankylosing spondylitis causes enthesitis inflammation where the tendons, ligaments, and bones meet.
A hallmark of ankylosing spondylitis is inflammation of the sacroiliac joint, the joint between the sacrum, which is the bony structure at the base of the spine, and the bones of the pelvis. In advanced cases, ankylosing spondylitis can cause new bone to grow in the inflamed areas and the vertebrae of the spine to fuse. This can lead to kyphosis, a type of spinal curvature that results in a forward-hunching posture.
What is Inflammatory Rheumatic Disease?
People with ankylosing spondylitis may also have inflammation in other parts of their body, including the eyes leading to a condition called uveitis. Inflammation can additionally occur in the heel area and the knees, elbows, shoulders, and ribs.
Ankylosing spondylitis is one of a group of inflammatory rheumatic diseases known as spondylitis, spondyloarthropathy, or spondylarthritis. After rheumatoid arthritis (RA), ankylosing spondylitis (AS) is one of the most common rheumatic diseases.
Ankylosing Spondylitis Symptoms
The most common symptom of ankylosing spondylitis is low back pain that develops so gradually that it may go unnoticed in the early stages. Other signs and symptoms of ankylosing spondylitis include;
- Stiffness that is worse in the morning
- Pain in the buttocks
- An improvement in pain and stiffness with physical activity
- Hunched posture
- Difficulty breathing deeply
Ankylosing spondylitis can also cause inflammation in other parts of the body, including the eyes, called uveitis, and the aortic valve and aorta called aortitis. Typically, symptoms worsen over time gradually for some people and more rapidly for others.
How Ankylosing Spondylitis Affects the Body?
People with ankylosing spondylitis often feel chronic pain, primarily in the spine, but sometimes also in other joints, including
- Small joints of the hands and feet
Chronic pain is usually a result of the inflammation caused by ankylosing spondylitis and can vary from mild to severe. Some people with ankylosing spondylitis report having an overall sense of discomfort and stiffness all the time.
Ankylosing Spondylitis Causes
Ankylosing spondylitis causes back pain that is worse at night, with an improvement upon arising. Some people experience worsening of back pain and awakening during the second half of the night in particular. There is usually an improvement in pain and stiffness with exercise, but no improvement with rest.
Many people with ankylosing spondylitis have buttock pain, which shows inflammation of the sacroiliac joints. The sacroiliac joints are at the base of the spine, where the spine meets the pelvis.
Neck pain is another symptom of the disease. Women with ankylosing spondylitis may have more neck and peripheral joint pain (pain in the knees, elbows, and ankles) and less spinal involvement than men.
What Cause Ankylosing Spondylitis?
The precise underlying cause of ankylosing spondylitis is unknown, but it is believed to have a strong genetic component, and possibly an environmental one. Most individuals who have ankylosing spondylitis have a gene variation called HLA-B27.
Populations with a low frequency of the HLA-B27 gene variant have a correspondingly low occurrence of ankylosing spondylitis. But most people with HLA-B27 do not develop ankylosing spondylitis, and it is not known how HLA-B27 increases the risk of developing it.
Is Ankylosing Spondylitis an Autoimmune Disease?
Whatever its trigger, ankylosing spondylitis is an “immune-mediated” disease, which means it results from abnormal activity of the body’s immune system. Immunologists disagree about whether it is an autoimmune disease. In autoimmune diseases, the body mistakenly attacks a substance called an antigen that’s produced by the body. The blood proteins that attack the antigen are called autoantibodies, and they are detectable in a blood sample.
In recent years, scientists have used the term “auto-inflammatory” to refer to inherited diseases that cause repeated episodes of inflammation in the absence of autoantibodies. In these diseases, it appears the immune system is reacting to something other than a self-antigen. But because ankylosing spondylitis has some autoimmune characteristics and some auto-inflammatory characteristics, many experts believe it falls into both categories simultaneously.
Ankylosing Spondylitis Diagnosis
There’s no single diagnostic test for ankylosing spondylitis. If your symptoms and medical history suggest you may have it, your doctor will probably do:
- A physical exam, including an exam of your spine and rib cage
- X-rays and possibly other imaging tests to look for bone or joint changes
- Blood tests to look for inflammation and to rule out other forms of arthritis
Ankylosing Spondylitis Complications
Osteopenia and osteoporosis, both terms for low bone mass or low bone mineral density, are common complications of ankylosing spondylitis, and both raise the risk of spinal fractures. While the lack of physical activity may contribute to low bone mass later in the disease. Other potential complications of ankylosing spondylitis include:
- Aortic valve disease
- Disturbances in the heart’s electrical impulses
- Weakened heart muscles
- Reduced blood flow to the heart
- Fibrosis, or scarring, of the upper lobes of the lungs
- Breathing impairment because of chest wall restriction
- Sleep apnea
- Spontaneous pneumothorax (collapsed lung)
Ankylosing Spondylitis Progression
Ankylosing spondylitis is a progressive disease. People with ankylosing spondylitis may initially have pain in the lower back, sacroiliac joints, or buttocks area that progress to other areas, including the hips, shoulders, or neck. For some, if the disease goes untreated, the inflammation may cause the spine to fuse. While knowledge is limited to the triggers of ankylosing spondylitis progression, researchers believe the following predictors are involved;
- Exposure to bisphosphonate, a type of osteoporosis treatment, in women
- High C-reactive protein levels, an indicator of inflammation, in men
- Obesity in men and women
- Smoking in men
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