Ankylosing Spondylitis – Treatment Modalities

Ankylosing spondylitis can be defined as an inflammatory state in which the joints of your spinal column are affected. This conditio is part of a category of diseases known as inflammatory arthritis. In this group, there are other disorders such as axial spondyloarthritis.

The word spondylitis refers to the inflammation of the vertebral column. Typically, the inflammation 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 such a mild form of the disease that most of the time you forget that you are suffering from it, but sometimes signs and symptoms are so severe that they have a significant impact on your quality of life.

Risk Factors for Ankylosing Spondylitis

Factors that may indicate an increased risk of developing ankylosing spondylitis include:

Gender

Males have a greater incidence than females to be affected by this condition.

Age

The disease usually expresses itself in the advancing age or sometimes in early adulthood.

Genetic Makeup

Genetic variation plays a key role in the occurrence of this disease. The 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.

Inheritance

Although ankylosing spondylitis is not a genetically transmitted disease, the risk for a person to be affected by it is increased when more than one first degree relatives are affected.

Symptoms of Ankylosing Spondylitis

People with ankylosing spondylitis may experience the following symptoms:

Back Pain

Pain and stiffness in the lumbar region that occurs specifically during the early morning is the most common symptom. The pain is eased during daytime 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 joints. This type of pain is often referred to as sacroiliitis. Some persons also complained of pain in the back of the thighs and buttocks.

Stiffness

This condition is characterised primarily by the stiffening of the spine, as the vertebrae fuse together.

Stiffness, or ankylosis, is also a common feature of ankylosing spondylitis that appears for at least half an hour in the morning. This stiffness is what differentiates simple back pain from ankylosing spondylitis. Sometimes symptoms are developed after taking rest or even at midnight.

Pain in the 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.

Swelling

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.

Enthesitis

It is a type of inflammation that can occur anywhere in the body where bones are attached with tendons, such as the heels and elbows. Swelling is not permanent and tends to come and go.

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.

Pain and Inflammation

Pain and inflammation in the fingers or toes may also happen. Dactylitis is a condition where the whole digit is inflamed and becomes tender.

Uncomfortable Sitting

The sufferer may also find sitting uncomfortable due to tenderness at the ischium (base of the pelvis which is your sitting point).

Chest Pain

This happens when the vertebral column is affected at the level of the chest. Movements are disturbed at the joints which are situated between the breastbone and ribs and thus breathing becomes difficult for the patient. Ribs also become tender.

Diagnosis

Symptoms in the early stages resemble more common back problems. In order to differential between generalised back pain and that which is caused by ankylosing spondylitis, your doctor will provide you with a diagnosis after taking the following steps:

  •  Asking for the detailed history of your current condition (the most important question to be asked is whether this discomfort or pain wakes you up during or after midnight)
  • Conducting a thorough physical examination
  • Having the sufferer take blood tests that show inflammatory cells or reactive proteins
  • Conducting imaging tests, i.e. X-Ray, CT scan or MRI, which the doctor advises according to the condition of the patient.

Prognosis and Traditional Treatment Modalities

Although there is no cure for ankylosing spondylitis, there are several approaches that can reduce inflammation to manage the pain and other symptoms.

For the treatment of ankylosing spondylitis, the first thing to be considered is exercise and attention to posture. However, to treat ankylosing spondylitis, a combination of the following methods is typically applied:

Painkillers

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.

DMARDS

This group of drugs includes methotrexate, sulfasalazine, and some other drugs which are effective for arthritis of the legs and arms but not very useful for symptoms that affect the vertebral column. These drugs are prescribed to decrease the damage to joints, although they tend to be slow acting.

Biological Therapies

This is another modality of treatment which is proven to be very beneficial for ankylosing spondylitis. Anti-TNF drugs are used for this approach, including etanercept, adalimumab, and golimumab.

Steroids

Steroids or corticosteroids 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

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.

Advanced Treatment

The Backrack™ device is an effective treatment for ankylosing spondylitis. Up to 98% of all back pain is either caused by, or directly linked to spinal compression. If we can decompress the spine (something which the backrack™ does) we can not only treat the causes but the symptoms of back pain. Backrack™ is for anybody who suffers from cervical (neck pain), thoracic (middle back), lumbar pain (lower back pain) or any of the symptoms associated by it.
Spinal Backrack Conditions

The Backrack™ Spinal Decompression Device is designed by Harley Street specialists to help reduce your back pain. The benefits include:

  • Long term relief from back pain and stiffness
  • Increased spinal flexibility and mobility
  • Complete relief from muscular pain and tension
  • Absolutely no side-effects
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