Ankylosing spondylitis (AS) is a type of condition that mainly affects the back. Here, joints of the neck, back and pelvis become swollen (inflammation) which causes pain and stiffness.¹

Spondylitis means inflammation of the spine²

It affects people in different ways: some people can almost forget their condition while, others can have big impact on their quality of life. It can also affects the other joints and occasionally, other parts of the body may also be affected^.2

Often starts in people in their late 20s.³

What are the symptoms of ankylosing spondylitis? 

AS symptoms varies from person to person. Most common are:^1,2

•   Pain and stiffness in back, buttocks or neck
•  Pain in tendons (tissues which connect muscles to bones) and ligaments (connect bones), often felt pain in chest, back of heel or below the foot.
•  Pain and swelling in joints other than those in the spine
•  Swollen fingers or toes
•  Symptoms worse after rest (early morning) & relieve with exercise
•  Tiredness
•  Sensitivity to pain or discomfort around heels
•  Eye inflammation (painful, bloodshot eyes)

Who can get ankylosing spondylitis?

The exact cause of ankylosing spondylitis is unknown. Following risk factor increases the chances of having spondylitis:^1,4

 

9 out of 10 people with AS have gene HLA-B27.¹

How can ankylosing spondylitis be diagnosed?

Most of the people in the early stages of ankylosing spondylitis believe that they have common back pain and do not seek help. Also, ankylosing spondylitis at first can be even misdiagnosed. There is no specific test for ankylosing spondylitis but, doctor can diagnose it from:^1.2

Nevertheless, these tests can be normal in the early stages. Hence, if the doctor suspects ankylosing spondylitis, then patient should be referred to rheumatologist (doctor specialises in arthritis). It is important to diagnose ankylosing spondylitis as early as possible. There are many effective treatments available to treat it.¹

What will happen to me? 

Most of the people with ankylosing spondylitis lead full and active lives with the right treatment. Sometimes their symptoms worsen. Ankylosing spondylitis can be controlled in most of the cases with treatment and the pain improves with time. Though, some people can have severe, long lasting pain.

Due to the inflammation in the spine, new bone can grow around the joints. This can cause permanent stiffness in the back or neck in people with AS. In severe cases, the extra bone can fuse the bones in the spine together which stop the spine from moving. This, fusion of the spine can lead to a bent or forward stooped posture.

There is no cure for ankylosing spondylitis but, better treatment options are available to manage .¹

What are the treatment options for ankylosing spondylitis? 

A number of treatments options are available which can ease pain and stiffness. But, exercise and paying attention to the posture are most important to keep the spine mobile and help to live a normal life. Treatment for ankylosing spondylitis usually includes:^1,2

Physiotherapy and Exercises

For the treatment of ankylosing spondylitis, physiotherapy is very important. This exercise programme can help to

•   Keep the spine strong and flexible
•  Improve posture
•  Improve muscle strength
•  Maintain mobility in the spine and other joints.

Thus, to avoid stiffening into a bent position, it is important to exercise the back and neck.  Some of the exercises which can be performed are hydrotherapy or aquatic therapy. It involves exercises for the spine, hips and shoulders performed in a special warm-water pool.^1,2,3

Drug Treatments

These are medicines given as tablets or injections to relieve pain, reduce inflammation or, to modify the condition itself. Some of the medicines which are prescribed in ankylosing spondylitis are:

•  Analgesics (pain relievers, such as paracetamol)
•  Non-steroidal anti-inflammatory drugs (NSAIDs)
•  Corticosteroid medicines or injections
•  Disease-modifying anti-rheumatic drugs (DMARDs)
•  Biological DMARDs.^1,3

Surgery

Surgery is rarely required however its done if the hip joints are badly affected. If the spine has become very bent, back surgery is used which is otherwise more uncommon. ^1,2,3

What can I do for ankylosing spondylitis? 

Apart from medical treatments which can control ankylosing spondylitis, there are many other things that one can do to improve the symptoms. Most important is to be active and pay attention to the posture which can be of great help to minimise the long-term effects of ankylosing spondylitis. Some of the things which can be done are: ^1,2,3

See a Rheumatologist

A rheumatologist can help diagnose ankylosing spondylitis and get the right treatment. If one have ankylosing spondylitis, then ask the doctor about referral to a rheumatologist.

Learn about ankylosing spondylitis and play an active role in the treatment

One should always talk to the doctor or healthcare professionals as, not all information one read or hears about ankylosing spondylitis is trustworthy.

Learn ways to manage pain

Apart from the drug treatments, one can try number of things to ease the symptoms. Some of the methods which can help protect joints and relieve pain are:

Live a healthy life

To help with the overall health and wellbeing, one should have optimum weight.

Though no foods can make AS either better or worse but, help maintain healthy weight. Overweight increases the strain on the back and other joints.

Stay Active

Regular exercise is good for the back movement and to stop the spine from stiffening. As, too much rest increases the spine stiffness, start exercise slowly and gradually. One can do stretching exercises after to ease stiffness or pilates, yoga and t’ai chi can also be useful for posture, strength and flexibility. Try to do some exercise each day. Also, swimming is one of the best forms of exercise which improves strength, stamina and flexibility. ^1,2,3

Acknowledge your feelings and seek support

As there is no cure for ankylosing spondylitis and it can affect your life. It is natural to feel scared, frustrated, sad and sometimes angry. Be aware of it and seek help if they are affecting the daily life.¹

References

• Ankylosing spondylitis, ARTHRITIS INFORMATION SHEET, https://arthritissa.org.au/downloads/2015-05-10_231606_Ankylosing-Spondylitis.pdf, last accessed on 16th March 2021.
• Ankylosing spondylitis and related conditions, https://www.versusarthritis.org/media/1247/ankylosing-spondylitis-information-booklet.pdf, last accessed on 16th March 2021.
• Ankylosing spondylitis and related conditions, https://www.versusarthritis.org/media/22269/ankylosing-spondylitis-and-related-conditions-information-booklet.pdf, last accessed on 16th March 2021.
• Overview of Ankylosing Spondylitis, https://spondylitis.org/about-spondylitis/types-of-spondylitis/ankylosing-spondylitis/, last accessed on 16th March 2021.