Ankylosing spondylitis: Effects and treatment
It is important for people to understand how ankylosing spondylitis (AS) affects the body and how it differs from signs of aging. There are also treatment options that are relevant to know about.
In this article, we examine how AS changes the body over time and what the outlook is for people with the disorder.
Effects on the spine
Back pain caused by aging improves after a period of rest, but pain caused by AS can get worse.
AS can cause symptoms similar to those that many people feel as they get older.
Symptoms of stiffness, pain, and inflammation can be created by both an aging spine and AS, but there are some differences.
When the spine ages, the spinal discs can lose their ability to cushion the vertebrae. This can cause collapsed, herniated, or bulging discs.
Over time, this breakdown can also lead to bone loss and nerve damage as vertebrae rub together and pinch nerves. This creates many symptoms in the back, including chronic pain, tingling or stinging sensations, and even numbness.
Aging can also affect the ligaments and muscles in the back, creating bad posture and decreasing range of motion in the spine.
The effects of AS can appear similar to the natural aging process, with a few key differences. Lower back pain that spreads down the buttock and thigh is a sign of early AS. Unlike back pain caused by aging, AS pain is made worse by rest, not better.
People with AS may find that their back pain eases with exercise and stretching, and is worse after waking up or while lying down. Pain caused by AS is also relieved with non-steroidal anti-inflammatory drugs (NSAIDs), which only help in some cases of back pain caused by aging.
Effects on the body
AS affects everyone differently. Some people may feel symptoms in their back alone, while others have symptoms throughout the body.
The disorder also progresses differently in individuals. Some may experience symptoms off and on throughout their life that never really get worse. In other cases, AS can progress quickly, with symptoms worsening over time.
AS creates different symptoms in specific areas of the body, and these symptoms may shift and change. There is no one specific way that the disorder progresses, however.
The first symptoms of AS are often felt in the spine, particularly in the lower back. This is usually a burning or radiating pain that can reach to the buttocks and thigh.
The inflammation more usually spreads up the spine, as the disorder progresses. The spread of inflammation can cause severe pain, stiffness, and affect a person's posture. AS that has progressed a lot may even cause complete loss of flexibility in the spine.
As the disorder worsens, it can create new bone growth in the body, usually in the spine. This can start with small bone spurs that stick out from the spine. With time, two or more bones may become fused together completely.
This can reduce mobility and flexibility, and may contribute to disability if left untreated.
The hallmark of ankylosing spondylitis is pain and inflammation in the sacroiliac joint, the spot where the spine and the pelvis join. Inflammation here often contributes to the lower back pain that people can experience as their first symptom.
Pain and inflammation in the sacroiliac joint contribute to the lower back pain that people with AS experience.
Symptoms of AS can appear in any joint, but they are most common in the larger joints of the body.
AS usually causes symptoms in the following joints:
Over time, the joints may become thinner. In some cases, AS causes the joints to disappear entirely as the bones fuse together. This is sometimes seen in the sacroiliac joint in cases where AS has progressed a long way.
In rare cases, the inflammation can affect the jaw, making it difficult to swallow or chew.
AS inflammation that spreads up the spine can affect the chest. The ribs are attached to the bones of the spine. When inflammation causes these joints to be stiff and tight, it can make it difficult for the chest to expand when a person breathes.
The result is a feeling of tightness in the chest, or a lack of breath. People may feel as though their breaths are not satisfying, as the lungs struggle to expand in a tight ribcage.
If the disorder progresses, the ribs may become fused to the spine, making these symptoms worse.
The expanding inflammation that AS creates in the body can reach the eyes and cause iritis or uveitis. These terms describe inflammation in the eye, and the conditions can lead to discomfort if left untreated.
The eyes may become bloodshot or make a person see dark spots. An individual may also feel pressure and pain in the eyes and may be sensitive to light.
In some cases, they may have difficulty seeing or have very blurry vision. If allowed to progress, this can cause blindness or permanent sight impairment.
Heart and lungs
Over time, AS may spread to the heart and lungs, leading to irregular heartbeats or an inflamed aorta, the main artery from the heart.
Some people with AS develop sleep apnea where breathing repeatedly stops during sleep. A person may also show signs of cysts, holes, lesions, and scarring on the lung tissue.
NSAIDs, such as ibuprofen, are often prescribed to help people with AS manage pain and inflammation.
Currently, there is no cure for AS. It is a chronic inflammatory disorder that requires varied approaches to treat.
Medicine is often used to help the condition. Research posted in Arthritis and Rheumatology strongly recommends that simple NSAIDs are very helpful for reducing inflammation in cases of AS. As this inflammation is the main cause of many symptoms and complications, these drugs are seen as a first line of defense.
When the disorder continues to progress, doctors often recommend using tumor necrosis factor inhibitors (TNFi). These drugs aim to get rid of a protein that creates inflammation in the body. This can reduce symptoms and may also reduce complications, such as tiredness.
Rare cases of AS may also require surgery if they reach the point where the bones are fusing together.
For back pain associated with AS, physical therapy, such as stretching and mobility exercises, can help reduce pain and stiffness.
Some people benefit from applying hot or cold packs to painful areas. Eating a varied and nutritious diet can also be a healthful part of any treatment plan.
What happens if ankylosing spondylitis is left untreated?
AS is a progressive disease. If left untreated, symptoms may spread and worsen throughout the body. Long-term inflammation can cause many complications, including an increased risk for heart disease, gut disorders, and extreme tiredness.
Untreated AS may also contribute to osteoporosis, making the bone mass reduce and weaken.
Chronic pain and inflexibility is a problem for many people with untreated AS, and it can lead to physical disability.
AS progresses differently from person to person. Some people may only experience mild symptoms, while others will have chronic symptoms that continue to worsen.
AS may not have a cure, but there are several promising treatments that can help reduce or control symptoms for many people.
Working directly with their doctor or rheumatologist, people with AS can usually create a treatment plan that helps keep the disorder in check. Once this happens, the plan should be followed to help prevent the disorder from progressing.