Ankylosing Spondylitis: Get All The Facts Here!

Ankylosing Spondylitis is a chronic inflammatory disorder of unknown cause. It is characterized by prominent inflammation of spinal joints and adjacent structures.

Progression of the Disease

The sacroiliac joints are usually the first to get affected followed by the lumbar spine and cervical spine. The hip, the knee and the manubrio-sternal joints are also involved frequently. The tissues like the annulus fibrosus, subchondral bone, periosteum and the synovium are affected, thus resulting in ostetitis, periostitis and synovitis respectively. In all the tissues the initial cellular inflammatory changes are followed by fibrosis and ossification, which ultimately leads to bony ankylosis or bone fusion. This fusion of the bones or vertebrae causes stiffness in the spine and bamboo spine appearance. Once the fusion occurs, the pain subsides but potentially leaves the individual with a kyphotic deformity of the spine and other deformities of the hip. Ankylosing spondylitis is more common in males and starts between 15-30 years of age. The inflammation and the disease runs its course up to 45-48 years after which the progression of inflammation plateaus.

Early Symptoms

The most common and characteristic complaint is insidious onset of low back pain and back stiffness that is worse in morning hours and after prolonged rest. The pain is typically relieved by movement and activity. The onset is between 15 - 40 years of age and persistent for at least 3 months. Some individuals also experience chest pain with coughing or sneezing. Mild to moderate reduction of chest expansion is also seen. Bony tenderness over costosternal junctions, spinous processes, iliac crest, tibial tubercles and heels may occur. The peripheral joints are known to be involved in few cases. The patients with Ankylosing Spondylitis present with fatigue, anorexia, fever or weight loss.

Diagnosis and Treatment

To confirm the diagnosis of Ankylosing Spondylitis, one must do the physical examination to assess the mobility of sacroiliac joint, spine and chest. The blood work is mostly positive for HLA B27 genetic marker. The erythrocycte sedimentation rate (ESR) and C-Reactive protein levels are elevated in most patients with active disease. Rheumatoid factors and serum IgA levels are also elevated. Pulmonary function tests are necessary and should be done periodically as a precaution and to judge the course of the disease. A radiograph of spine, pelvis and hips will show the bony changes and level of ankylosing so as to help predict the course and plan the treatment to increase the mobility of particular joints. There are effective Ankylosing Spondylitis treatment in Mumbai protocols held by spine clinics to ease this disorder.