Ankylosing Spondylitis (AS)
What is Ankylosing Spondylitis?
Ankylosing spondylitis (AS) is a chronic inflammatory arthritis that affects the spine and pelvis.
Most commonly affected are the axial skeleton (80 bones in the head, face, ear, neck, rib cage, sternum and vertebral column) and the sacroiliac joints.
Usually the sacroiliac joints where the spine meets the pelvis are affected first. Inflammation then moves to where ligaments and tendons attach to the vertebrae.
Calcium deposits can form in the ligaments around the intervertebral discs, which can cause the spine to fuse together, preventing movement (ankylosis).
Spinal fusion happens in severe cases of AS, and usually occurs in the upper back (thoracic spine) and neck (cervical spine).
AS causes stiffness and back pain, decreased range of motion, and can lead to deformity, severely affecting your quality of life. It can also cause inflammation, pain, and stiffness in other joints (usually the hips, knees and shoulders), and can even affect the eyes, lungs, and heart.
What Causes Ankylosing Spondylitis?
There is no one cause of ankylosing spondylitis, but factors that increase your likelihood of developing it include:
- Genetics – 95% of people with AS have the human leukocyte antigen (HLA)-B27 protein in their blood; while other genes work together with HLA-B27 and its exact role is unknown, it is known that the risk of passing the antigen on to any children is 50%, so there is a strong hereditary factor associated with the disease
- Family history of ankylosing spondylitis or another spondyloarthropathy disorder such as:
- Psoriatic arthritis
- Reiter’s syndrome (reactive arthritis)
- Arthritis associated with inflammatory bowel disease, such as Crohn’s disease and ulcerative colitis
- Juvenile chronic arthritis
- Juvenile-onset AS
- Age – AS is most common from the late teens to early 40’s (ages 17-45); if it occurs before age 16, it is called juvenile-onset AS
- Race – AS is more prevalent in Caucasians or people with Northern European ancestry
- Gender – AS is three times more likely in males
- Environmental factors such as a bacterial infection
- Frequent gastrointestinal infections
What are the Signs and Symptoms of Ankylosing Spondylitis?
Symptoms of AS vary greatly from person to person.
Pain usually comes on gradually, and can range from mild to severe. The pain often comes and goes, flaring up at times followed by temporary periods of remission.
Symptoms of ankylosing spondylitis can include:
- Dull pain in the hips, buttocks (sacroiliac joints), and low back at first
- As the disease progresses, pain can be felt in the upper back and ribs
- Pain that is worse in the morning or after periods of inactivity, and better with exercise
- Affected joints (usually the hips and spine) become more stiff and sensitive over time
- Decreased range of motion in the neck, back, or hips
- Eye disease such as pink eye (conjunctivitis) and eye inflammation (iritis) occur in about 25% of people with AS
- Over time, the heart and lungs can be affected; it may be difficult to breathe because of decreased range of motion in the chest due to stiff rib joints
- The spinal canal can narrow (spinal stenosis), putting pressure on the spinal cord and nerves, possibly resulting in nerve damage due to a spinal fracture or cauda equine syndrome (associated with bowel and bladder dysfunction which should be treated as an emergency)
How is Ankylosing Spondylitis Treated?
Treatments for ankylosing spondylitis typically include medications, physiotherapy, and surgery.
Early diagnosis helps to control pain and stiffness better, and reduces the chance of your spine fusing together and resulting deformities.
Treatment options include:
- Physiotherapy (considered essential in treating AS)
- Medications, including:
- Non-steroidal anti-inflammatory drugs (NSAIDs), either prescribed, or over-the-counter, such as ibuprofen (Advil, Motrin) or naproxen (Aleve)
- Biologic medications such as TNF inhibitors biphosphonates and have shown to be successful in treating AS symptoms and can potentially slow the progression of the disease
- Antibiotics (as there’s an association between AS and bacterial infection, including enterobacteria)
- Corticosteroid injections to relieve inflammation
- Disease modifying anti-rheumatic drugs (DMARDs), though these drugs have only proven effective for the outer joints that can be affected by AS, such as the shoulders and knees
- Surgery – usually surgery is not necessary, but can be performed when there is a high risk of complications; if surgery is needed after other less invasive treatments have not helped, physiotherapy is an important part of rehabilitation
Physiotherapy for Ankylosing Spondylitis
Physiotherapy is a drug-free and non-surgical treatment that focuses on reducing pain, preventing deformity, regaining strength, and increasing joint mobility, function, and quality of life.
Depending on your individual needs, physiotherapy for ankylosing spondylitis can include:
- Stretching, strengthening, and range of motion exercises
- Activity modification and functional retraining
- A personalized exercise routine (which can delay or prevent the progression of the disease)
- Breathing exercises
- Patient education so you feel in control of your condition, including postural and proper sleeping education
- Cross-disciplinary pain-relieving therapies such as:
Are you seeking physiotherapy for Ankylosing Spondylitis? Book an assessment today.
Can Ankylosing Spondylitis Go Away on Their Own?
Unfortunately, no. There is no cure for ankylosing spondylitis as it is a chronic condition, but with proper treatment, it can be managed effectively.
If you have AS, there are things you can do to make daily living easier, including:
- Stretching and exercising daily to prevent or improve joint stiffness and pain; however, do not do anything that exacerbates the pain
- Practicing Pilates, which has been shown to increase quality of life in people with AS
- Switching from high-intensity activities like jogging, to low-intensity activities like walking and swimming; aerobic exercises like walking and swimming have shown to be beneficial for many areas of the body, including the lungs
- Quitting smoking because of increased risk of lung problems with AS
- Applying heat and cold therapy
- Using a properly supportive pillow and mattress
- Using an ergonomic chair at work and home
- Taking fish oil supplements, a natural anti-inflammatory that has been proven to improve several conditions such as rheumatoid arthritis and may help with back pain
- Taking mindfulness courses, which have a positive effect in managing AS, including improvements in self-efficacy, pain and symptoms, emotional processing, fatigue, self-care ability and overall well-being
Can You Prevent Ankylosing Spondylitis?
There is no specific way to prevent AS, however, there are steps you can take to reduce the chance of developing it, including:
- Exercising regularly, including stretching exercises such as yoga or tai chi, at least 30 minutes every day (regular exercise increases the flow of nutrients and blood to the spine and decreases pressure on the intervertebral discs)
- Staying active; avoid staying in one position for too long
- Eating a non-inflammatory diet (avoiding sugar, and processed and refined foods) and drinking plenty of water
- Maintaining a healthy weight (which reduces stress on the facet joints in the spine)
- Practicing good posture
Book a Physiotherapist Consult for Ankylosing Spondylitis Today
Concerned about symptoms of Ankylosing Spondylitis ? Book an assessment with a physiotherapist today.