The term ankylosis refers to a stiffening of the joint. This is not caused by muscles – that would then be a contracture – but by disease processes in the joint itself. In most cases, it is inflammatory processes that lead to connective tissue scarring and thus to immobility of the joint bodies.
What is ankylosis?
Joints are fundamental to the body’s ability to move – so it’s easy to imagine that stiffening of the joint, as in ankylosis, is a real problem for sufferers. The exact causes are quite varied, but can usually be traced back to inflammatory processes and genetic basis. The most “famous” representative among the ankyloses is probably Bechterew’s disease, which is therefore also called “ankylosing spondylitis“. The following is an overview on the topic of “ankylosis” in general.
Causes
There are several causes of joint stiffness (ankylosis). Basically, in fibrinous ankylosis, connective tissue bridges have formed between the cartilage surfaces and synovial membranes, which fuse together, rendering the joint immobile. In this case, there are usually years of inflammatory processes as in gout, rheumatoid arthritis or psoriatic arthritis. In more severe cases, this can even lead to a bony adhesion (bony ankylosis). In ankylosing spondylitis, this particularly affects the sacroiliac joint between the sacrum and iliac crest, resulting in deep-seated back pain and progressive immobility in the spine. Genetic conditions are known to lead to increased susceptibility to ankylosing spondylitis as well as other ankylosing diseases, particularly a specific expression of the gene HLA-B27. Ankylosing spondylitis often affects men between the ages of 15 and 30 – so ankylosing spondylitis is by no means just a problem for older people. In Scheuermann’s disease, too, the thoracic vertebrae stiffen during puberty, leading to the typical clinical picture of a hunchback. Bad posture and muscular overload are held responsible for this. There are even cases of congenital ankylosis – when the joints are not even born mobile due to growth and development disorders in the womb (congenital ankylosis). Otherwise, chronic osteoarthritis or any other joint inflammation can also cause stiffening of joints in the long run. If a joint is intentionally stiffened for a medical indication (e.g., to spare other structures or to treat motion-related pain), it is referred to as an “arthrodesis.”
Symptoms, complaints, and signs
Ankylosis primarily results in restricted movement. This is often accompanied by pain in the joint, triggered by the chronic inflammation and accompanying symptoms such as joint wear or muscle tension. In older people, chronic stiffness, known as joint stiffness, can occur. In addition, ankylosing spondylitis may manifest itself as osteoarthritis or arthritis. In ankylosing spondylitis, there is pain at night, which is also due to inflammation of the joints. As the disease progresses, the spine also increasingly stiffens. This leads to a pronounced hunchback and further movement restrictions. If the thoracic spine is involved, breathing difficulties or even shortness of breath may occur. Some sufferers experience tightness in the chest, which occurs mainly at night and in the morning after getting up and recedes during the day. If ankylosis is not treated, the above-mentioned symptoms and complaints increase in intensity and eventually also affect the mental state of the affected person. Then, depressive moods, mood swings and social anxiety may occur due to the external changes. With early treatment, the symptoms usually subside after some time. Chronic inflammation can cause recurrent symptoms even after therapy.
Diagnosis and course
Ankylosing spondylitis primarily results in restricted and unrestricted movement. This is often associated with pain in the joint due to chronic inflammation – which, however, can become quiescent as the joint stiffens. Especially older diseased people get great difficulties in everyday movements such as sitting, standing or reaching due to the ankylosis of joints – this can lead to more or less great disability in everyday life.Bekhterev’s disease primarily leads to nocturnal inflammatory pain and then to progressive stiffening of the spine with a massive hunchback and restricted movement. If the thoracic spine is affected, this can even lead to impaired breathing via the ribs. The diagnosis of ankylosis begins with a specific anamnesis, in which the exact circumstances of the disease are inquired. This includes, above all, previous damage to the joint and general previous illnesses as well as rheumatic diseases in the family. The examination first of all concerns the affected joint itself, here the degrees of movement are examined and documented in writing in order to be able to objectify a chronic progression of the stiffening at an early stage. Other joints and other organs frequently affected by rheumatic diseases (eye, mucous membranes) must also be examined in case of suspicion. Blood tests include general inflammatory parameters and special markers such as the rheumatoid factor or the expression of the HLA-B27 gene, which can be determined in case of suspicion, but has no probative value for a disease (one can also remain healthy with HLA-B27 for life). In addition, ultrasound, X-ray, or other imaging techniques can be used to visualize a process in the joint space.
When should you see a doctor?
If ankylosis is suspected, one should go to the doctor immediately, if possible. A medical clarification is already recommended when the first movement restrictions of the joints occur. If back or joint pain is then added, ankylosis or another condition is probably present and must be clarified immediately. Patients who already suffer from arthrosis or arthritis should discuss any unusual symptoms with their doctor. The same applies if there are already cases of ankylosis in the family or if there is a genetic predisposition to rheumatism or osteoarthritis. Older people with joint, muscle or bone diseases should generally consult a doctor if they experience joint stiffness, pain or other complaints. Medical advice is especially needed if the discomfort leads to misalignment or a decrease in well-being. Then a doctor should diagnose the ankylosis and initiate treatment directly. Other contacts are rheumatologists and orthopedists. A dentist or orthodontist should be consulted for ankylosis of the teeth.
Treatment and therapy
The therapy of ankylosis depends on the disease. Chronic inflammation is treated with non-steroidal anti-inflammatory drugs such as ibuprofen, in addition, there are many special immunomodulating agents that can stop the process of stiffening. A very important part of ankylosis therapy is always physiotherapy. Under expert supervision, regular exercise helps to prevent or at least halt the stiffening process and relieve pain. Other physical measures such as heat, cold or ultrasound therapy can also be helpful. Once a joint has stiffened, however, it will rarely regain full mobility. In advanced cases of the disease, this can probably only be achieved by a surgical joint replacement, an endoprosthesis, which is now also available for many smaller joints.
Outlook and prognosis
Without medical treatment and intervention, there is no prospect of cure or symptom relief for ankylosis. Working with a physical therapist, tips and advice can be given for temporary improved weight-bearing and range of motion. This will minimize pain or further discomfort. However, a cure for ankylosis is not possible with this support. Nevertheless, due to the progressive course of the disease, there is a steady increase in discomfort. Eventually, a stiffening of the joint sets in, which can no longer be corrected without surgical intervention. If medical care is sought, there is a good chance of improved quality of life. Replacement of the affected joint can lead to a positive development of the state of health after only a few weeks or months. If rehabilitation measures and targeted training are taken advantage of, an optimized and more sustainable result can also be achieved. However, the possibilities of movement are not fully comparable with those of a healthy natural joint.In addition, complications or defensive reactions of the organism can occur, which result in further impairments and reductions in well-being. In the case of inflammatory diseases, a drug treatment method is chosen. This is also promising, so that healing occurs within a few weeks.
Prevention
Prevention of rheumatic diseases such as ankylosing spondylitis is not possible, or at least not currently known. However, those who have the disease once can do a lot to slow down the stiffening of the joints with physiotherapy and other therapeutic measures.
Aftercare
Ankylosing spondylitis cannot yet be treated causally. Like the treatment itself, follow-up care for joint stiffness focuses on checking the condition of the joint at regular intervals. If the causative rheumatoid arthritis has been treated out, regular adjustment of drug therapy is also an important part of follow-up. Individuals who have ankylosing spondylitis need to see a rheumatologist or orthopedist every four to six months so that the status of the underlying disease can be reviewed. If no complications occur, the rotation can be gradually reduced. Meanwhile, the causative disease must continue to be treated. Ankylosing spondylitis in particular requires ongoing therapy, as the symptoms increase over the course of a person’s life and treatment must be continued accordingly. In the event of complications, ankylosing spondylitis follow-up care must be interrupted. For example, joint pain or movement restrictions must be treated as part of normal therapy. In most cases, patients are prescribed painkillers. In individual cases, a physician may surgically treat the joint stiffness as well as the associated symptoms. Because ankylosing spondylitis occurs as a result of a variety of conditions and can progress in very different ways, patients should speak with the appropriate physician regarding follow-up care.
Here’s what you can do yourself
If joint stiffness is suspected, a doctor should definitely be consulted. This is especially true if the symptoms occur together with back and joint pain. Because a completely stiffened joint will generally never regain its full functionality, measures to prevent progression of the disease are particularly important. This is also the best approach to self-help. Physiotherapeutic measures can help maintain the mobility of the impaired joints. Those affected should consult a qualified physiotherapist and have an individual training program developed. Consistency and perseverance are critical in this process. Exercises must be performed regularly in the prescribed manner and almost always over a long period of time. Some patients must also accept the lifelong requirement of physical therapy. If the ankylosis is due to chronic inflammatory processes associated with gout or rheumatoid or psoriatic arthritis, naturopathic medications may be used in addition to allopathic ones. In particular, devil’s claw, curcumin, an active ingredient from turmeric, as well as arnica and frankincense are used as alternatives to non-steroidal anti-inflammatory drugs. The positive influence of frankincense on joint mobility in arthritis has been scientifically proven. The effect of devil’s claw is also supported by relevant studies.
