Understanding Ankylosing Spondylitis: Symptoms, Diagnosis, and Management

Ankylosing spondylitis, a rare form of arthritis, primarily affects the spine, causing stiffness and pain. Also called Bechterew’s disease, it begins in the lower back and can progress upward, impacting the neck and other joints. It involves inflammation of the vertebrae, leading to potential fusion of bones in severe cases. While incurable, symptoms can be managed effectively through medications and exercises, helping to alleviate pain and maintain mobility.

Common Signs and Symptoms

Symptoms vary but often include periods of flare-ups with alternating symptom-free intervals. Back pain, especially in the morning or at night, is typical, along with joint discomfort in shoulders and hips. Other signs include:

Morning stiffness

Postural issues like stooping

Loss of appetite

Persistent low-grade fever

Weight loss

Fatigue

Anemia from low iron

Breathing difficulties

Because inflammation can involve other body parts, additional symptoms may include:

Intestinal inflammation

Minor eye inflammation

Heart valve issues

Achilles tendinitis

Lower back pain is often linked to trauma but in ankylosing spondylitis, it worsens upon waking and can improve with physical activity. Young people experiencing persistent lower back pain, especially where the spine meets the pelvis, should consult a doctor. A family history of the disease increases risk, as genetic factors like the HLA-B27 protein are involved. Symptoms may also include chest discomfort, which affects breathing, and progressive movement of pain up the spine, risking permanent deformity. Early use of anti-inflammatory medications can provide relief but do not cure the disease.

Potential Causes

The precise cause remains unknown, but genetics play a key role. A family history and presence of HLA-B27 gene significantly increase susceptibility, with studies showing over 90% of affected individuals carrying this gene. Factors influencing the development include:

Family history and genetic markers

Age, typically between 20 and 40 years

Male gender, three times more likely to be affected

Caucasian ethnicity

Complications to Watch For

If untreated, the disease can lead to serious health issues such as:

Spinal fusion caused by chronic inflammation

Involvement of shoulders and hips

Reduced flexibility due to tendon and ligament inflammation

Breathing difficulties

Eye irritation and potential vision loss

Heart and bowel damage

Spinal fractures from compression

Impact on the Body

Primarily affecting the spine, ankylosing spondylitis can involve other joints and organs, leading to various health issues:

Bone stiffening and deformity – pain and reduced mobility, especially in the lower back and neck

Nerve damage resulting in sexual or urinary problems

Eye inflammation like iritis, risking vision impairments

Skin conditions such as psoriasis

Anemia and cardiovascular risks, including aortic enlargement and heart disease

Diagnosis Methods

Doctors assess mobility and pain points through physical exams, asking patients to perform bends and deep breaths. Imaging tools like X-rays and MRIs reveal structural changes. Blood tests identify inflammation markers, though no specific test confirms the disease.

Management and Treatment

While there’s no cure, early intervention reduces symptoms and slows progression. Treatment strategies include:

Medications: NSAIDs to lessen inflammation and pain, with stronger options like biologics if needed.

Physical therapy: Targeted exercises enhance flexibility, correct posture, and strengthen muscles.

Surgical options: Usually reserved for severe joint damage or hip replacements.

Lifestyle adjustments: Staying active, applying heat or cold therapy, quitting smoking, and maintaining good posture help manage symptoms.