Ankylosing Spondylitis

What is Ankylosing?

Ankylosing Spondylitis (AS) is chronic, inflammatory condition primarily affecting the spine and large proximal joints.  It typially starts in the sacroiliac joints, which are located at the base of the spine where it meets the pelvis. Over time, the inflammation can lead to pain and stiffness and loss of range of motion if the disease is left untreated. In more severe and rare cases of AS, the bones in the spine (vertebrae) can fuse due to the inflammation from this disease. As a result, the spine is less flexible, motion of the spine becomes limited, and may result in a hunched posture position.

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What are the Signs and Symptoms of Ankylosing Spondylitis?

Ankylosing Spondylitis is a type of arthritis that causes inflammation in the spine and other joints. The inflammation typically starts in the sacroiliac joints and can spread to the spine. Other joints, such as the shoulders, hips, and knees, may also be affected. While not common, in some cases, symptoms may present in other organs, such as the eyes and heart. Signs and symptoms vary from person to person, but may include:

• Sacroiliac joint pain and stiffness - in the lower back and hip, chronic pain and stiffness may occur, especially in the morning or after sitting for a long time or inactivity at night.
• Other joint pain - inflammation in other joints, such as the knees, ankles, and hips.
• Breathing difficulty - inflammation can involve the chest wall and ribs making it difficult to take deep breaths.
• Vision - inflammation in the eyes (such as from uveitis or iritis) may present vision changes and eye pain.
• Fatigue - continued or severe tiredness that does not improve with sleep or resting.
• Enthesitis - tendon or ligament may become inflamed at the bone, which may occur in the heel, ribs, or elbow (common types include plantar fasciitis, Achilles tendonitis, and tennis elbow).
• Tenderness - commonly at the base of the pelvis, which may make sitting on a chair uncomfortable (especially a hard or non-padded chair).
• Other Signs & Symptoms - appetite loss, weight loss, abdominal pain and loose bowel movements, skin rashes, anemia, fever, hunched or stooped posture.
   

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What are the Treatment Options for Ankylosing Spondylitis?

In treating ankylosing spondylitis, individualized treatment plans are based upon each person's health assessment including the severity of the condition, age, general health, symptoms, and disease prognosis. AS treatment plans may include:

• NSAIDs - nonsteroidal anti-inflammatory drugs – to assist with pain and inflammation.
• DMARDs - disease-modifying antirheumatic drugs – may be considered for managing and controlling skin rashes and joint pain (like sulfasalazine or methotrexate may be used if peripheral joints are involved).
• Biologic Therapies – may be considered for patients with active or recurring SA, including TNF inhibitors and IL-17 inhibitors for moderate to severe cases.
• Targeted synthetic DMARDs - these can also be quite affective at treating AS (examples include JAK inhibitors).
• Physical Therapy - stretching exercises help maintain flexibility and prevent excessive spinal stiffness.
• Exercise - adding routine exercise routines may help with the body and mind overall. This can also help decrease inflammation.
• Surgery - surgery may be required to repair or replace damaged joints or correct deformities (in some cases).

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Living with an Ankylosing Spondylitis Diagnosis

Diagnosis of Ankylosing Spondylitis varies from person to person. In many individuals, the disease progresses slowly, with episodes of flare-ups and periods of remission. Early diagnosis, symptoms management, treatment planning, and ongoing checkups with your healthcare team can help improve quality of life.

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