Ankylosing Spondylitis

  • Ankylosing spondylitis is an autoimmune disease where there is inflammation of joint synovium because of Immune attack.
  • Usually affect Spine, sacroiliac joints and large joints of Lower limb
  • Due to inflammation, there is pain, swelling, and difficulty in movement of joints
  • Symptoms become more prominent in morning hours after getting up from bed
  • Patients usually have difficulty in getting up from the bed, moving the neck, lifiting objects from ground , going toilet in the morning, performing day to day activities etc
  • Usually this present with difficulty in getting up from bed, pain while turning in bed in late night, alternate buttock pain etc.
  • Main problem is Back pain. The pain usually starts in lower back which becomes gradually worse over several months. You may have pain over your buttocks and down the back of your thighs.
  • A person suffering from AS may have difficulty in going to toilet, bending forward to lift object, move the the neck in morning
  • Many a times this causes joint deformity making the patient bedbound
  • The stiffness can be quite severe first thing each morning. It usually improves with activity and exercise, and tends to ease as the morning goes on
  • Other joints may be affected like the hips, knees, ankles and shoulders. Affected joints can become painful, stiff and swollen.
  • Tendons and ligaments in various parts of the body may become inflamed and painful where they attach to bones which is called as enthesitis.
  • Inflammation of the eye can occur in 20 percent of these patients which is known as Uveitis. Urgently see doctor if you have AS and develop a painful or red eye.
  • Ankylosing spondylitis is an autoimmune disease where there is inflammation of joint synovium because of Immune attack.
  • Normally our Immune system attack outside invading organism like bacteria and Viruses etc and designed to protect our own body parts like Joints. In Ankylosing spondylitis, immune system become dysregulated and attacks one’s own joints. Although it is not completely known, why this happens, there is contribution of multiple factors such as gene, environment, infection etc.
  • There is a strong hereditary (genetic) tendency. For example, there is a strong association with a gene called HLA-B27. About 9 out of every 10 people with AS have this gene compared with less than 1 out of every 10 in the general population.
  • However, having only HLA B27 gene does not mean that you will automatically develop AS. Most people with this gene do not develop AS.
  • Some people develop AS but do not have HLA B27 gene. It is thought that something like some infections or other environmental factors may trigger AS to develop in people who have a genetic background in the form of HLA B27
  • Ankylosing spondylitis affects around 1 per cent population of the world which means that out of 100 people one is likely to have this disease
  • It most commonly affect young adults (between the age 20-40)
  • Males are more prone to get this disease than their female counterparts with a ratio 3-4:1. For every 3-4 men affected by AS, you have one female who experiences the same.
  • Because some genetic factors like HLA B 27are responsible for AS, this may run in family
  • With Proper treatment, one can have normal lifestyle in Ankylosing spondylitis
  • Rheumatologist are specialists who are trained to treat this disease
  • AS is mainly diagnosed by a trained rheumatologist or physician by taking complete symptom history and good clinical examination.
  • AS should not be diagnosed only based upon the blood test
  • HLA B27 testing in blood may increase the probability of somebody having AS.But all people having HLA B27 positive doesnot have AS. So this tesing should be done with proper rheumatology consultation as some normal healthy persons can be positive for this but they don’t have the disease. On the other hand 1 out of 10 of AS patients can have negative blood test results but they suffer from AS
  • Radiological tests like X ray is helpful only in detecting inflammation in sacroiliac joints. In Early cases X ray may not reveal any abnormality and your doctor may ask you to do a MRI which picks early inflammatory changes in sacroiliac joints and confirm a diagnosis of AS.
  • Some blood tests are ordered to monitor the effects of prescribed drugs . These include Complete Blood Count (CBC), C-Reactive Protein (CRP), Erythrocyte Sedimentation ASte (ESR), Liver Function test (LFT) and Kidney Function test
  • Exercises like swiiming or cycling form the major treatment of AS patients as this prevent fusion of bones and maintains mobility
  • You may be prescribed with pain killers (NSAIDs) which has to be continued for many months as they are the 1st line treatment for most AS patients
  • All patients are different and some may respond to a particular drug whereas others don’t feel any benefit. Some drugs may cause severe gastritis or other complications where as they don’t cause any problems in others . So the drug response and side effects differ in different patients and it has to be continued under supervision of a trained rheumatologist
  • The drugs that are useful in treating AS are known as DMARDs(Disease modifying antirheumatic drugs). They Include Methotrexate, sulfasalazine, Hydroxycholoroquine, leflunamide etc. They are particularly useful for knee or ankle joint swelling but not for upper or lower back problems
  • These drugs should be prescribed and taken under supervision of a rheumatologist as they are trained to periodically monitor your blood test to look for any side effects of these drugs.
  • If taken properly under supervision, these drugs helps to control joint inflammation and give patient a normal life
  • Biological drugs are new drugs that target specific molecules like TNF and other cytokines like IL 17 which incite inflammation in AS. They are very effective drugs but because of high costs, usually given after failure of other drugs.
  • Biologic drugs that are effective in AS include – Eternacept, Adalimumab, Infliximab, Golimumab, Secukinumab etc.
  • With Proper treatment, a Ankylosing spondylitis patient can lead a normal life without pain and deformity.
  • But if not treated properly from an early stage, there may be fusion of bones leading to loss of natural movements and severe joint deformity .
  • This may increase risk of heart attack
  • The hip joint may be fused for which the patient will be unable to walk or sit and may require joint replacement therapy.
At OARC, we offer holistic care to patients suffering from all kind of arthritis and autoimmune diseases by our renowned rheumatologist. Because of chronic illness of the disease, we spend some time with the patient helping them to know about their disease, and demystify the myths regarding the disease and treatment. We have collaboAStion with NABL accredited laboAStory where all kind of blood tests can be done at reasonable costs. We also have patient support system where patient can approach in case of any emergency. We believe in a friendly relation with patients so that they can share all their sufferings and get the best possible treatment.