How to recognize ankylosing spondylitis
It is important to understand the early signs and symptoms of the disorder, as well as how it progresses. Understanding ankylosing spondylitis (AS) may help people know when they should see a doctor and what to expect from their diagnosis.
This article aims to provide a visual guide to how AS affects the body and how this changes over time.
Overview and symptoms
When does it occur?
AS is a lifelong disorder that occurs in both men and women. The first symptoms of AS usually occur around the age of 30, and rarely occur after the age of 45.
The disorder is chronic and is often progressive, meaning that individuals who are affected by it will be affected for most of their lives.
What parts of the body are affected?
AS is an inflammatory disorder that is considered a form of arthritis. It mainly involves the spine and the sacroiliac joints, which are the joints between the sacrum and the iliac bones on either side of the body.
The condition causes inflammation of the vertebrae, which are the joints connecting the bones in the spine.
This inflammation often leads to long-lasting pain that ranges from uncomfortable to severe. Other joints may also be affected if the disorder progresses.
The most common symptoms of AS are inflamed, painful, or stiff joints. These are most common in the back and sacroiliac joints, where it is known as sacroilitis.
Sacroilitis causes pain in the lower back, buttocks, and sometimes the legs. Doctors will look here first when trying to diagnose the disorder. It is also common for a person to show signs of inflammation and stiffness in the hips, shoulders, heels, hands and feet, and ribs.
Symptoms of AS tend to flare up in the early stages. This means that people may experience pain and inflammation for a short time followed by a period of remission where they experience no symptoms.
The joints of people with AS can appear wider or smaller than normal.
AS may progress in some joints to a condition called ankylosis. Ankylosis causes new bones to be formed in the spine as one or more bones fuse together.
New sections of bone are fixed in position and immobile.
As the disorder progresses, it can limit the physical function of the body, reduce a person's ability to work, and greatly affect their quality of life. In some cases, AS can lead to disability, but the disorder affects everyone differently.
It is important to diagnose the disorder early and monitor any progression to avoid complications as much as possible.
Some people who have AS may experience a few complications, such as being fatigued. The body spends a lot of energy focusing on fighting the symptoms of AS, and this can make people feel worn out.
Symptoms of AS are also associated with other disorders, such as:
- peripheral arthritis
- inflammatory bowel disease
People with AS may also experience inflamed, painful eyes or blurred vision. Some may not be able to expand their chest fully, making breathing difficult. Others may have reduced mobility in their spine that may require surgery.
In rare cases, the lungs or heart may even become affected. A small number of people experience inflammation of the jaw.
There is no single test to diagnose AS. Doctors will often use X-rays, CT scans, and MRIs to find evidence of inflammation in key areas, such as the joint between the sacrum and ilium.
Doctors will also want to gather more information about the type of back pain the person is experiencing. People with AS usually have symptoms before the age of 45, and their symptoms develop gradually, usually over a period of 3 months or more.
People with AS also commonly suffer from back pain that gets worse while they sleep, and then starts to feel better once they are in motion. The pain caused by AS will often not improve from resting, and tends to get better with exercise and physical motion.
Doctors will often ask people whether these situations apply to them and then move on to imaging to confirm that it is AS.
There is also a blood test that looks for a gene called the HLA-B27 gene. While having the gene does not mean that someone will have the disorder, it does appear in many cases.
When to see a doctor
Anyone experiencing symptoms linked to AS would benefit from a visit to their doctor. The doctor may run tests themselves or refer the individual to a rheumatologist for testing.
People who have been diagnosed with AS, even those with minor symptoms that can be managed at home, should continue to see a rheumatologist at least once a year. These checkups allow a doctor to track the progress of the disorder, and to monitor for complications that may not be showing symptoms.
Treatment for AS involves many different approaches designed to make the symptoms manageable.
A typical treatment plan will include physical approaches, such as exercise, physical therapy, and practicing correct posture. These plans can also include medication and applying heat or cold to relax muscles and reduce pain. Severe cases may require corrective surgeries to keep the spine in place.
Because AS has the potential to progress over time, doctors often use medications that will help slow this progression as much as possible. Research published in Arthritis & Rheumatology suggests that using drugs called nonsteroidal anti-inflammatory drugs (NSAIDs) greatly benefit people with AS, as they reduce the inflammation that causes symptoms.
Other drugs called tumor necrosis factor inhibitors are also commonly used alongside NSAID treatment. These drugs inhibit a protein called TNF-a, which plays a key role in the symptoms of AS.
Oral glucocorticoids may also be prescribed for some people with AS. These are drugs that help to suppress an overactive immune system and have anti-inflammatory effects. They are not popular because of their side effects, however, and the latest research suggests not using glucocorticoids when treating AS.
AS affects everyone differently. Some people hardly notice their symptoms and can manage them from home while others are severely affected by them.
It is important for people with AS to see a doctor or rheumatologist regularly to check on the progression of any symptoms, and to follow their treatment plan. Doing so provides people with AS the best chance of managing their symptoms.