Ankylosing Spondylitis

It is a type of autoimmune disease which causes arthritis of the spine predominantly. It belongs to spondyloarthritis group of diseases.

The cause of ankylosing spondylitis is unknown, but genes and inheritance play a role in its etiology. Scientists have discovered a gene called HLA-B27 that is found in more than 90% of people with AS. It is a member of the family of genes associated with the immune system, which defends the body against infections.

Having the HLA-B27 gene does not necessarily mean that you will have AS. In fact, a person carrying the HLA-B27 gene who does not have relatives with AS has only 2% risk of developing this disease. For people with the HLA-B27 gene who have a father or sibling with AS, the risk of suffering from the disease is only 20%. Therefore, factors other than HLA-B27 play a role in the development of the disease.

Recent studies have focused on several bacteria that could influence the development of AS, but a defined or specific infectious agent has not yet been detected.

Inflammation of AS usually begins around the sacroiliac junction, where the low spine attaches to the pelvis.

The most common early symptoms of AS are chronic pain and stiffness of the lower back and hips. This discomfort usually develops slowly for several weeks or months. In contrast to back pain of different origin, the pain associated with AS is worse during periods of rest or inactivity. People with AS often wake up in the middle of the night with back pain and feel very stiff in the morning. Typically, the symptoms are lessened with movement and exercise.

Over time, pain and stiffness can progress to the superior spine and even the cavity of the ribs and neck. Ultimately, inflammation can cause the sacral iliac bones and vertebrae to fuse or grow together. When bones are fused, the spine and neck lose their normal flexibility and become stiff. The chest cavity can also melt, which can limit the normal expansion of the chest and make breathing difficult. Inflammation and pain can also be seen in the hips, shoulders, knees, or ankles, which can limit movement. The heels can be compromised, so you feel uncomfortable standing or walking on hard surfaces.

Ankylosing spondylitis is a systemic disease, which means it can affect other organs of the body in some people. The disease can cause fever, loss of appetite, fatigue and inflammation in organs such as the lungs, heart and eyes.

Ocular inflammation (called iritis) occurs in a quarter of people with AS. Iritis causes redness and pain in the eye that gets worse when you look in bright light. This is a serious disorder that requires immediate medical attention from an ophthalmologist (eye specialist).

The symptoms of AS can be similar to those that occur in other diseases such as psoriasis, inflammatory bowel disease, or Reiter’s syndrome (reactive arthritis). An appropriate diagnosis is important in order to be prescribed the appropriate ankylosing spondylitis treatment in Agra

In Rheumatoid arthritis, inflammation of small joints is the hallmark whereas in AS the sites of inflammation is predominantly spine and entheses which are sites of attachment of ligaments and tendons to bones.

Rheumatologist assesses your medical history, examines the musculoskeletal system and based on the clinical scenario orders for blood tests, X ray or MRI. HLA B27 genetic testing may also be ordered as a part of diagnostic work up.

Definitely No. Not all persons with HLA B 27 will AS. So it is important this test is interpreted by your Rheumatologist in conjunction with the clinical scenario and imaging evidence.

Over a period of time with persistent inflammation, calcium gets deposited on ligaments of the spine. The vertebral joints fuse & become stiff. This lead to difficulty in bending, turning the neck.

Early treatment which relieves symptoms and prevents progression of disease can help a person  near normal life. There is no permanent cure without treatment.

The first line of treatment are the NSAIDs (non-steroidal anti inflammatory drugs) like indomethacin, diclofenac, naproxen etc. No NSAID is superior to another. These drugs give relief from pain for most patients. For joint and tendon related pains local injections of steroids (localized joint pain, tendon sheaths) or oral steroids (multiple joint pains) are effective. If there is no response to the above treatment, disease modifying antirheumatic drugs (DMARDs) such as sulfasalazine, methotrexate, leflunomide may be useful. If there is no response to DMARDs, then biological injections like TNF alpha blockers or IL-17 blockers can be used. Biologics like TNF alpha blockers are the most effective drugs available in treating the spinal and peripheral joint symptoms. Examples of TNF alpha blockers available in our country are infliximab (Administered as Intravenous infusion), etanercept, Adalimumab, golimumab (Administered under the skin).

Yes. A very important role. Patients must do regular exercises that promote spinal extension and mobility as Advised by the doctor and physiotherapist. Activities like aerobics, walking, swimming, cycling etc are encouraged.

Work-related issues:

Most people with AD can continue a productive life and an active work schedule. Whether you work inside or outside the home, the following suggestions can help you.

• Avoid lifting heavy objects, stoop and remain in flexed or tight or narrow positions. If possible, adjust the height of your work area to avoid bending or bending.
• Change position frequently and move at least every hour. Some people find it beneficial to alternate between standing and sitting. Use a pad if it hurts to sit.
• Organize small rest periods throughout the day. Remember that distributing your activities during the day will allow you to function as much as possible.

If your current job forces you to stop or cause excessive strain on your back, perhaps you should consider a job change. Contact a vocational rehabilitation agency in your area for guidance. The agency can also help you if your experience, education or training makes it difficult for you to change jobs.

Uveitis : Inflammation of a part of eye called uvea causing redness, pain and blurred vision. Eye examination by ophthalmologist as and when suggested by your Rheumatologist is a must for AS patients.
Psoriasis : Any changes in skin, nail and scalp must be reported to your Rheumatologist in the form of Patches, scaly plaques, discolored nails,excessive dandruff could be psoriasis which is seen in some patients with AS and vice versa. Psoriasis is managed in conjunction with a dermatologist.
Gastrointestinal symptoms : diarrhea and constipation could be due to intestinal inflammation which need further evaluation by Rheumatologist in conjunction with gastroenterologist.
Osteoporosis : Long standing AS and those with fused spine are at risk for developing osteoporosis which needs evaluation by the Rheumatologist. You may need to take calcium and vitamin D supplements and anti-osteoporotic as prescribed by Rheumatologist

If you are HLA B 27 positive & your child inherits the gene, there is only 5- 20% chance that he/ she will develop AS. If you are HLA B 27 negative, then the chance of your child developing AS is even lower. Hence AS should not deter you from starting a family.

No. Stem cell therapy for AS is in experimental stages & is currently not approved/ proven to be useful for AS.

Yes. Smoking has been shown to increase the inflammation of AS & also reduce the responsiveness to therapy.