Ankylosing Spondylitis (AS)
Ankylosing spondylitis is a painful, long-term disease that affects the spine, bones, muscles, and ligaments that connect bones. There is presence of joint pain and inflammation related to arthritis in this condition.
Ankylosing spondylitis is a chronic inflammation of the joints characterized by damage to the spine and pelvis. It manifests as painful flare-ups interspersed with lulls. It can sometimes progress to stiffening of the affected joints.
The main complication of ankylosing spondylitis is therefore the functional handicap it generates: loss of flexibility of the spine with stiffness of movements and weakening of the bone with an increased risk of vertebra fracture.
What are the different forms of the disease?
“There are different ankylosing spondyloarthritis depending on the location of the inflammation: the axial, peripheral or enthesopathic form. Some patients experience mixed forms”, according to Dr. Pauline Guyader:
Axial ankylosing spondylitis or axSpA is the most common form. The inflammation affects the vertebrae and joints of the spine and pelvis.
Peripheral articular ankylosing spondylitis: it affects the joints of the lower and upper limbs.
Enthesopathic Peripheral Ankylosing Spondylitis: It affects the entheses in the limbs, which are the attachment points of muscles or ligaments to bones.
Symptoms Ankylosing spondylitis
It begins with flare-ups of back pain or lumbar pain (low back pain) which may seem trivial. These attacks last for a few days to a few weeks and eventually subside. In this context, the diagnosis can be made up to eight years after the onset of the disease, which further delays medical treatment.
This is why, in the event of pain in the spine, certain suggestive symptoms should alert the patient and encourage him to consult:
- the pains of the spine are of the “inflammatory” type: they appear rather at night and wake the person up around two or three in the morning and they are not calmed by rest;
- pain occurs in one buttock, sometimes in both and sometimes “rocking”;
- a heel (or both) is painful (talalgia) in the morning on waking, and the situation gradually improves when walking;
- a finger or toe swells;
- stiffness in one or more other joints (knees, ankles, shoulders, etc.) is present in the morning upon awakening and lasts more than half an hour;
- pain is associated with severe fatigue;
- painful attacks persist for at least three months, and tend to last longer and longer.
Diagnosis
Early diagnosis of ankylosing spondylitis allows for effective treatment. Its objectives are to alleviate symptoms and avoid complications (especially stiffening of the spine or joints in bad position).
This is why it is important to consult promptly if you have symptoms suggestive of the disease.
The attending physician examines the patient and questions him about his symptoms thoroughly.
He then prescribed examinations:
blood tests. They can be used to look for signs of possible inflammation and the presence of autoantibodies;
x-rays of the spine, pelvis. They help locate the first joint damage in painful areas of the body.
To clarify the diagnosis, the doctor takes the advice of a rheumatologist.
If the results of the initial assessment do not provide enough information, the doctor prescribes other examinations, depending on the damage related to the disease:
- an MRI and / or CT scan of the sacroiliac joints and the spine;
- an ultrasound of the painful peripheral joints (examination using ultrasound).
If the rheumatologist deems it necessary, additional blood tests are done. They make it possible to search for possible genetic predispositions to the development of ankylosing spondylitis (search for the HLA B gene).
Finally, in the event of damage to the skin or the eye, the advice of a dermatologist or an ophthalmologist is sometimes necessary.
The final diagnosis of ankylosing spondylitis is based on a set of elements obtained from these various assessments.
THE EVOLUTION OF ANKYLOSING SPONDYLARTHRITIS
At the start of the disease, the course of ankylosing spondylitis is unpredictable. There is no link between the intensity of the pain and the development of ankylosis.
Current treatments usually make it possible to limit relapses and their consequences. Rigorous medical monitoring is essential to adapt the treatment according to the phases of the disease.
The course is variable depending on the patient. The disease often develops very differently from person to person.
Sometimes spondyloarthritis does not progress very well and does not have major consequences. These minor forms seem to be more common in women.
Most patients suffer from intermediate forms of spondylitis.
In other patients, ankylosing spondylitis becomes more and more severe, with more and more frequent attacks. Mild symptoms may even persist during periods of remission. The inflammation spreads to an increasing number of joints (for example, it spreads throughout the spine). The affected areas can gradually stiffen up to total ankylosis, which causes very significant deformation and discomfort.
In some cases, at an advanced stage of the disease, the normal arch of the lumbar spine disappears and the back is hunched (dorsal kyphosis). When peripheral joints are affected, their mobility may also be limited.
If the eye is affected, scarring that interferes with vision is possible. To prevent and detect these possible complications, ophthalmologic monitoring is scheduled.
Treatment of ankylosing spondylitis
To combat the pain of ankylosing spondylitis, the doctor prescribes nonsteroidal anti-inflammatory drugs and pain relievers. If these drugs are insufficient, a basic treatment is administered under strict medical supervision.
OBJECTIVE OF TREATMENT FOR ANKYLOSING SPONDYLARTHRITIS
Ankylosing spondylitis requires comprehensive management including drug treatment, rehabilitation and rehabilitation care, and social and professional measures.
All of these are equally important for:
- fights pain associated with inflammation;
- avoid stiffness and prevent possible complications;
- improve your quality of life.
The medical team providing care consists of the attending physician, and other necessary healthcare professionals: rheumatologist, specialist in physical medicine and rehabilitation, ophthalmologist, dermatologist or gastroenterologist, orthopedic surgeon, physiotherapist, chiropodist, occupational therapist…
Information: Cleverly Smart is not a substitute for a doctor. Always consult a doctor to treat your health condition.
Photo description: Main areas affected by ankylosing spondylitis.
Sources: PinterPandai, NHS UK, Versus Arthritis, Web MD, National Center for Biotechnology Information (NCBI)
Photo credit: Meliza13 / Wikimedia Commons