What is ankylosing spondylitis?

Ankylosing spondylitis (A.S.) is a term used to describe a form of arthritis which mainly affects the joints in the spine. However, it may affect other parts of the body e.g. the hips, shoulders, knees or ankles.

• ankylosing - means to become still or rigid
• spondyl - means spine
• itis - means inflammation.

A.S. causes inflammation outside the joint where the ligaments and tendons are attached to the bone, whereas in most forms of arthritis, inflammation affects the inside of the joint. It usually affects the little joints between the vertebrae of the spine and tends to diminish the movement which takes place at these joints.

A.S. is a chronic (i.e. continuing, long-lasting) condition, but in most cases it is mild in its effects. With early diagnosis and proper management the pain and stiffness of A.S. can be minimised and the disability and deformity considerably reduced or even prevented.

What causes ankylosing spondylitis?

As with other forms of arthritis, the cause is not known, but there appears to be a hereditary factor (gene HLA B27 occurs in 90% of people with A.S, although having the gene doesn't necessarily mean you will develop A.S).

Who gets ankylosing spondylitis?

A.S. usually affects young people between 13 and 35 (average age 24 years) but may appear in the older age group. About three times as many males are affected than females.

Early symptoms

• slow or gradual onset of back pain
• increasing back stiffness over weeks or months
• early morning back stiffness and pain.

Pain is not always confined to the back. Some people will have chest pain from time to time. This pain comes from the joints between the ribs and backbone, from inflammation in the sternum joints, or from the sites where ligaments join the ribs.

A.S. often begins with an ache in the buttocks, in the back of the thighs and down the leg and in the lower part of the back. One side is commonly more painful than the other. Increased pain and stiffness can be experienced after long periods of sitting, and sleep may be interrupted by early morning pain.

How is it diagnosed?

• medical history including symptoms
• x-rays
• possibly blood tests for the HLA B27 gene.

Diagnosis is often difficult in the early stages or in mild cases. The diagnosis is confirmed by x-rays, but because the changes may take several years to appear it may not be possible to make a definite diagnosis initially.

Treatment

At present there is no cure for A.S. but there is a great deal each individual can do to help manage his/her disease and to make it easier to lead a normal working and social life.

The treatment is designed to minimise the amount of stiffness and rigidity which takes place in the various parts of the spine (ie. to retain mobility) and to provide as correct a posture as possible.

Physiotherapy
Physiotherapists can provide a daily exercise routine to relieve stiffness, promote good posture and increase the range of movement of certain joints, particularly shoulders and hips. It is important to keep muscles strong because reduced movement, even for a short time, will lead to weakness.

Posture
A person with A.S. should be aware of posture at all times. Every effort should be made to keep the spine straight and to stay as erect as possible. A firm mattress without pillows and sleeping on one's back rather than in the curled up position encourage good posture, as does lying on one's tummy on a firm surface for about 20 minutes each day. The physiotherapist will advise about these matters.

Exercise
In addition to the prescribed exercises, other exercise is beneficial. Swimming is perhaps the best form of exercise because it uses all the joints and muscles. Other suitable sports include badminton, tennis, golf and cricket; in fact any non-contact sports which are enjoyed are encouraged. However, contact sports are best avoided as joints or the spine may be injured.

If there is too much stiffness or pain to exercise comfortably, a hot bath or shower will help ease the pain and tension, so the exercise can be carried out.

Medication
There is no drug which will cure A.S. but there is a wide range of drugs - mainly anti-inflammatory drugs - to help the pain and reduce inflammation. These drugs are not habit forming but will relieve the stiffness and pain and therefore allow the person to exercise regularly.

Surgery
Surgery plays a small part in the management of A.S. In most cases where it is required it will involve a hip replacement. Surgery is rarely used to correct and restore a straighter posture of the spine and neck.

Employment

People with A.S. are capable of doing most types of job. An ideal occupation is one which allows periods of sitting, standing and walking, while a job requiring crouching over a bench for long periods of time is not very suitable.

Outcome

As age creeps on, the spine tends to become naturally less mobile. This loss of mobility is more marked in those with A.S, who will be stiffer than a 50-year-old without A.S. Because A.S. varies in severity from case to case, it is impossible to predict how much mobility a person will lose in the future. It can be minimised by doing prescribed exercises regularly, and paying attention to posture.

By following the individualised programme the chances of A.S. interfering with an active, functional life are kept to a minimum.

Unproven remedies

The promises of quick 'cures' and 'miraculous relief' sound wonderful to a person with a chronic illness. Most of the products advertised in this way, whether drugs, dietary supplements or mechanical devices are not harmful, but worthless and expensive. To avoid falling into these traps, people should discuss with their doctor any other forms of treatment they are considering.

Original material provided by Arthritis New Zealand. Reviewed by everybody, July 2005.