Ankylosing Spondylitis (AS) is a chronic autoimmune condition and a form of inflammatory arthritis that mainly affects the spine. The disease leads to ongoing inflammation in the joints and ligaments of the spine, causing pain, stiffness, and reduced mobility. In more severe cases, AS can cause the bones of the spine to fuse, significantly impacting posture and flexibility.

AS is a progressive disease with no known cure. However, proper management through medications, lifestyle changes, and physical therapy can help control symptoms and maintain quality of life.

Recognizing Symptoms

AS symptoms vary widely between individuals. They tend to develop gradually and are typically noticeable before the age of 45. Many people with AS experience flares, or episodes of worsening symptoms, followed by periods of improvement.

Common symptoms include:

  • Back pain and stiffness, especially in the lower back and hips

  • Morning stiffness or stiffness after rest, improving with movement

  • Enthesitis, or inflammation where tendons and ligaments attach to bones

  • Fatigue, due to inflammation or side effects of medication

  • Pain in other joints, including hips, shoulders, knees, and feet

  • Restricted mobility as inflammation limits spinal flexibility

  • Uveitis, a form of eye inflammation leading to redness, pain, and light sensitivity

In later stages, AS can lead to kyphosis (forward-stooped posture), difficulty breathing (from chest wall rigidity), and anemia. Emotional symptoms like depression may also occur.

Understanding the Causes

The exact cause of AS remains unclear, but it's believed to arise from a combination of genetic and environmental influences.

  • The HLA-B27 gene is strongly associated with AS. Around 90% of individuals with AS have this gene, though not everyone with HLA-B27 will develop the disease.

  • Immune system dysfunction leads the body to attack its own tissues, resulting in chronic inflammation.

  • Environmental triggers, such as infections or gut inflammation, may initiate the autoimmune response in genetically predisposed people.

Key Risk Factors

Several factors can increase a person's likelihood of developing AS:

  • Age: Most people are diagnosed before the age of 40

  • Gender: AS is more common and often more severe in males

  • Family history: Having a parent or sibling with AS raises your risk

  • Inflammatory bowel disease (IBD): Conditions like Crohn’s or ulcerative colitis are linked to AS

  • Smoking: May worsen symptoms and increase the rate of spinal fusion

How AS Is Diagnosed

Diagnosing AS involves a comprehensive evaluation by a healthcare provider. The process includes:

  • Medical history and review of symptoms

  • Physical examination, including checking spinal mobility and joint function

  • Genetic testing for HLA-B27

  • Imaging:

    • X-rays to detect joint damage or spinal fusion

    • MRI scans to identify early inflammation in joints and soft tissue

  • Blood tests to check markers of inflammation, such as ESR and CRP

A diagnosis is confirmed when the symptoms and test results align with clinical criteria for AS.

Available Treatments

Although there's no cure for AS, treatment can effectively relieve symptoms, slow disease progression, and improve quality of life. Treatment strategies typically include:

Medications

  • NSAIDs (e.g., ibuprofen, naproxen): First-line treatment for pain and inflammation

  • TNF inhibitors (e.g., adalimumab, etanercept): Biologics that block the protein responsible for inflammation

  • IL-17 inhibitors (e.g., secukinumab): Target other immune pathways to reduce inflammation

  • DMARDs (e.g., sulfasalazine): Used mainly for peripheral joint involvement

  • Corticosteroids: Short-term use for severe inflammation

Physical Therapy

Physical therapy is essential for maintaining mobility and function. Key goals include:

  • Strengthening muscles that support the spine

  • Improving posture and flexibility

  • Preserving lung capacity through chest-expanding exercises

  • Stretching routines to reduce stiffness

Surgery

Surgery may be required in advanced cases where joint damage severely impairs function:

  • Hip replacement for joint deterioration

  • Spinal fusion to stabilize vertebrae

  • Osteotomy or laminectomy to correct spinal deformities and relieve nerve pressure

Managing Flares

AS flares can occur unexpectedly and may significantly impact quality of life. Common triggers include stress, illness, poor sleep, and lack of movement.

Ways to reduce flare frequency:

  • Regular exercise and stretching

  • Following your treatment plan consistently

  • Getting adequate sleep and maintaining a routine

  • Managing stress through mindfulness, breathing techniques, or therapy

  • Quitting smoking, if applicable

Noticing more frequent or severe flares? Speak to your healthcare provider to adjust your treatment plan.

Associated Health Conditions

People with AS often experience other health conditions. These include:

  • Depression: Living with chronic pain increases mental health risks

  • Cardiovascular disease: Inflammation may raise the risk of heart problems

  • Osteoporosis: Chronic inflammation and reduced activity can lead to bone thinning

  • IBD: About 10% of people with AS develop Crohn's or ulcerative colitis

  • Psoriasis or skin rashes

Managing these coexisting issues often requires a multidisciplinary healthcare approach.

Life With AS

Living with ankylosing spondylitis can be physically and emotionally demanding. However, many people manage the condition effectively with the right care and support.

Tips for improving day-to-day life:

  • Stay active, even during flares, with low-impact activities like swimming or yoga

  • Work with a rheumatologist to fine-tune treatment plans

  • Build a support system of family, friends, and support groups

  • Track symptoms using journals or apps

  • Stay informed on new treatments and clinical trials

With proper treatment and self-care, many individuals with AS lead active, fulfilling lives.