Ankylosing spondylitis
Ankylosing spondylitis
Ankylosing spondylitis is a long-term (chronic) condition where the spine, or other parts of the body, become inflamed. Over time, this can cause part of the spine to join up (fuse), so it loses its flexibility (ankylosis).
The condition usually starts developing in the teenage or young adult years, though most people are diagnosed, and notice most symptoms, in their 20s.
Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
Causes
Doctors don't fully know what causes ankylosing spondylitis.
Research has found a link between it and a gene called HLA-B27. Having this gene does not mean you will definitely get ankylosing spondylitis.
About 8% of people carry the HLA-B27 gene, but most of them never develop ankylosing spondylitis.
Diagnosis
Ankylosing spondylitis is often not easy to diagnose, mainly because it develops slowly over time. Since back pain is quite common in general, this can delay both getting checked and being referred on to a specialist, called a Rheumatologist.
If you have symptoms of ankylosing spondylitis, you should speak to your GP. They will usually ask:
- what symptoms you are experiencing
- when the symptoms started
- how long you have had them
Your GP may also arrange blood tests to check for signs of inflammation, along with x-rays of your lower back and pelvis.
A Rheumatologist is a specialist who deals with conditions affecting the muscles and joints. They may carry out further tests, which can include:
- an x-ray
- an MRI scan
- an ultrasound scan
- genetic testing
Treatment
Treatment for ankylosing spondylitis
There is no cure for ankylosing spondylitis. But, treatment is available to help relieve the symptoms.
Treatment can also help delay or prevent the spine from fusing (joining up) and stiffening.
In most cases, treatment will involve a mix of:
- exercise
- physiotherapy
- medication
Most people with ankylosing spondylitis will not need surgery. But, if the joint becomes very damaged, joint replacement surgery may be recommended. This can help to improve pain and movement in the joint.
Keeping active can improve your posture and range of spinal movement. It can also prevent your spine from becoming stiff and painful.
Further information on exercise for ankylosing spondylitis
Physiotherapy
Physiotherapy is a key part of treating ankylosing spondylitis. A Physiotherapist can explain the best exercises for you. They can also draw up an exercise programme that suits you.
Types of physiotherapy for ankylosing spondylitis include:
- a group exercise programme
- an individual exercise programme
- massage
- hydrotherapy (exercise in warm swimming pool)
With hydrotherapy the buoyancy of the water helps make movement easier by supporting you. The warmth can also help relax your muscles.
Some people prefer to swim or play sport to keep flexible. This is usually fine, although some daily stretching and exercise is also important.
Speak to your Physiotherapist or Rheumatologist if you’re worried about taking up a new type of sport or exercise.
The National Ankylosing Spondylitis Society (NASS) has information about different types of exercise to help you manage your condition.
You may need painkillers to manage ankylosing spondylitis. But, not everyone needs them all the time. Types of painkillers you may be prescribed include:
- non-steroidal anti-inflammatory drug (NSAID)
- paracetamol
Some people may be given a type of medication called Biologics. These are used if painkillers and exercise don’t help.
Examples of Biologics used are:
- Anti TNF medication (Adalimumab, Etanercept, Golimumab)
- Monoclonal Antibody Treatment (Secukinumab, Ixekizumab)
- JAK Inhibitors (Baricitinib, Updacitinib)
All these medications work by reducing inflammation.
Corticosteroids
Corticosteroids have a powerful anti-inflammatory effect. They can be taken as tablets or injections.
If a particular joint is inflamed, corticosteroids can be injected directly into the joint. After the injection, you will need to rest the joint for up to 48 hours.
Disease-modifying anti-rheumatic drugs (DMARDs)
DMARDs may be prescribed in ankylosing spondyliits if there is pain and inflammation in peripheral joints such as the hands, knees, feet. They don’t work on the spine.
Complications
Ankylosing spondylitis has no cure, but with the right care most people go on to live a fairly normal life, managing daily activities with only small adjustments.
Work
Over time, ankylosing spondylitis can make work harder to manage. Most people are still able to keep working, often with a few changes that support good posture during long spells of standing or sitting and help with tiredness.
This might mean adjusting your work station or building in regular breaks. It helps to talk this through with your employer.
Complications of ankylosing spondylitis
Ankylosing spondylitis can affect many parts of the body, and over time it may lead to complications that touch your daily life or bring on other health problems.
Some of the complications linked to ankylosing spondylitis include:
- reduced flexibility in the spine
- joint damage, leading to pain and stiffness
- osteoporosis
- spinal fractures
- iritis, with painful eyes, swelling and sensitivity to light
- blurry or cloudy vision, or redness in part of the eye
- cauda equina syndrome
People with ankylosing spondylitis may also face a higher risk of cardiovascular disease (CVD).