What Causes Ankylosing Spondylitis and How it is managed?

Introduction 

 

Ankylosing spondylitis is a type of arthritis that lasts a lifetime. Although it can spread farther up the spine, its primary location is the lower back. Sometimes, different joints and body parts are impacted. Individual differences exist in the degree of impact.

There isn't a cure, but there are treatments available, such as medicine and physical therapy. Remember this crucial point: if you have ankylosing spondylitis and experience pain or redness in your eye, call your doctor right away. Uveitis is a serious eye complication that can be successfully treated if it is treated quickly.

 

Anatomy of Spine 

 

 A large number of bones stacked on top of one another make up the spine. A disc sits between each vertebra, which are all made like squat cylinders. Because the discs are composed of a material that resembles rubber, the spine can flex somewhat. 

The vertebrae (spinal bones) are joined to one another by strong ligaments, which reinforce the spine. Five vertebrae at the base of the spine are fused together. The sacrum, a triangular-shaped bone, is formed by them. The base of the spine is joined to the pelvis by two sizable joints on either side. The sacroiliac joints get their name from the fact that they connect the sacrum (sacro-) to the main pelvic bone, which is known as the ilium.

 

what we know  about AS so far?

 
Ankylosing spondylitis (AS) is a rheumatic (persistent) arthritic disease. We do not know the cause of it. It primarily affects the sacroiliac joints, which are the joints that join the base of your spine to your pelvis. Occasionally, the body's other joints and parts are impacted. Ankylosing is the verb for uniting or fusing. The term "spondylitis" refers to a spinal inflammation. Because of the type of inflammation in AS, the afflicted joints fuse together to form a single bone.

 

The average onset age of AS is between 20 and 30 years old, though it can also sometimes appear in younger people and elderly adults. It is twice as common in men as in women. 

 

The common area affected are the sacroiliac joints and the ligaments surrounding them. The sacrum and pelvis may eventually fuse together as a result of this inflammation as well. Another common site to be inflamed is lower back ligament  in AS at the locations where the ligaments connect to the vertebrae, the spinal bones. As a result, the bone-forming cells inside the ligaments are gradually encouraged to grow bone. These bony growths may eventually enlarge and form bony bridges connecting adjacent vertebrae. This has the potential to eventually fuse some vertebrae together to form a single, larger bone.

 

Causes of AS

 It is unknown what caused it. There is, nonetheless, a significant inherited (genetic) tendency. For instance, a gene known as HLA-B27 has a strong correlation. In individuals who have a strong inherited tendency to develop AS, as indicated by the gene HLA-B27, it is believed that something may trigger the development of AS.

 

Symptoms of AS

 

The most common symptom is back pain. Usually, the lower back is where the pain begins. At first, you might consider it to be merely a slight backache. Usually, over several months, it gets progressively worse. Pain could be felt down the back of your thighs and across your buttocks. One side may occasionally experience the pain in the buttocks, and vice versa. Pain may worsen if you cough or strain. Sleeping it off won't help. In fact, the discomfort might cause you to wake up. Rather, movement and exercise typically reduce the pain. 

Early in the morning, the stiffness can be pretty intense. Exercise and movement usually help, and as the morning wears on, it usually gets easier.

Other joints like ankles, shoulders, hips, and knees might become swollen, stiff, and painful at some point in the life of already diagnosed patient with AS.

Other ligaments, such as the Achilles tendon, which connects the heel to the lower leg, may become inflamed, and costochonritis may result from involvement of other chest cartilages.

An eye inflammation is called uveitis. Approximately 1 in 3 persons with AS experience it sometimes.Some AS sufferers have generalised symptoms of fatigue or depression. Anaemia or unintentional weight loss can happen occasionally.

Diagnosing the Condition

Your symptoms and any X-ray or magnetic resonance imaging (MRI) images are used to diagnose this condition. Blood tests are useful, but primarily for the purpose of ruling out other illnesses.

Typical alterations appear on X-ray images of the spine and sacroiliac joints as the disease advances. The vertebrae (bones) can be seen gradually fusing together in the X-ray images. But it might take a few years for these alterations to worsen to the point where they can be seen in X-ray images.

Bamboo spine 

Up until recently, the only reliable method to confirm AS was with X-ray changes. In order to confirm the diagnosis earlier, an MRI of the sacroiliac joints has been used more recently. Compared to a conventional X-ray image, an MRI scan can provide a much more detailed view of a joint and can identify inflammation.

Treatment

Adopting a regular exercise regimen and maintaining optimal posture are crucial. This could help keep your condition from getting worse while also preserving your full range of spinal movement. The extent of any potential spinal deformity is believed to be limited by regular, targeted exercise. Back pain may also be relieved by the workouts. A physiotherapist who can provide you with specific exercise instructions will typically be referred to you. It might be especially advantageous to exercise in a group.It's critical to include exercise in your everyday schedule. Try to complete them each day.

Anti-inflammatory drugs have the potential to both lessen AS symptoms and delay the disease's advancement. As a result, it is advised to take them consistently rather than only when discomfort flares up. There are numerous anti-inflammatory medications, such as naproxen, diclofenac, and ibuprofen.

If you are unable to take an anti-inflammatory painkiller and your symptoms are mild in between flare-ups, then paracetamol may be enough. To relieve pain even more, you can take paracetamol in addition to an anti-inflammatory medication.

Biological medicines are compounds produced by living things, like white blood cells that have been cloned. To put it another way, they've undergone genetic engineering. Their purpose is to target particular immune system molecules that are linked to inflammation. Inflammation in AS is brought on by a substance known as cytokine tumour necrosis factor alpha (TNF-alpha). A class of medications known as TNF-alpha inhibitors inhibits this chemical's function in some cases. Consequently, they reduce inflammation and shield the joints from injury. TNF-alpha inhibitors are occasionally referred to as anti-TNF-alpha medications.

For individuals with severe AS who have not responded well enough to NSAIDs or are unable to take them, TNF-alpha inhibitors are now advised. There are numerous TNF-alpha inhibitors on the market:

    Adialimumab.
   Certolizumab.
    etanercept.

These medications carry risks, and since some users experience severe side effects, extra care must be taken when using them. For instance, using these medications may increase your risk of contracting a serious infection, such as pneumonia, sepsis, or tuberculosis.

Sometimes the best way to relieve the pain is to inject a steroid straight into the severely inflamed joint. AS does not use liquid or tablet form steroids. Treatment for osteoporosis linked to AS involves the use of medications known as bisphosphonates.

It might be necessary to operate:

    A hip replacement, since AS can occasionally cause serious hip damage or severe spinal deformityneeds surgery sometimes.