Ankylosing spondylitis can be defined as it is an inflammatory state in which the joints of your spinal column are affected. The word spondylitis refers to the inflammation of the vertebral column or spinal column. Typically the inflammation in this condition starts in the joints between the pelvis and vertebral column but it may extend up your spinal column to your neck. Sometimes, other parts of the body are also involved like eyes, joints or tendons. The severity of the disease varies from person to person. Sometimes, you have so mild form of the disease that most of the time you forget that you are suffering from this disease but sometimes signs and symptoms are so severe that they leave a significant impact on your quality of life.
Risk Factors for Ankylosing Spondylitis
There may be several risk factors for the disease some of which are discussed as follows:
Although other joint disorders are more common in females, this disease is more common in males. Males have a greater incidence than females to be affected by ankylosing spondylitis.
The disease usually expresses itself in the advancing age or sometimes in early adulthood.
It is proven from researches that genetic variation plays a key role in the occurrence of the disease. HLA-B gene is significant in this regard. It produces a protein that plays a significant role in the immune system of human beings. One of the variations of this gene is the HLA-B27 gene that enhances the risk for the occurrence of this spinal column disease but the exact mechanism of action is still not known.
Although ankylosing spondylitis is not a genetically transmitted disease but the risk for a person to be affected by this disease is increased when more than one first degree relatives are affected. The disease is affected by multiple environmental and genetic factors.
Symptoms of Ankylosing Spondylitis
There are many symptoms of this disease some of which are discussed below:
Pain and stiffness in the lumbar region specifically during the early morning is its most common symptom. The pain is eased during day time or with exercise. Pain is also felt in the joints where the pelvis meets with the lower part of the vertebral column, i.e. sacroiliac joint. Some persons also complained of pain in the back of the thighs and buttocks.
Stiffness is also a common feature of ankylosing spondylitis that remains for at least half an hour in the morning. This is the stiffness that differentiates simple back pain with ankylosing spondylitis. Sometimes symptoms are developed after taking rest or even at midnight.
Pain in Neck, Shoulders, and Hips
Some patients may also develop pain in the hips, shoulders or neck region. The characteristic of this pain is that it becomes worse when you remain inactive for a period of time. The example can be given as when you are doing office work in front of a computer.
Some patients may develop swelling and stiffness in their ankles and knees. It is especially to be noted in teenagers and children where hips and knees are affected first rather than back.
It is the inflammation anywhere in the body where bones are attached with tendons for example heel and elbows. Swelling is not permanent at a place rather it comes and goes. Thus symptoms vary with time. The degree of pain along with this swelling also varies with time.
The symptoms discussed above are the major symptoms but you may also develop some other symptoms which are:
Tenderness at the heel
Tenderness at heel makes it difficult for the affected person to stand on a hard surface. The tenderness is mostly due to the inflammation developed at the back of the heel where heel bone meets with Achilles tendon.
Pain and Inflammation
Pain and inflammation at fingers or toe may also happen. Dactylitis is a condition where the whole digit is inflamed and become tender.
Uncomfortable sitting may also happen due to tenderness at the ischium (base of the pelvis which is your sitting point)
Chest pain also is known as strapped-in feelings may gradually develop. This happens when the vertebral column is affected at the level of the chest. Movements are disturbed at the joints which are between the breastbone and ribs and thus breathing becomes difficult for the patient. Ribs also become tender.
The symptoms at the early stages resemble more common back problems. Your doctor makes the diagnosis after taking the following steps:
- The detailed history of the current condition. (the most important question to be asked is whether this discomfort or pain wakes you during or after midnight?)
- A thorough physical examination
- Blood tests show inflammatory cells or reactive proteins.
- Imaging studies, i.e. X-Ray, CT scan or MRI which the doctor advises according to the condition of the patient.
Traditional Treatment Modalities
For the treatment of ankylosing spondylitis, the first thing to be considered is exercise and attention to the posture. Other treatment modalities include:
These are the analgesic drugs used to relieve pain. NSAIDs is the most commonly used group in this regard. Other painkillers like co-codamol and paracetamol are also effective. Commonly used NSAIDs are aspirin, naproxen, and ibuprofen.
This group of drugs includes methotrexate, sulfasalazine, and some other drugs which are effective in the arthritis of legs and arms but not very useful for the symptoms of the vertebral column. These drugs are prescribed to decrease the damage to joints. They are slow acting drugs.
This is another modality of treatment which is proven very beneficial for the treatment of ankylosing spondylitis. Anti-TNF drugs are used for this approach including etanercept, adalimumab, and golimumab.
Steroids are used only for short term to control flare-ups. They can be given as slow release IM injections or intra-joint injections. They are also used for painful swollen tendons.
Physiotherapy plays an important role in the treatment of this condition. You must perform regular exercises according to the advice of your physiotherapist or doctor.
We DO NOT recommend to use any medicine without consulting your doctor.
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