Ankylosing Spondylitis: Causes, Symptoms & Treatment

Ankylosing spondylitis, also known as ankylosing spondylitis or ankylosing spondylitis, is a rheumatic disease with a chronic course. Ankylosing spondylitis mostly affects the joints, specifically the spinal joints.

What is ankylosing spondylitis?

Ankylosing spondylitis, or ankylosing spondylitis’ and ankylosing spondylitis, is a chronic inflammatory rheumatic disease that mainly affects the joints. It primarily affects the spinal joints, which become increasingly stiff as the disease progresses. In addition, inflammatory changes occur in the tendons, eyes, large joints, and heart muscle, as there are no rheumatoid factors in the blood. Internal organs are rarely affected.

Causes

The cause of ankylosing spondylitis is a disturbed interplay between environmental influences and hereditary factors. In approximately 95 percent of those affected, the hereditary trait HLA-B27 is found, which leads to a faulty immune response and thus favors the development of chronic inflammation. This hereditary trait indicates that the cause of the disease is partly based on heredity. In addition, the HLA-B27 hereditary trait may cause the human immune system to interfere with the normal germs in the intestinal flora in such a way that this also leads to chronic inflammation.

Symptoms, complaints, and signs

The main symptoms of ankylosing spondylitis are deep-seated back pain, morning stiffness, and pain at night. If these symptoms persist for at least three months, it is an unmistakable sign that ankylosing spondylitis is present. During the day, the body becomes more mobile again. The symptoms improve especially with movement. When resting, on the other hand, the pain and stiffness increase again. The pain is usually located in the lower part of the spine and radiates into the buttocks and thighs. Early signs of ankylosing spondylitis may include such uncharacteristic symptoms as occasional heel, hip, knee, or shoulder pain. There may also be increased fatigue, pain when sneezing or coughing, and weight loss in the early stages. Bursitis and other tendon disorders are also possible. Bekhterev’s disease occurs in relapses. Between relapses, the patient is almost symptom-free. The posture of those affected typically changes over time with curvature of the thoracic spine (hunchback) and simultaneous flattening of the lumbar spine. Over time, painful movement restrictions may also affect the hip and knee joints, as well as the shoulder and elbow. A smaller proportion of patients develop cardiac arrhythmias, visual disturbances or renal insufficiency. More rarely, inflammation of the aorta or other cardiovascular diseases occur. It is also suspected that some intestinal or urinary tract infections are associated with ankylosing spondylitis.

Disease progression

The course of ankylosing spondylitis is very inconsistent. In some cases, internal organs, joints, or limbs may also be affected, and in some cases the disease manifests itself only in the spinal region. Inflammatory pain is predominant in some cases, occurring in episodes over many years. In other cases, however, the stiffening of the spine is in the foreground, which progresses increasingly, especially in the first 30 years. However, complete stiffness of the spine and disability as a result of the disease are rare. However, if the disease takes a severe course, it can lead to damage to organs and joints and thus to permanent movement restrictions. For example, arthritis in the hip joint can destroy the joint and make hip replacement necessary. Ankylosing spondylitis is currently not curable, but its course can be influenced by appropriate therapy.

Complications

Ankylosing spondylitis primarily causes patients to experience severe pain in the back. This pain can continue to spread to other regions of the body and cause severe pain. Especially at night, rest pain can cause severe sleep problems or sleep disturbances. These affect the quality of life enormously and lead to irritability of the patient. In general, permanent pain can lead to psychological discomfort and depression.Likewise, the patient’s back stiffens, so that there are limitations in movement and in the performance of various sports. Likewise, it is not uncommon for heart complaints and palpitations to occur. The heart complaints usually have a negative effect on the patient’s life expectancy and can significantly reduce it. The hips can also be irreversibly damaged without treatment. Ankylosing spondylitis is treated by taking various medications and performing physiotherapy. Complications do not usually occur. However, not all symptoms can be limited in every case.

When should you go to the doctor?

Back pain or joint discomfort should be presented to a doctor as soon as it increases in intensity or persists unabated for several days. If the discomfort was not triggered by physical overload, there is cause for concern. If the daily demands or usual sporting activities can no longer be fulfilled, a doctor should be consulted. Weight loss, flu-like symptoms such as cough or cold, and increased fatigue should be examined by a physician. If there are limitations in mobility, morning stiffness, or if the affected person awakens during the night due to existing pain, a physician is needed. An inner restlessness, a feeling of heaviness or a reduced sense of well-being indicate a health impairment. A visit to the doctor is necessary so that a diagnosis can be made and a treatment plan designed. Pain in the heels, knees or hips is characteristic of ankylosing spondylitis. Irregularities along the spine to the shoulder should receive medical attention. If the affected person experiences an improvement in symptoms with movement and an increase in pain in a resting position, a visit to the doctor is advisable. A bent posture, disturbances of vision and heart rhythm are warning signs of the organism. If discomfort during urination sets in, inflammation occurs as well as an inner restlessness, a visit to the doctor is necessary.

Treatment and therapy

The first clue for the diagnosis of ankylosing spondylitis is the typical low back pain. Additional symptoms, such as inflammation of the anterior chamber of the eye as well as the iris, can further support this suspicion. Above all, it is important in the diagnosis to detect inflammation of the sacroiliac joints. For this purpose, a physician tests the “Menell’s sign”, which indicates inflamed sacroiliac joints. X-rays as well as magnetic resonance imaging can also confirm the diagnosis for ankylosing spondylitis. Therapy for ankylosing spondylitis is mainly aimed at combating pain as well as maintaining the mobility of the spine. Regular physiotherapy is indispensable for this. In addition, inpatient treatment in an appropriate rheumatology clinic can also be helpful. Furthermore, drug therapy with non-steriodal anti-rheumatic drugs is used. In addition, sulfasalazine or methotrexate is also used as a basic medication to influence the course of the disease. In a very active form of Bechteres’ disease, drug treatment with the pro-inflammatory messenger TNF-alpha can be used. This biological inhibitor can reduce the activity of the disease and thus delay or even prevent its progression. In contrast, surgery is rarely used and only when a hip joint is also affected by inflammation and an artificial hip joint becomes necessary.

Outlook and prognosis

The prognosis can vary widely among affected individuals, as there are significant differences in the severity of ankylosing spondylitis. However, the course can be influenced very positively by active cooperation of the patients. Around 80 percent of patients are still able to work despite their disease, even if their mobility is often somewhat restricted. In an average of 10 to 20 percent of patients, however, the course is so severe that progressive stiffening occurs. This can eventually lead to severe long-term disabilities. However, Bekhterev’s disease can also come to a complete standstill at any time. If the disease occurs at an early age, i.e. before the patient reaches the age of 18, the prognosis for these patients is significantly worse.In addition, the ineffectiveness of NSAID preparations and the severe stiffening of the diseased spine in an unfavorable position as well as the involvement of the hip joint are unfavorable. In general, the disease is often milder in affected women. Stiffening of the spine also occurs less frequently in them. The influence of the disease on life expectancy is not clear. According to some studies, however, there is a shortening of life expectancy. Deaths occur due to aortic insufficiency, respiratory insufficiency, injury to the spinal cord, or due to side effects of therapy.

Follow-up

Follow-up care of affected individuals is directly correlated with factors such as pain, mobility, and inflammation. Therefore, lifelong follow-up is based on the pillars of medication compliance, lifestyle adjustment, and physical therapy. While readiness is usually very high in relapse-free intervals, it often decreases in the case of acute inflammation. Therefore, especially the follow-up between inflammatory episodes is essential. Drug therapy in follow-up care consists primarily of non-steroidal anti-inflammatory drugs, which relieve pain, maintain mobility and thus improve the feeling of being alive. But many NSAIDs can cause gastrointestinal discomfort, necessitating renewed medication. In advanced stages, physicians also use sulfasalazine or TNF alpha blockers to relieve disease symptoms. All of these medications must be taken separately and at different times of the day. Medication compliance is extremely important and essential for disease progression. A healthy lifestyle can also have an enormous impact on the course of ankylosing spondylitis. Various studies have shown that sports such as walking, yoga, cycling and gymnastics are beneficial to well-being. This is because it not only strengthens the muscles and tendons of those affected. These gentle and even movements gently stretch the joints, enrich them with sonovial mucus and help straighten the spine. To prevent the rapid progression of the disease, those affected should change their diet in addition to exercising. This is because arachidonic acid in particular, which accumulates in meat, promotes inflammation and favors disease flare-ups.

What you can do yourself

People suffering from ankylosing spondylitis can counteract the development of the disease through their own behavior. This includes everyday efforts to keep as upright a posture as possible. A positive, self-confident outlook on life promotes an attitude of “not wanting to bend over.” With this awareness, ongoing helpful corrections to posture can occur. To improve movement and posture, training of the musculature, gymnastic stretching exercises are beneficial. To strengthen the condition and breathing capacity, endurance sports are also recommended. Sitting during working hours or leisure time should also avoid a crooked back, even if it involves effort. Soft, low chairs should be avoided. While driving, a seat wedge or a suitable cushion in the back area can support the posture to be aimed for. The limited elasticity of the spine can cause problems when walking on a hard surface such as tar, stone or concrete. Wearing shoes with springy soles or cushioning insoles and elastic heels will reduce discomfort. The bed should in no case be equipped with a soft mattress. If possible, when lying down at lunchtime, the spine relaxes and straightens. Even when lying down, care should be taken to keep the spine as straight as possible. Gentle postures should be avoided in all areas of everyday life. A sensible lifestyle with a healthy, balanced diet also makes sense.